Showing papers in "African Journal of AIDS Research in 2011"
TL;DR: The objective of the review was to search the literature for quantitative studies conducted in sub-Saharan Africa on mental health and HIV and to critically evaluate and collate the studies in order to identify research needs and priorities.
Abstract: The relationship between mental illness and HIV/AIDS is complex and bidirectional. A significant amount of research has been performed in high-income countries but less is known about HIV and mental health in sub-Saharan Africa. The objectives of the review were to search the literature for quantitative studies conducted in sub-Saharan Africa on mental health and HIV and to critically evaluate and collate the studies in order to identify research needs and priorities. The databases Ovid, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI) were searched for variations of search terms related to HIV/AIDS and mental health and studies limited to the populations of African countries. In addition, we hand-searched indexes of key journals and the databases of academic theses. We included 104 papers or research publications. The majority of these were published after 2005. The major topics covered were: mental-health-related HIV-risk behaviour, HIV in psychiatric populations, and mental illness in HIV-positive populations. The reported prevalence levels of mental illness among people living with HIV or AIDS (PLHIV) was high, with all but one study noting a prevalence of 19% or higher. Neurocognitive changes in adults with HIV were also prevalent, with reported deficits of up to 99% in symptomatic PLHIV and 33% in non-symptomatic PLHIV. Research on HIV in relation to mental health is increasing; however, there is a need for good-quality prospective studies to investigate the bidirectional effects of mental illness and HIV on each other.
114 citations
TL;DR: A conceptual framework — the employment continuum — is introduced that maps multiple points of entry within the workplace to address HIV-related stigma and discrimination and emphasises the importance of the workplace as a site for intervention and behaviour change.
Abstract: The article presents findings from three surveys of people living with HIV (PLHIV) and civil society organisations about the experience of employment discrimination and stigma in the workplace. The work seeks to contribute to efforts by businesses and other organisations to effectively respond to the HIV epidemic within the world of work, and to deepen our understanding of the ways in which HIV stigma and employment discrimination persist in the workplace. The findings of global and regional surveys indicate the existence of high levels of employment discrimination based on HIV status worldwide, including forced disclosure of HIV status, exclusion in the workplace, refusals to hire or promote, and terminations of people known to be living with HIV. The survey findings show that employment discrimination based on HIV status is experienced in all African subregions. Country-level surveys conducted in Kenya and Zambia indicated that PLHIV face marked barriers to employment, including discrimination in hiring, loss of promotions, and termination because of HIV status. Additionally, large variances were found in the degree of support versus discrimination that employees living with HIV in those two countries received following their disclosure. The discussion emphasises the importance of the workplace as a site for intervention and behaviour change. To address this, we introduce a conceptual framework - the employment continuum - that maps multiple points of entry within the workplace to address HIV-related stigma and discrimination. Additional recommendations include: actions to ensure equal opportunity in hiring for PLHIV; ensuring that HIV testing is voluntary, never mandatory, and that disclosure is not necessary for employment; ensuring confidentiality of HIV status; communicating and enforcing HIV-related antidiscrimination policies; establishing support groups in the workplace; providing safe and confidential processes for resolving complaints of employment discrimination; and taking affirmative responsibility to verify that any job terminations are not the result of mistreatment or bias.
48 citations
TL;DR: Women who endorse the belief linking HIV to witchcraft had a higher likelihood of unprotected sex with a main partner, whereas women who endorsed the belief that a cure for AIDS was being withheld had a lower likelihood of having had unprotected sex.
Abstract: In South Africa, approximately 20% of 15-49-year-olds are infected with HIV. Among black South Africans, high levels of HIV/AIDS misconceptions (e.g. HIV is manufactured by whites to reduce the black African population; AIDS is caused by supernatural forces or witchcraft) may be barriers to HIV prevention. We conducted a cross-sectional study of 150 young, black adults (aged 18-26; 56% males) visiting a public clinic for sexually transmitted infections, to investigate whether HIV/AIDS misconceptions were related to low condom use in main partner relationships. We assessed agreement with HIV/AIDS misconceptions relating to the supernatural (e.g. witchcraft as a cause of HIV) and to genocide (e.g. the withholding of a cure). In multivariate models, agreement that 'Witchcraft plays a role in HIV transmission' was significantly related to less positive attitudes about condoms, less belief in condom effectiveness for HIV prevention, and lower intentions to use condoms among men. The belief that 'Vitamins and fresh fruits and vegetables can cure AIDS' was associated with lower intentions among men to use condoms. Women who endorsed the belief linking HIV to witchcraft had a higher likelihood of unprotected sex with a main partner, whereas women who endorsed the belief that a cure for AIDS was being withheld had a lower likelihood of having had unprotected sex. Knowledge about distinct types of HIV/AIDS misconceptions and their correlates can help in the design of culturally appropriate HIV-prevention messages that address such beliefs.
