Understanding the AIDS epidemic and reacting sensibly to it

Stigma trajectories among people living with HIV (PLHIV) embarking on a life time journey with antiretroviral drugs in Jinja, Uganda

Background

Stigma is a barrier to HIV prevention and treatment. There is a limited understanding of the types of stigma facing people living with HIV (PLHIV) on antiretroviral therapy (ART). We describe the stigma trajectories of PLHIV over a 5-year period from the time they started ART.

Methods

Longitudinal qualitative in-depth interviews were conducted with 41 members of The AIDS Support Organisation (TASO) from 2005 to 2008 in Jinja, Uganda, who were part of a pragmatic cluster-randomised trial comparing two different modes of ART delivery (facility and home). Participants were stratified by gender, ART delivery arm and HIV stage (early or advanced) and interviewed at enrolment on to ART and then after 3, 6, 18 and 30 months. Interviews focused on stigma and ART experiences. In 2011, follow-up interviews were conducted with 24 of the participants who could be traced. Transcribed texts were translated, coded and analyzed thematically.

Results

Stigma was reported to be very high prior to starting ART, explained by visible signs of long-term illnesses and experiences of discrimination and abuse. Early coping strategies included: withdrawal from public life, leaving work due to ill health and moving in with relatives. Starting ART led to a steady decline in stigma and allowed the participants to take control of their illness and manage their social lives. Better health led to resumption of work and having sex but led to reduced disclosure to employers, colleagues and new sexual partners. Some participants mentioned sero-sorting in order to avoid questions around HIV sero-status. A rise in stigma levels during the 18 and 30 month interviews may be correlated with decreased disclosure. By 2011, ART-related stigma was even more pronounced particularly among those who had started new sexual relationships, gained employment and those who had bodily signs from ART side-effects.

Conclusion

This study has shown that while ART comes with health benefits which help individuals to get rid of previously stigmatising visible signs, an increase in stigma may be noticed after about five years on ART, leading to reduced disclosure. ART adherence counselling should reflect changing causes and manifestations of stigma over time.

Correlates of HIV knowledge and sexual risk behaviors among female military personnel

Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Multivariate logistic regression analysis revealed that level of education and knowing someone infected with HIV/AIDS were significant (P < 0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P < 0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P < 0.05) associated with number of children, annual income, and number of sexual partners. Data indicates the importance of incorporating these predictor variables into intervention designs.

Correlates of HIV testing among women in Ghana: some evidence from the Demographic and Health Surveys

Ghana's strategic framework for controlling HIV/AIDS endorses voluntary HIV testing as an important strategy toward risk reduction and HIV/AIDS prevention. Yet, like other sub-Saharan African countries, utilization of testing services in Ghana is very low. Using the 2003 Ghana Demographic and Health Surveys and applying both complementary and negative log-log models, this study investigates the correlates of HIV testing among women aged 15-49. Two major dependent variables are considered, "ever tested for AIDS" and "wanting to test for AIDS." Results show that majority of Ghanaian women have not tested for HIV but say they want to do so. Having tested for HIV is strongly related to respondents' knowledge about someone dead of AIDS and other socio-economic and demographic variables such as education, region of residence, rural-urban residence, religion, and marital status. Majority of Ghanaian women do not know where to get an HIV test, although knowing where to get a test was significantly related to wanting to get the test done. To increase voluntary testing for HIV among women in Ghana it is recommended that testing services be made more accessible and visible especially to those residing in rural areas who may be economically disadvantaged. Interventions, including routine checking of HIV serostatus among patients seeking healthcare in clinics and home/work-based testing programs, must be encouraged as ways of expanding access among women in Ghana.

Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan widows

The paper reports the findings of a qualitative study using focus group discussions and in-depth interviews about the challenges faced by widows as they confront the direct and indirect impacts of HIV/AIDS in Nyanza, Kenya. Two focus groups were conducted with widows from two community-based organizations. This was followed by in-depth interviews with four members and two leaders from each of the community-based organizations. The contents were analysed using grounded theory. The findings reveal several challenges encountered by widows in their struggles with the direct and indirect impacts of HIV/AIDS. Widows who know or do not know their HIV status are conscious about the possibility of contracting or transmitting the virus. Wife inheritance (a Luo custom), emerged as an outstanding issue for the widows in the context of HIV/AIDS transmission. The widows employ various strategies to resist being inherited. Widows in the current epidemic navigate issues of sexuality in various ways, such as insisting their partners use condoms or permanently abstaining from sexual intercourse.

Fosterage patterns in the age of AIDS: continuity and change

An estimated 4 million children, or about 10% of the entire South African population, will be orphaned by the year 2015. There is growing consensus that the extended family system is no longer capable of providing for orphans given severe economic constraints. There is, therefore, an urgency to develop appropriate interventions to support families and take care of these children. This article examines some of the existing literature on child fosterage and uses it to highlight understudied aspects of the current situation of children orphaned through AIDS in South Africa. Of particular concern are the points of continuity and change in fosterage patterns before and after the onset of the epidemic in South Africa. I suggest that an understanding of the short- and long-term consequences for children orphaned by AIDS in South Africa calls for historical contextualisation given that child fostering, both voluntarily and involuntarily, has been a feature of black family life since well before the onset of HIV/AIDS. In addition, I demonstrate the value of examining kinship, family, and networks in order to fully understand the circumstances of fostering these children. The paper concludes with a call for more research on children orphaned by AIDS in South Africa that will provide not only more data, but also enrich theoretical approaches to studying patterns of child fosterage in Africa and elsewhere.

Evaluation of the PSAMAO "Roulez Protégé" mass media campaign in Burkina Faso. Prévention du SIDA sur les Axes Migratoires de l'Afrique de l'Ouest

This study assesses the impact of the Prevention du SIDA sur les Axes Migratoires de l'Afrique de l'Ouest Roulez Protege mass media campaign in Burkina Faso on truckers' likelihood of talking with colleagues about HIV/AIDS, using condoms with an occasional sexual partner, and intending to use a condom in the future. A total of 764 and 1,032 truckers were interviewed in 1997 and 2000 along the Ouagadougou-Niangoloko trucking route. Truckers' exposure to the program has been high and the main message promoted has been greatly understood among those exposed. Logistic regression analyses suggest that the campaign did not have direct behavioral impacts. Exposure to radio spots and participation in group discussions were found to be significantly associated with truckers discussing AIDS with peers or reporting intentions to use a condom in the future. Exposure to Roulez Protege messages through television or billboards was not found to be significantly associated with interpersonal discussion or condom use intentions. Programs should seek to sustain and expand the indirect effects of these types of programs in West Africa. Reinforcing interpersonal counseling interventions should, down the road, lead to overall knowledge and behavior changes among the high-risk trucker population.

Infect one, infect all: Zulu youth response to the AIDS epidemic in South Africa

The province of KwaZulu-Natal leads South Africa in HIV/AIDS infection, with over two-thirds of the currently estimated 1.8 million cases. Recent studies show that the spread of HIV is accelerating, especially among young people under the age of 25. For Zulu township youth, HIV infection has come to be accepted as a new and inevitable part of growing up. Ongoing political violence and high levels of crime characterize the townships, from which has emerged a youth culture where young people who suspect they may be infected with HIV will avoid a definite diagnosis while at the same time seek to spread the infection as widely as possible. This response to the growing HIV/AIDS epidemic is examined against the cultural ethos of ubuntu and the strategies once used by youth to forge solidarity in their struggle against the former white regime. The social impact of this response, which may include increasing rape incidence, is discussed.