Drought, HIV Testing, and HIV Transmission Risk Behaviors: A Population-Based Study in 10 High HIV Prevalence Countries in Sub-Saharan Africa

Extreme Weather Events and Linkages with HIV Vulnerabilities Among Young Sex Workers and Sexually Diverse Men in Nairobi, Kenya: Qualitative Multi-method Insights

There is growing attention to the impacts of climate change and related extreme weather events (EWE) on HIV vulnerabilities, yet this research largely overlooks key populations such as sex workers and gay, bisexual, and other men who have sex with men (gbMSM). This is a critical knowledge gap in contexts that are greatly affected by climate change, EWE, and HIV, such as Kenya. To address this gap, this study examined the lived experiences of sex workers and gbMSM aged 18-24 in Nairobi, Kenya, regarding the relationships between climate change and EWE, resource insecurities (e.g., food, water), and HIV vulnerabilities. In 2023, we conducted a multi-method qualitative study in Nairobi, Kenya, including individual interviews using the SenseMaker web-based data collection tool and group digital storytelling workshops among 36 participants, including 21 sex workers and 15 gbMSM. Participant narratives aligned with the following themes highlighting the interconnections between EWE and HIV vulnerabilities: (1) EWE, specifically droughts and flooding, led directly and indirectly to resource scarcities and infrastructure damage; (2) participants enacted strategies to navigate resource scarcities, some of which increased HIV vulnerabilities (e.g., reduced condom agency, transactional sex engagement); (3) EWE and resource scarcities increased sexual violence risks; and (4) LGBTQ stigma exacerbated resource scarcities. Participants provided recommendations for multi-level strategies for HIV prevention, sexual health, and wellbeing for young sex workers and gbMSM in Kenya. Learning from young sex worker and gbMSM experiences can advance climate-informed HIV programming that addresses stigma, resource scarcities, and violence to advance sexual health and rights.

Beyond HAART: unveiling the reality of antiretroviral therapy knowledge among pregnant women living with HIV in Kaduna State, Nigeria

To ensure the prevention of mother-to-child-transmission of HIV (MTCT), 81% of pregnant women received antiretroviral therapy (ART) in 2021 worldwide. Despite the global efforts to prevent MTCT of HIV, significant knowledge gaps persist among these women including a lack of basic knowledge of HIV and ART. This study aimed to determine the levels of HIV knowledge, knowledge of ART, and attitude toward ART in HIV-positive pregnant women in Kaduna State. It was a hospital-based, cross-sectional study among 318 HIV-positive pregnant women attending antenatal care in the nine selected hospitals using a three-stage sampling technique. Data was collected using the Open Data Kit. Up to 54.4% had a fair knowledge of ART while 75.4% of the respondents had good knowledge of HIV, and up to 98.6% had a positive attitude towards ART. Knowledge of ART and attitude to ART are positively influenced by receiving multiple counselling (p = 0.031, aOR = 6), being on ART for ≥ 2 years (p = 0.021, aOR = 6); and not taking unprescribed medications (p = 0.047, aOR = 17) respectively. Sustained, focused counselling and patient education are necessary to establish and optimise the required adherence in this group. Also, implement clear task-sharing strategies for health personnel to provide tailored services.

Transgression of planetary boundaries and the effects on child health through an infectious diseases lens

PURPOSE OF REVIEW

Life on earth, as we know it, is changing. The likelihood of more frequent pandemics and disease outbreaks is something that current global healthcare infrastructure is ill equipped to navigate. Human activity is forcing our planet into a new geologic epoch, the Anthropocene, which is typified by increased uncertainty resulting from human disruption of earth's life-giving ecosystems. Plagues and pandemics have always been unfortunate partners to periods of disruption, as they will be again if the frequency and severity of climate and conflict-mediated disasters increase in coming years. If we continue to exceed and degrade the planetary boundaries that protect human health, our children and their children will reap the consequences.

RECENT FINDINGS

Scientists have defined nine 'safe operating' planetary boundaries for life in all its glorious diversity to thrive on planet earth. Recent evidence suggests that six of these nine boundaries have already been transgressed, but the potential implications for these transgressions upon child health is not well articulated. We highlight how contravention of these boundaries will impact infectious disease risk and humans' ability to survive and thrive. We reflect specifically on how paediatricians are called upon to speak up for the most vulnerable members of our species, young children and as yet unborn future generations.

SUMMARY

Post COVID-19 initiatives to improve pandemic preparedness and response are certainly warranted, but pandemic prevention should include committed efforts not to exceed safe planetary boundaries. Willingly exceeding these boundaries has deep moral consequences that are poorly articulated by current ethical frameworks. Paediatricians are best placed to develop and champion the neglected 'third dimension' of medical ethics, recognizing the moral imperative to protect the long-term best interests of children and future generations.