48 citations
TL;DR: Investigation of how men negotiated therapeutic citizenship efforts – normally characterised in the academic literature as ‘therapeutic citizenship’ – in relation to men's socio-cultural definitions of masculinity found that most of the men gained the knowledge and skills necessary to adhere to treatment.
Abstract: The article explores the idea of therapeutic citizenship in relation to the experiences of men who attend support groups for people living with HIV or AIDS (PLHIV). At a rural South African health facility offering free antiretroviral (ARV) medicines, support groups aim to empower HIV-positive clients through knowledge and skills that enable them to adhere to their ARV regimen. Members are exhorted to abandon their ‘traditional’ health and gender beliefs in favour of a biomedical understanding and approach to health; to embrace participation in a support group for PLHIV; and to actively challenge HIV stigma through the public disclosure of their HIV-test result. Fourteen months of ethnographic fieldwork conducted in Bushbuckridge, Mpumalanga Province, South Africa, investigated how men negotiated these efforts – normally characterised in the academic literature as ‘therapeutic citizenship’ – in relation to men's socio-cultural definitions of masculinity. The findings reveal that most of the men gained the...
46 citations
TL;DR: It is argued that teachers are well-positioned to manage school-based psychosocial support in order to create relevant and caring spaces for vulnerable individuals in the school community.
Abstract: The article describes the pilot phase of a participatory reflection and action (PRA) study. The longitudinal investigation explores teachers’ ability to provide psychosocial support within the context of HIV/AIDS following an asset-based intervention. The study ensued from our desire to understand and contribute to knowledge about the changed roles of teachers due to adversity in the community, specifically in relation to HIV/AIDS and education. The supportive teachers, assets and resilience (STAR) intervention was facilitated from November 2003 to October 2005 and consisted of the research team undertaking nine field visits and facilitating 20 intervention sessions (2–3 hours each), and 12 post-intervention research visits have been conducted to date. Ten female teachers were selected for participation through random purposeful sampling at a primary school in an informal settlement outside Port Elizabeth, South Africa. Data-generation included PRA activities, observation, informal interactive interviews,...
42 citations
TL;DR: It is proposed that the national HIV/AIDS response can and should engage with internal and cross-border migrants in informal workplaces — which is in line with the principle of universal access and will strengthen the national response.
Abstract: South Africa has the largest population of people living with HIV globally and is associated with high population mobility. The majority of migrants move in search of improved livelihood opportunities, and many who migrate (both internally and across borders) move into urban areas, often through peripheral informal settlements where HIV prevalence is shown to be double that of urban formal areas. While the relationship between migration and the spread of HIV is acknowledged as complex, the context of migration may place individuals at increased risk for acquiring HIV. Studies have demonstrated the long-wave impact of HIV and AIDS on livelihood activities and, more recently, on patterns of migration. Many migrants engage in livelihood strategies situated within the urban 'informal economy'; these informal workplaces are often overlooked in global and national legislation governing workplace responses to health and HIV and AIDS. This study draws on existing research and limited primary data to explore the i...
37 citations
TL;DR: HIV/AIDS-service providers and programme planners should actively draw on observations to encourage increased HIV testing in communities and to ensure that the maximum number of people get the HIV treatment and care services that they require.
Abstract: Previous quantitative studies suggest a mutually reinforcing relationship between HIV counselling and testing (HCT) and antiretroviral treatment (ART). HCT is the entry into ART, and access to ART appears to increase HIV-testing uptake in settings with historically low uptake. Adopting a qualitative approach, this study examined the influence of ART on willingness to test for HIV, in a rural community in South Africa. Ninety-six in-depth interviews from a large community-based HIV-prevention trial were analysed. The data provide insight into the community members’ views, perceptions and experiences regarding ART, and how they draw on these in making decisions about HIV testing. Several key factors that supported a positive relationship between ART and HIV testing were noted. These included the beliefs that ART brings hope and that it prolongs life; the powerful positive effect of witnessing the recovery of someone on treatment; and that ART encourages early HIV-testing behaviour. A few negative factors th...
28 citations
TL;DR: Age, race, geographical location, and level of education were found to be important determinants of age at sexual debut among South African youths in the age group 15–24 years, and HIV prevalence was consistently higher among the females than among the males.
