Makerere University

About: Makerere University is a education organization based out in Kampala, Uganda. It is known for research contribution in the topics: Population & Public health. The organization has 7220 authors who have published 12405 publications receiving 366520 citations. The organization is also known as: Makerere University Kampala & MUK.

‘‘Telling my husband I have HIV is too heavy to come out of my mouth’’: pregnant women’s disclosure experiences and support needs following antenatal HIV testing in eastern Uganda

Abstract: Introduction: Disclosure of HIV serostatus by women to their sexual partners is critical for the success of the prevention of mother-to-child transmission of HIV (PMTCT) programme as an integrated service in antenatal care. We explored pregnant HIV-positive and HIV-negative women’s partner disclosure experiences and support needs in eastern Uganda. Methods: This was a qualitative study conducted at Mbale Regional Referral Hospital in eastern Uganda between January and May 2010. Data collection was through in-depth interviews with 15 HIV-positive and 15 HIV-negative pregnant women attending a follow up antenatal clinic (ANC) at Mbale Hospital, and six key informant interviews with health workers at the clinic. Data management was done using NVivo version 9, and a content thematic approach was used for analysis. Results: All HIV-negative women had disclosed their HIV status to their sexual partners but expressed need for support to convince their partners to also undergo HIV testing.Women reported that their partners often assumed that they were equally HIV-negative and generally perceived HIV testing in the ANC as a preserve for women. Most of the HIV-positive women had not disclosed their HIV status to sexual partners for fear of abandonment, violence and accusation of bringing HIV infection into the family. Most HIV-positive women deferred disclosure and requested health workers’ support in disclosure. Those who disclosed their positive status generally experienced positive responses from their partners. Conclusions: Within the context of routine HIV testing as part of the PMTCT programme, most women who test HIV-positive find disclosure of their status to partners extremely difficult. Their fear of disclosure was influenced by the intersection of gender norms, economic dependency, women’s roles as mothers and young age. Pregnant HIV-negative women and their unborn babies remained at risk of HIV infection owing to the resistance of their partners to go for HIV testing. These findings depict a glaring need to strengthen support for both HIV-positive and HIV-negative women to maximize opportunities for HIV prevention. Keywords: pregnant women; HIV disclosure to partner; HIV testing by proxy; support needs; intersectionality. (Published: 14 August 2012) Citation: Rujumba J et al. Journal of the International AIDS Society 2012, 15 :17429 http://www.jiasociety.org/index.php/jias/article/view/17429 | http://dx.doi.org/10.7448/IAS.15.2.17429

Antiretroviral therapy and sexual behavior: A comparative study between antiretroviral-naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda

Abstract: We examined whether use of antiretroviral (ARV) therapy is associated with increased sexual risk behavior in a cross-sectional study of patients undergoing ARV therapy (ARV experienced) compared to patients not undergoing ARV therapy (ARV-naive) attending an urban HIV clinic in Kampala, Uganda. Sexual behavior during the prior 6 months and sexually transmitted disease (STD) treatment was determined by face-to-face structured interviews. Multiple logistic regression was used to identify independent correlates of sexual activity, multiple sexual partners, inconsistent condom use, and STD treatment during the prior 6 months. Three hundred forty-seven (48%) of the 723 respondents reported a history of sexual intercourse in the 6 months prior to the interview (sexually active). Receipt of ARV therapy was not associated with a significantly higher likelihood of being sexually active (adjusted odds ratio [AOR], 2.0 95% confidence interval [CI], 0.3-9.9). Among both ARV-experienced and ARV-naive persons who were sexually active, 35% (120) reported one or more casual sexual partners in addition to a main partner (no difference by ARV status). Consistent condom use with spouse, regular, casual, and commercial partners was reported by 57%, 65%, 85%, and 85% of the sexually active respondents, respectively. The ARV-experienced respondents were more likely to report consistent condom use with their spouses than were ARV-naive respondents (OR 2.82 95% CI 1.74-4.6). ARV-experienced respondents were more likely than ARV-naive respondents to have disclosed their HIV status to their spouses (OR 1.57 95% CI 1.07-2.30).The ARV-experienced group was more likely to report STD treatment in the prior 6 months (AOR 2.62 95% CI 1.8-3.83) than the ARV-naive group. The findings suggest that in this population, use of ARV therapy was not associated with risky sexual behavior in the prior 6 months. Still, recall and social desirability biases remain important limitations in interpreting these conclusions.

Urban and peri-urban agriculture and forestry: Transcending poverty alleviation to climate change mitigation and adaptation

Abstract: A range of published and grey literature over the last three decades has underlined the importance of urban and peri-urban agriculture and forestry (UPAF) in cities of developing regions. The focus in the published literature is on livelihoods, poverty reduction and ecosystems services at multiple city scales. Cities of developing regions, particularly in Africa, are searching for ways of addressing the unavoidable impacts of climate change and UPAF has demonstrated scalable adaptation and mitigation potential. However, evidence of UPAF’s role in mitigating and adaptation to climate change is scattered in various reports and has not been synthesized for its potential role in developing urban adaptation strategies. Building on the earlier poverty reduction focus of UPAF research, this paper contributes to UPAF knowledge regarding mitigating and adapting to climate change in urban and peri-urban areas in East and West Africa. The paper reports a synthesis based on a systematic review of the available literature on these regions, and selected sources on other parts of sub-Saharan Africa. The paper also examines the extent to which literature conveys any evidence for UPAF playing a role in mediating the effects of climate/environmental change. Limited empirical verification was undertaken in Kampala and Ibadan, but this does not form the basis for systematic generalization. The key emerging areas of adaptation and mitigation include enhanced food security, productive greening, ecosystem services and innovative policy for urban resilience and transformation.

Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries

Abstract: Background: Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study’s main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher’s exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.