Climate change and extreme weather events and linkages with HIV outcomes: recent advances and ways forward

PURPOSE OF REVIEW

Discuss the recent evidence on climate change and related extreme weather events (EWE) and linkages with HIV prevention and care outcomes.

RECENT FINDINGS

We identified 22 studies exploring HIV prevention and care in the context of EWE. HIV prevention studies examined sexual practices that increase HIV exposure (e.g., condomless sex, transactional sex), HIV testing, and HIV recent infections and prevalence. HIV care-related outcomes among people with HIV included clinical outcomes (e.g., viral load), antiretroviral therapy adherence and access, HIV care engagement and retention, and mental and physical wellbeing. Pathways from EWE to HIV prevention and care included: structural impacts (e.g., health infrastructure damage); resource insecurities (e.g., food insecurity-related ART adherence barriers); migration and displacement (e.g., reduced access to HIV services); and intrapersonal and interpersonal impacts (e.g., mental health challenges, reduced social support).

SUMMARY

Studies recommended multilevel strategies for HIV care in the context of EWE, including at the structural-level (e.g. food security programs), health institution-level (e.g., long-lasting ART), community-level (e.g. collective water management), and individual-level (e.g., coping skills). Climate-informed HIV prevention research is needed. Integration of EWE emergency and disaster preparedness and HIV services offers new opportunities for optimizing HIV prevention and care.

Climate change and sexual and reproductive health and rights research in low-income and middle-income countries: a scoping review

Introduction

This study aimed to provide an overview of the research landscape and to identify research gaps linking climate change events and sexual and reproductive health and rights (SRHR) in low-income and middle-income countries (LMICs), where the negative impacts of climate change are most severe.

Methods

We conducted a scoping review to map research studies that link climate change events or factors and SRHR aspects in LMICs. We performed a structured literature search across six databases to identify relevant peer-reviewed publications between January 1994 and 6 September 2023. The literature search yielded 14 674 peer-reviewed articles. After screening, 75 articles were included, spanning 99 countries across the globe.

Results

Climate change events such as extreme temperatures, drought, rainfall shocks, cyclones and floods were found to be associated with negative maternal and newborn health outcomes ranging from reduced or low birth weight, preterm births and low Apgar scores, to lack of pregnancy care, pregnancy complications, stillbirths, and newborn and maternal deaths. Associations were also found between climate-related events and increased gender-based violence and HIV prevalence, as well as fertility decisions and harmful practices such as female genital mutilations and early and forced marriages. About two-thirds (48/75) of the articles were from the African or Western Pacific regions. The main research gaps on climate change-related events and SRHR included abortion, reproductive cancers and contraception use.

Conclusion

Complementing existing evidence with targeted research to fill these knowledge gaps could enhance mitigation programmes and policies.

Extreme weather events and disruptions to HIV services: a systematic review

BACKGROUND

Extreme weather events pose a risk to health and disproportionately affect vulnerable groups, such as people living with HIV. We aimed to investigate the effects of extreme weather events on HIV testing uptake, HIV treatment and care, and HIV transmission.

METHODS

For this systematic review, we searched PubMed, Web of Science, and PsycINFO for peer-reviewed studies published between database inception and Aug 31, 2023. Eligible studies were English-language qualitative, quantitative observational (retrospective, prospective, cross-sectional, longitudinal, case-control, and cohort), and mixed-method studies, and randomised controlled trials related to HIV and extreme weather events. We excluded reviews, mathematical models, and case reports. After exporting the search results, two authors independently screened the titles and abstracts of identified articles, reviewing the full text of those that met the inclusion criteria. We used systems thinking to develop a framework linking extreme weather events and HIV and summarised the results using thematic narrative synthesis.

FINDINGS

Of the 6126 studies identified by the search, 27 met the inclusion criteria and were eligible for analysis, of which 19 were quantitative, six were qualitative, and two were mixed-method studies. We identified five main themes linking extreme weather events to HIV: economic and livelihood conditions (12 studies), psychosocial factors (19 studies), infrastructure damage and operational challenges (17 studies), migration and displacement (ten studies), and associated medical conditions and health-care needs (12 studies). We showed how these themes interact in complex ways, resulting in a reduction in uptake of HIV testing, interruption of HIV care and subsequent disease progression, altered risk behaviours, and an increased prevalence of HIV.

INTERPRETATION

Extreme weather events are associated with disruptions to HIV services. Owing to the design of the included studies, we could not establish a causal relationship between extreme weather events and HIV incidence, highlighting a research gap. Appropriate adaptations and mitigation policies that protect the health and wellbeing of people living with HIV during and after extreme weather events are warranted. Such actions will be crucial to achieving the UNAIDS goal of ending HIV as a public health threat by 2030.

FUNDING

None.