Abstract: The research uses data from a representative national survey to explore the determinants of age at sexual debut among South African youths in the age group 15–24 years. A random sample of 5 708 youths were interviewed and 92% responded to questions on whether or not they had ever had sex and their age at first sex for those who had. The research used survival analyses techniques to combine ‘current status data’ and ‘recall data’ for respondents who reported ever having had sex. The females were more likely than the males to report ever having had sex (p≤0.001). The median age at sexual debut was 18 years for both males and females. The hazard ratio pertaining to early sexual debut was 0.81-times less for those in the age group 15–19 as compared to those in the age group 20–24 (p≤0.001). Age, race, geographical location, and level of education were found to be important determinants of age at sexual debut. The ‘hazards of sexual debut’ (θ=0.112; p≤0.001) varied significantly between geographical areas (rur...
27 citations
TL;DR: The article identifies a theoretical framework to decode the most common components of this mix, namely: lack of access to material resources, cultural norms wherein women are subservient to men and masculinity is partly defined in terms of multiple sexual partners and intergenerational sex, combined with high levels of violence against women.
Abstract: Epidemiological data clearly show that the highest levels of HIV prevalence occur in sub-Saharan Africa. Less visible, however, is the complex combination of forces that fuel HIV epidemics in this region — these have been dubbed 'the lethal cocktail.' It is this 'cocktail' that creates an enabling environment for the spread of HIV. The HIV epidemic in the region is increasingly 'feminised' as a growing proportion of new infections occurs among and affects women. The gendered pattern of distribution of HIV in South Africa reflects a similar pattern. The aim of this article is to interrogate the contextual factors underlying the differential vulnerabilities of men and women, and the implications for HIV prevention, treatment and care. The analysis, based on a review of documents and applicable literature, reveals that a perilous mix of biomedical, political, economic, and cultural forces shapes the gendered dynamic of the HIV epidemic in South Africa. The article identifies a theoretical framework to decode...
26 citations
TL;DR: It is found that depression is common but seldom clinically recognised in people with HIV, and that it is associated with a reduction in quality of life.
Abstract: The study aimed to determine the frequency of depressive disorder in a sample of patients with HIV and its level of underdiagnosis by attending physicians. The study also explored the effect of depressive disorder on the quality of life (QOL) of patients with HIV. A sociodemographic questionnaire was administered to patients with HIV attending a medical out-patient clinic at Ahmadu Bello University Teaching Hospital, central northern Nigeria. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to screen for depressive symptoms, and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to confirm the diagnosis of depressive disorder. The patients’ medical records were screened for documentation of depressive symptoms or previous treatment with antidepressants by an attending physician. The World Health Organization Quality of Life assessment short version (WHOQOL-BREF) was used to measure six domains of QOL. A total of 310 patients with HIV participated in the study; o...
24 citations
TL;DR: Evidence suggests that a fear of knowing one's HIV status is a deep-seated anxiety that is often not openly acknowledged, and that it is intertwined with the stigma related to the ‘new’ TB associated with HIV and AIDS.
Abstract: A cornerstone of tuberculosis (TB) control is early diagnosis and treatment. The first hurdle that prospective TB patients must overcome is to present at a public health clinic for treatment. The Global Plan to Stop TB addresses the new challenges of the intersecting epidemics of TB and HIV, and it aims to cut the transmission chain by achieving early and effective treatment of all people with TB infection. This goal may be more difficult to achieve in practice. Findings from a representative community survey conducted in an area of high HIV prevalence in the Eastern Cape Province of South Africa suggest that patients must conquer fear of knowing their HIV status in order to present for TB diagnosis and treatment. A total of 1 020 adults residing in a low-income suburb of Grahamstown, Makana Municipality, participated in a questionnaire survey that probed attitudes and opinions about TB and HIV/AIDS-related issues. The respondents were presented with eight factors previously cited in the literature as cau...
TL;DR: It is concluded that even though social capital may at times have negative effects on individuals’ HIV-prevention efforts, this study provides initial evidence that social capital is largely protective through empowering vulnerable groups such as women and the poor to protect against HIV infection and by promoting protective sexual behaviours.
Abstract: The article presents a synthesis of data from three village case studies focusing on how structural and cognitive social capital may have influenced the progression of the HIV epidemic in the Kagera region of Tanzania. Grounded theory was used to develop a theoretical model describing the possible links between structural and cognitive social capital and the impact on sexual health behaviours. Focus group discussions and key informant interviews were carried out to represent the range of experiences of existing social capital. Both structural and cognitive social capital were active avenues for community members to come together, empower each other, and develop norms, values, trust and reciprocal relations. This empowerment created an enabling environment in which members could adopt protective behaviours against HIV infection. On the one hand, we observed that involvement in formal and informal organisations resulted in a reduction of numbers of sexual partners, led people to demand abstinence from sexual relations until marriage, caused fewer opportunities for casual sex, and gave individuals the agency to demand the use of condoms. On the other hand, strict membership rules and regulations excluded some members, particularly excessive alcohol drinkers and debtors, from becoming members of the social groups, which increased their vulnerability in terms of exposure to HIV. Social gatherings (especially those organised during the night) were also found to increase youths' risk of HIV infection through instances of unsafe sex. We conclude that even though social capital may at times have negative effects on individuals' HIV-prevention efforts, this study provides initial evidence that social capital is largely protective through empowering vulnerable groups such as women and the poor to protect against HIV infection and by promoting protective sexual behaviours.
TL;DR: An examination of the historical origins of polygamy and monogamy reveals that it is the practice of universal monogamy in stratified societies which is the outlier, and this sexual behaviour ‘spandrel’ is a large contributor to the lower levels of HIV prevalence among whites.
Abstract: The differences in HIV prevalence between South Africa's racial/ethnic groups (19.9%, 3.2%, and 0.5% among 15-49-year-old blacks, coloureds and whites, respectively) are as big as those between the countries with the highest and lowest levels of HIV prevalence worldwide. These large racial/ethnic differences are largely determined by different sexual network structures. In networks among black South Africans, sexual partnerships are more likely to be arranged concurrently - a configuration that leads to exponential increases in the spread of HIV. An examination of the historical origins of polygamy (where it is normative for partnerships to be arranged concurrently) and monogamy (serial or lifetime) reveals that it is the practice of universal monogamy in stratified societies which is the outlier. The ideology and practice of universal monogamy originated in Europe as the result of several factors, most prominently conflicts between the Christian Church and the nobility. After its imposition in Europe, the European colonial project would see this ideology disseminated around the world. Under the influence of liberalism it would mutate into a secular and unacknowledged value-programme of monogamy as a universal norm. This value-programme and practice of monogamy (mostly serial) is still the norm for white South Africans; thus, this sexual behaviour 'spandrel' (by-product of other historical processes) is a large contributor to the lower levels of HIV prevalence among whites. In pre-colonial African societies, polygyny was normative, and the Christian value-programme of monogamy never achieved the hegemonic status it did in Europe and other areas of conquest. Married black African men who converted to Christianity were no less likely to have additional sexual partners, but only more likely to conceal them. The ongoing secrecy about having concurrent partners has contributed to the connectedness of sexual networks among black Africans at large and in this manner has contributed to the rapid spread of HIV.
TL;DR: The assessment of the role that the Zimbabwean state has played in this development leads to the conclusion that a decline in HIV prevalence has been as much an artefact of dire social, political and economic conditions as the outcome of deliberate interventions.
Abstract: For more than 10 years Zimbabwe has experienced social, political and economic instability, including the near collapse in 2008 of its health system. Paradoxically, this period has also seen a fall in estimated HIV prevalence, from 25.6% in 1996 to 13.7% in 2009. This article examines this development in a socio-political and historical context. We focus on the complex interplay of migration, mortality, individual behaviour change, and economic patterns in shaping the presumed epidemiological waning of HIV prevalence in Zimbabwe and explore the evolution and management of the country's HIV/AIDS response. Our assessment of the role that the Zimbabwean state has played in this development leads to the conclusion that a decline in HIV prevalence has been as much an artefact of dire social, political and economic conditions as the outcome of deliberate interventions. Lastly, we propose the need to contextualise available epidemiological data through qualitative research into the social aspects of HIV and the everyday lives of individuals affected by it.
TL;DR: The images and messages that specifically targeted young people were highest in inducing perceived susceptibility to HIV infection, while pictorial descriptions of the physical consequences of HIV infection and those messages related to the stigma and discrimination faced by HIV-infected or affected people induced greater perceptions of severity.
Abstract: The aims of the study were to elicit the perceptions of young people in Tanzania on the role of fear appeals in HIV-prevention messages and to identify important contextual factors that may influence young people's perceptions of HIV-prevention posters. A total of 10 focus groups were conducted to investigate the role of fear appeals using the extended parallel process model (EPPM) as a guide. Young people were shown a series of images (mostly posters) with alternating high and low-threat messages (fear appeals), and then asked questions about their overall beliefs about HIV and AIDS, as well as about their response in terms of perceived susceptibility to HIV infection, the severity of the message, and their perceptions of self-efficacy and response efficacy. The images and messages that specifically targeted young people were highest in inducing perceived susceptibility to HIV infection, while pictorial descriptions of the physical consequences of HIV infection and those messages related to the stigma and discrimination faced by HIV-infected or affected people induced greater perceptions of severity. The information-based posters rated high in inducing response efficacy, while none of the images seemed to convince young people that they had the self-efficacy to perform the recommended health behaviours. The young people expressed a preference for fear-based appeals and a belief that this could work well in HIV-prevention efforts, yet they also stated a desire for more information-based messages about how to protect themselves. Finally, the messages evoking the most emotional responses were those that had been locally conceived rather than ones developed by large-scale donor-funded campaigns. Finding the appropriate balance between fear and efficacy in HIV-prevention messages is imperative. Further research is needed to better understand how and when fear appeals work and do not work in African settings, especially among young people.