HIV Vulnerabilities Associated with Water Insecurity, Food Insecurity, and Other COVID-19 Impacts Among Urban Refugee Youth in Kampala, Uganda: Multi-method Findings

Food insecurity (FI) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n = 24), focus groups (n = 4), and a cross-sectional survey (n = 340) with refugee youth, and IDI with key informants (n = 15). Quantitative data was analysed via multivariable logistic and linear regression to assess associations between FI and WI with: reduced pandemic sexual and reproductive health (SRH) access; past 3-month transactional sex (TS); unplanned pandemic pregnancy; condom self-efficacy; and sexual relationship power (SRP). We applied thematic analytic approaches to qualitative data. Among survey participants, FI and WI were commonplace (65% and 47%, respectively) and significantly associated with: reduced SRH access (WI: adjusted odds ratio [aOR]: 1.92, 95% confidence interval [CI]: 1.19-3.08; FI: aOR: 2.31. 95%CI: 1.36-3.93), unplanned pregnancy (WI: aOR: 2.77, 95%CI: 1.24-6.17; FI: aOR: 2.62, 95%CI: 1.03-6.66), and TS (WI: aOR: 3.09, 95%CI: 1.22-7.89; FI: aOR: 3.51, 95%CI: 1.15-10.73). WI participants reported lower condom self-efficacy (adjusted β= -3.98, 95%CI: -5.41, -2.55) and lower SRP (adjusted β= -2.58, 95%CI= -4.79, -0.37). Thematic analyses revealed: (1) contexts of TS, including survival needs and pandemic impacts; (2) intersectional HIV vulnerabilities; (3) reduced HIV prevention/care access; and (4) water insecurity as a co-occurring socio-economic stressor. Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.

Associations between climate change-related factors and sexual health: A scoping review

There is growing attention to the ways in which climate change may affect sexual health, yet key knowledge gaps remain across global contexts and climate issues. In response, we conducted a scoping review to examine the literature on associations between climate change and sexual health. We searched five databases (May 2021, September 2022). We reviewed 3,183 non-duplicate records for inclusion; n = 83 articles met inclusion criteria. Of these articles, n = 30 focused on HIV and other STIs, n = 52 focused on sexual and gender-based violence (GBV), and n = 1 focused on comprehensive sexuality education. Thematic analysis revealed that hurricanes, drought, temperature variation, flooding, and storms may influence HIV outcomes among people with HIV by constraining access to antiretroviral treatment and worsening mental health. Climate change was associated with HIV/STI testing barriers and worsened economic conditions that elevated HIV exposure (e.g. transactional sex). Findings varied regarding associations between GBV with storms and drought, yet most studies examining flooding, extreme temperatures, and bushfires reported positive associations with GBV. Future climate change research can examine understudied sexual health domains and a range of climate-related issues (e.g. heat waves, deforestation) for their relevance to sexual health. Climate-resilient sexual health approaches can integrate extreme weather events into programming.

Associations of inter-annual rainfall decreases with subsequent HIV outcomes for persons with HIV on antiretroviral therapy in Southern Africa: a collaborative analysis of cohort studies

BACKGROUND

Periods of droughts can lead to decreased food security, and altered behaviours, potentially affecting outcomes on antiretroviral therapy (ART) among persons with HIV (PWH). We investigated whether decreased rainfall is associated with adverse outcomes among PWH on ART in Southern Africa.

METHODS

Data were combined from 11 clinical cohorts of PWH in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, participating in the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration. Adult PWH who had started ART prior to 01/06/2016 and were in follow-up in the year prior to 01/06/2016 were included. Two-year rainfall from June 2014 to May 2016 at the location of each HIV centre was summed and ranked against historical 2-year rainfall amounts (1981-2016) to give an empirical relative percentile rainfall estimate. The IeDEA-SA and rainfall data were combined using each HIV centre's latitude/longitude. In individual-level analyses, multivariable Cox or generalized estimating equation regression models (GEEs) assessed associations between decreased rainfall versus historical levels and four separate outcomes (mortality, CD4 counts < 200 cells/mm3, viral loads > 400 copies/mL, and > 12-month gaps in follow-up) in the two years following the rainfall period. GEEs were used to investigate the association between relative rainfall and monthly numbers of unique visitors per HIV centre.

RESULTS

Among 270,708 PWH across 386 HIV centres (67% female, median age 39 [IQR: 32-46]), lower rainfall than usual was associated with higher mortality (adjusted Hazard Ratio: 1.18 [95%CI: 1.07-1.32] per 10 percentile rainfall rank decrease) and unsuppressed viral loads (adjusted Odds Ratio: 1.05 [1.01-1.09]). Levels of rainfall were not strongly associated with CD4 counts < 200 cell/mm3 or > 12-month gaps in care. HIV centres in areas with less rainfall than usual had lower numbers of PWH visiting them (adjusted Rate Ratio: 0.80 [0.66-0.98] per 10 percentile rainfall rank decrease).

CONCLUSIONS

Decreased rainfall could negatively impact on HIV treatment behaviours and outcomes. Further research is needed to explore the reasons for these effects. Interventions to mitigate the health impact of severe weather events are required.