TL;DR: Investigating the differing 'gendered' perceptions of HIV risk among young women and men in a high-HIV-prevalence community in South Africa reveals diverse understandings of the relationship between gender and HIV risk.
Abstract: It has become evident that sexual health and HIV-risk behaviours cannot be addressed effectively without paying adequate attention to constructions of gender and sexuality. While the body of literature examining these themes is growing and becoming more nuanced, there is still a significant gap in our understanding of the relationship between gendered sexual identities and vulnerabilities to disease. In particular, few studies have explored how youths themselves perceive this relationship, and how these perceptions may differ among males and females. The purpose of this study was to investigate the differing 'gendered' perceptions of HIV risk among young women and men in a high-HIV-prevalence community in South Africa. Five focus groups were conducted with youths involved with a local school-based HIV-prevention programme in a resource-deprived, peri-urban community in KwaZulu-Natal Province. The data were recorded, transcribed, translated and thematically coded. We used a critical social science approach...
TL;DR: Transportation costs were a chief concern among the poorest while those who were better off were more likely to be concerned about stigma and discrimination, which should be borne in mind when designing and locating services to maximise ongoing accessibility to ART.
Abstract: With about 3 million people living with HIV, Nigeria has approximately 8% of the global burden of HIV cases. In 2009, only about 34% of those in need of antiretroviral treatment (ART) were able to access care, which means that Nigeria was far from achieving the United Nations target of ‘universal access’ by 2010. This study aimed to describe the barriers to accessibility and the coping strategies employed to overcome these barriers among users of free ART services overall and by socioeconomic status (SES). Data were collected from 240 people receiving ART at one urban and one peri-urban health facility in Enugu State, south-eastern Nigeria. Information on SES, demographic characteristics, and barriers and coping mechanisms for accessing ART were elicited from the respondents. The high cost of transportation, HIV stigma, and long waiting hours were found to be key barriers to the use of ART services. On average, ART clients spent just under four hours at the clinic during their monthly appointments. The us...
TL;DR: The sexually active university students who reported an earlier age of initiation of sexual intercourse and having only one sexual partner during the last year were more likely to not use a condom every time, whereas the sexually active students that had experienced initiation ofSexual intercourse while in an older age group (17–24 years) and who had two or more sexual partners in the lastyear were morelikely to use a condoms every time.
Abstract: In South Africa, new HIV infections are concentrated among persons aged 15–24 years. The university population falls within this age group and are prone to higher-risk behaviours that place them at risk of acquiring HIV. In a study to assess this risk among sexually active students, we classified higher-risk sexual behaviours as not using condoms at every instance of sex, having had more than one sexual partner during the preceding 12 months, a relatively young age at first sexual intercourse (7–16 years), and experience of sexual violence and/or transactional sex. In total, 796 first-year students at the University of the Western Cape in Cape Town, South Africa, completed a self-administered questionnaire in 2006. The sample included 263 sexually active, unmarried students, aged 16 to 24 years. The responses showed that 62% did not use a condom for every instance of sex, 39% had two or more sexual partners in the previous 12 months, 53% had initiated sexual intercourse at a younger age (7–16 years), and ...
TL;DR: Generally high acceptance of FC2 is shown, which should be added to the existing HIV/STI-prevention and family-planning options in Uganda and other countries, with sufficient training and support to ensure correct use.
Abstract: The new version of the female condom (FC2) was introduced in Uganda in October 2009, following an unsuccessful female condom programme begun in 1998. The failure of the earlier programme was partly attributed to low acceptance of the first type of female condom (FC1). We evaluated the acceptability of FC2 and the experiences of users and their sexual partners. This was a qualitative cross-sectional evaluation. We conducted 16 in-depth interviews with FC2 users (8 women and 8 male partners). We also conducted eight focus group discussions with women who used FC2, and 22 key informant interviews with service providers. All the female users appreciated FC2 as a tool to empower them to avoid sexually transmitted infections (STIs) and unwanted pregnancies. They liked FC2 because it has no smell, is not noisy, and does not rupture easily. The men also liked FC2 because of its soft texture and lubrication. Some women found FC2 insertion cumbersome, while others feared that it would slip in on itself during sex. Concurrent use of male condoms with FC2 and the reuse of FC2 were also mentioned. Providers reported a high demand for FC2; their main challenges were inadequate supplies and distribution mechanisms. This evaluation shows generally high acceptance of FC2. The experiences of users and their partners were largely positive, although some fears and incorrect practices arose. FC2 should be added to the existing HIV/STI-prevention and family-planning options in Uganda and other countries, with sufficient training and support to ensure correct use.
TL;DR: More research is needed on the issue of sibling bereavement associated with AIDS, and interventions that address the multiple needs of these vulnerable young people need to be developed.
Abstract: While increasing attention has been paid in recent years to studying the impact of parental death from AIDS on children, we know little about how a sibling’s death from AIDS affects children. In this qualitative descriptive study, 11 in-depth interviews were conducted by trained social workers with adolescents who had lost a sibling to AIDS, in KwaZulu-Natal Province, South Africa. The average time since the sibling’s death was 18 months. These adolescents had been actively involved in caring for their sick sibling, yet they received inadequate emotional support from any source both before and after the sibling’s death. HIV/AIDS stigma as well as the family’s daily struggle to survive caused these adolescents to keep their feelings and their grief to themselves. Despite the trauma of losing a beloved sibling and the hardships of their environment, they demonstrated remarkable fortitude as well as concern for others. More research is needed on the issue of sibling bereavement associated with AIDS, and interventions that address the multiple needs of these vulnerable young people need to be developed.
TL;DR: The general findings of the audit and the complex issues arising from HIV-vaccine research, specifically, are discussed and specific ways in which the ethical/legal frameworks guiding research with human participants in these countries can be improved are proposed.
Abstract: Ethical and legal frameworks are important for ensuring that the goals of scientific research are realised while at the same time the rights and welfare of human participants are adequately protected. A balance in attaining these two goals can be achieved if such frameworks provide for legally binding structures and processes to oversee, regulate, and monitor research on human participants according to accepted norms and standards. From 2007 to 2009, an ethical/legal audit, sponsored by the WHO/UNAIDS Ethics, Law and Human Rights Working Group of the African AIDS Vaccine Programme (AAVP ELH), was conducted in regard to five African countries (Cameroon, Malawi, Nigeria, Rwanda and Zambia) to determine whether these countries have adequate laws, ethical guidelines and policies in place to regulate HIV-vaccine research. This article discusses the findings of the audit with a view to highlighting key lessons that can be learnt from these countries. The article provides the context of the audit by highlighting...
TL;DR: It is concluded that to alter university students’ sexual-risk behaviour, a great deal of relevant intervention should be carried out during earlier school years, and the observed link between a greater frequency of sexual- risk behaviour and higher income needs to be investigated.
Abstract: A cross-sectional study design was used to assess sexual-risk behaviour and HIV-preventive practices among students at Hawassa University, Ethiopia, in 2009. Among 1 220 students eligible for the study, approximately 29% reported experience of sex (36.3% of the males and 9.3% of the females). Of the total sexually active respondents, 67.1% had begun sexual activity while still in secondary school. For the previous 12-month period, 42.1% said they did not use condoms during the last sexual encounter, 46.1% of the males claimed having had sex with ‘bar ladies,’ and 39% said they had an active symptom of a sexually transmitted infection (STI). Logistic regression analysis demonstrated a significant association of higher-risk sexual practices in the previous year with being female and having an income greater than US$30/month. Having multiple sexual partners was strongly associated with being female, having a monthly income greater than US$30, a sexual debut before age 18 and before attending university, ever...
TL;DR: A descriptive, comparative cross-sectional study among adults receiving HAART medication at the Zewditu Memorial Hospital ART clinic in Addis Ababa found that there is a need to design and implement targeted adherence interventions that could lead to better treatment outcomes.
Abstract: There has been a massive expansion of highly active antiretroviral therapy (HAART) services in Ethiopia since 2005. To assess clients' self-reported adherence to HAART medication, a descriptive, comparative cross-sectional study was carried out among adults receiving HAART medication at the Zewditu Memorial Hospital ART clinic in Addis Ababa. Of 1 808 clients eligible for the study, 1 722 agreed to participate. The data were collected over six weeks in February and March 2010. Ordered and binary logistic regression models were applied to analyse the data. The majority of participants were over age 30 years, most were females, and 90% had some formal education. More than half reported being 'extremely sure' about their ability to take most or all of their medication. Self-reported adherence to the medication was generally good, as 62% said they had never missed a dose. The most commonly cited reason for missing medication was being busy (57.5%). The odds of ever missing a dose of HAART were lower for males (adjusted odds ratio [AOR]: 1.44; 95% confidence interval [CI]: 1.15-1.79), older persons (AOR: 0.98; 95% CI: 0.97-0.99), and those who did not drink alcohol regularly. Similarly, the odds of being self-confident about taking the medication properly were higher for males and for those who did not drink alcohol regularly (AOR: 0.48; 95% CI: 0.35-0.64). The odds of self-confidence in taking the medication were lower among those in lower income group. Those who reported an expenditure income of Birr 501-999 (AOR: 0.35; 95% CI: 0.24-0.49) or Birr 1 000-1 999 (AOR: 0.41; 95% CI: 0.29-0.60) had less self-confidence in taking their medication properly as compared to those who had an expenditure income of Birr 2 000 or more. There is a need to design and implement targeted adherence interventions that could lead to better treatment outcomes.
TL;DR: This article argues that the Ehlers & Clark (2000) cognitive model of PTSD provides a useful conceptual framework for understanding HIV-related PTSD in South Africa and highlights the role of trauma appraisals in the development and maintenance of PTSD.
Abstract: A number of epidemiological studies have attempted to measure the prevalence of HIV-related posttraumatic stress disorder (PTSD) in sub-Saharan Africa A systematic review of the literature identified eight relevant studies that put current estimates of the prevalence of HIV-related PTSD between 42% and 40% Even the lower estimates suggest that PTSD in response to the trauma of being diagnosed and living with HIV is a significant mental health burden However, a conceptual framework to advance our understanding of the prevalence and phenomenology of HIV-related PTSD is lacking This article argues that the Ehlers & Clark (2000) cognitive model of PTSD provides a useful conceptual framework for understanding HIV-related PTSD in South Africa The model emphasises the role of trauma appraisals in the development and maintenance of PTSD, which can also be usefully applied to some of the other psychological disorders associated with HIV infection The model appears to fit some of the important research findings, and it offers insights into the relationships between HIV-related PTSD and other psychological disorders, HIV stigma, the high prevalence of non-HIV traumatic events, occasional problems with the delivery of antiretroviral drugs in the South African public health service, the unpredictable course of HIV illness, and the quality of HIV testing and counselling Implications for individual treatment strategies and broader public health interventions are briefly discussed
TL;DR: A bivariate model is explored for understanding the adherence behaviours that influenced different patterns of ART adherence among the sample, and recommendations for HIV-prevention and treatment interventions in a mining workplace are offered.
Abstract: Social and psychological barriers to the disclosure of one's seropositive HIV status to significant others and poor adherence to taking medications pose significant challenges to the scaling-up of access to antiretroviral treatment (ART) in the workplace. Such barriers are predictive of sub-optimal treatment outcomes and bedevil HIV-prevention interventions at a societal level. Against this background, this article explores the lived experiences of 19 HIV-positive male participants, between the ages of 33 and 57 years, who were enrolled in an ART programme managed at an occupational health clinic at a mining company in South Africa. The majority of these mineworkers had been aware of their HIV status for between 5 and 7 years. The study explored psychological and relational factors, as aspects of these participants lived experiences, which had a bearing on their adherence to their ART regimen and the disclosure choices that they made regarding their HIV status. In our sample, those participants who were a...
TL;DR: It is suggested that down-referred patients take antiretroviral treatment to save time and money, feel more respected, perceive lower stigma and show better adherence levels, but unintended consequences include increased costs of using private physicians and self-care, highlighting the need to further promote the potential gains ofdown-referral interventions in resource-poor settings.
Abstract: We conducted an evaluation of healthcare accessibility among patients taking antiretroviral treatment (ART) after they were 'down-referred' from hospital-based programmes to primary healthcare (PHC) centres in a rural South African setting. A cross-sectional design was used to study 109 PHC users compared to a randomly selected control group of 220 hospital-based users. Both groups were matched for a minimum duration on ART of six months. Using a comprehensive healthcare-accessibility framework, the participants were asked about availability, affordability and acceptability of their ART care in structured exit interviews that were linked to their ART-clinic record reviews. Unadjusted and adjusted regression models were used. Down-referral was associated with reduced transportation and meal costs (p = 0.001) and travel time to an ART facility (p =0.043). The down-referred users were less likely to complain of long queues (adjusted odds ratio [AOR] 0.06; 95% confidence interval [95% CI]: 0.01-0.29), were more likely to feel respected by health providers (AOR 4.43; 95% CI: 1.07-18.02), perceived lower stigma (AOR 0.25; 95% CI: 0.07-0.91), and showed a higher level of ART adherence (AOR 8.71; 95% CI: 1.16-65.22) than the hospital-based users. However, the down-referred users preferred to consult with doctors rather than nurses (AOR 3.43; 95% CI: 1.22-9.55) and they were more likely to visit private physicians (AOR 7.09; 95% CI: 3.86-13.04) and practice self-care (AOR 4.91; 95% CI: 2.37-10.17), resulting in increased health-related expenditure (p = 0.001). Therefore, the results indicate both gains and losses in ART care for the patients, and suggest that down-referred patients save time and money, feel more respected, perceive lower stigma and show better adherence levels. However, unintended consequences include increased costs of using private physicians and self-care, highlighting the need to further promote the potential gains of down-referral interventions in resource-poor settings.
TL;DR: It is argued that tackling HIV in the military demands critical examination of the constructions of masculinity, including patriarchal notions that men ‘need’ sex and cannot endure being without it, and that they have the right to demand it from their partner or to seek it from multiple partners.
Abstract: The military's organisational culture tends to condone or encourage risk-taking behaviour. Willingness to accept and engage in risk-taking behaviour is central to good soldiering and is strongly associated with readiness for combat. This core attribute of military culture might predispose soldiers to engage in other higher-risk behaviours, such as unprotected sex. Soldiers’ working and living conditions, such as the high level of work-related stress in combat and deployment situations, and being away from home and particularly from partners for long periods, are reported as contributing to high levels of HIV in military groups. This article explores the underlying value system in the military context as a strong enabler of higher-risk sexual practices among male soldiers. This not only obstructs gender equality in the military organisation but also impacts on the prevalence of HIV. The article derives from a qualitative study of a diverse sample of 23–33-year-old male South African soldiers. Semi-structur...
TL;DR: Although the sample of elderly people in Dzivaresekwa district were sexually active, HIV/ AIDS-related interventions in the form of IEC campaigns mainly focus on the age group of 14–49-year-olds, and otherwise consider the elderly only as a group indirectly affected by the epidemic and less at risk of HIV infection.
Abstract: This ethnographic study in Dzivaresekwa district, Harare, Zimbabwe, examines the issue of sexuality among the elderly and their challenges in accessing information, education, and communication (IEC) campaigns in the face of HIV and AIDS. The research depended heavily on collecting life histories through key informant interviews. The theory of structuration (as proposed by Anthony Giddens) was adopted as a framework to analyse the findings. The findings reveal that although the sample of elderly people in Dzivaresekwa district were sexually active, HIV/ AIDS-related interventions in the form of IEC campaigns mainly focus on the age group of 14–49-year-olds, and otherwise consider the elderly only as a group indirectly affected by the epidemic and less at risk of HIV infection. This is mainly a result of society's presumption that people withdraw from sexual life with advanced age. Thus, the elderly are incorrectly regarded as sexually inactive and not susceptible to contracting sexually transmitted infect...
TL;DR: It is suggested that rather than repeating the project's focus on developing stories tailored to specific HIV/AIDS myths, a more effective approach could be to develop stories that support core messages for facilitating HIV prevention, testing and treatment.
Abstract: The failure to bring about widespread or effective behavioural change in response to South Africa's HIV epidemic requires that new forms of health communication be explored. This article reports on an action research project in which a group of workplace HIV/AIDS peer educators at a South African mining company recorded HIV/AIDS myths that they encountered, around which they then developed stories as an alternative response to repeating factual, scientific messages, which seem to have little effect on target populations. A total of 16 stories were developed during the project. Some of the peer educators appeared to be much better at using stories within their activities than others. In part, this was a reflection of the enthusiasm and abilities of individual peer educators. It was also observed that the stories were used to respond to situations that were sometimes quite different from the original stimulus for the story. The complex range of skills that allows an individual to introduce and effectively use a story in day-to-day conversation should not be underestimated. The article suggests that rather than repeating the project's focus on developing stories tailored to specific HIV/AIDS myths, a more effective approach could be to develop stories that support core messages for facilitating HIV prevention, testing and treatment.
TL;DR: HIV prevention in the world of work in sub-Saharan Africa: research and practice is described.
Abstract: HIV prevention in the world of work in sub-Saharan Africa: research and practice Gavin George a & Courtenay Sprague b a Health Economics and HIV and AIDS Research Division (HEARD) , University of KwaZuluNatal , Westville Campus, Private Bag X54001, Durban, 4000, South Africa b University of the Witwatersrand, Graduate School of Business Administration , 2 St David's Place, Parktown, 2193, Johannesburg, South Africa Published online: 15 Dec 2011.