Safety in stigmatizing? Instrumental stigma beliefs and protective sexual behavior in Sub-Saharan Africa

Examining legal and ethical challenges in HIV/AIDS disclosure obligations and medical practices: a case study from China

In accordance with China's regulations on the prevention and control of HIV/AIDS, individuals diagnosed with HIV are required to disclose their medical condition when soliciting medical care in Mainland China. Empirical field investigations, however, indicate that people living with HIV (PLHIV) predominantly comply with this mandate only under conditions of absolute necessity. The ensuing conundrum, juxtaposing the imperative of privacy against the duty of disclosure, has materialised into a recurrent vicious cycle in its practical application, intensifying the intrinsic trust disparities characterising doctor-patient interactions. A meticulous scrutiny of pertinent legal precedents, coupled with in-depth field studies, reveals that the genesis of these complications can be traced back to an unforeseen metamorphosis in the legislative intent underpinning HIV/AIDS prevention and therapeutic strategies. While the initial objective was risk mitigation, the effect of enactment in real-world scenarios has significantly decreased. Owing to factors including extensive media reporting as well as prevailing public discourse, PLHIV, rather than being perceived as rights-bearing entities in legal frameworks, are increasingly relegated to the restrictive and dehumanising labels of 'HIV/AIDS'. As these individuals navigate their rights through alternative non-regulatory channels, circumventing formal legal obligations, their efficacy in actualising these rights is concurrently undermined.

Temporal changes in HIV-related stigma and sexual behaviours: An examination of 22 African countries

ABSTRACTDespite non-trivial success against the HIV epidemic, health experts in Sub-Saharan Africa (SSA) remain concerned about new infections, stigma attitudes, and increasing rates of higher-risk sexual behaviours (HRSBs). Although this concern has produced voluminous scholarship on the behavioural consequences of belonging to stigmatised populations, scholars have only recently examined the behavioural consequences of holding stigmatising attitudes. Existing work generally finds a positive relationship between stigmatising beliefs and the practice of HRSBs. Yet, it is unknown whether this relationship has changed for countries over the past two decades. We fill this gap using Demographic and Health Survey data from 22 SSA countries. We first find that in most countries, the practice of HRSBs has increased, while stigma beliefs have become more tolerant. Second, the relationship between stigma beliefs and HRSBs changed in only six countries: Nigeria, Kenya, Mozambique, Sierra Leone, Ethiopia, and Lesotho. It changed from non-existent or negative to positive in Nigeria, Kenya, Mozambique, and Ethiopia, but non-existent to negative in Sierra Leone. In Lesotho, the positive association weakened over time. These findings highlight the importance of social and epidemic contexts when considering how stigma impacts sexual behaviours and HIV rates in SSA.

Exposure to Parental Violence and Self-Reported Sexual Violence among Unpartnered Adolescent Girls in Nigeria: Evidence from a National Survey

Objectives

Despite the high prevalence of sexual violence among young and adolescent women in Nigeria, there is a paucity of studies on the extent of sexual violence among adolescent girls, especially unpartnered girls, and the role of parental violence. This study assesses the prevalence of self-reported sexual violence and the influence of exposure to parental violence among unpartnered adolescent girls (aged 15-19) in Nigeria.

Methods

The women's data (n = 5,145) from the 2013 and 2018 Nigeria Demographic and Health Surveys were pooled and analyzed with descriptive analysis and multinomial logistic regressions.

Results

Of all adolescent girls, 5.65% had ever experienced sexual violence, 94.09% said they never did, and 0.26% did not respond. Adolescent Girls exposed to parental violence were more likely to have ever experienced sexual violence than the unexposed girls (aRRR= 1.90; 95% CI: 1.29-2.79).

Conclusion

Interventions to prevent sexual violence among adolescent girls should sensitize parents on the potential negative implications of parental violence for their daughters' wellbeing.

HIV stigma beliefs and unprotected sex among teenagers and young adults in sub-Saharan Africa: The moderating role of mass media exposure

Despite significant advances in the fight against HIV in sub-Saharan Africa, health experts remain concerned about new infections and risky sexual behavior among teenagers & young adults (T&YAs). These concerns have spurred efforts to buttress a voluminous literature on the social determinants of risky sexual behavior in Africa. Absent from this flurry of new scholarship is a consistent focus on associations between HIV stigma beliefs and risky sexual behavior, especially among T&YAs. Alongside health professionals' concerns about sexual behaviors is growing alarm about a dramatic expansion of sexual content in African mass media markets, which experts suspect may lead to T&YA risky sexual behavior. Yet, little work using multi-country data has confirmed whether mass media exposure increases the likelihood of risky sexual behavior. We fill these two gaps in the literature using a Demographic and Health Survey sample of unpartnered sub-Saharan African people, ages 15-24, in 30 countries. With this sample, we examine the direct relationships between HIV stigma beliefs, mass media exposure, and unprotected sex. We also explore whether the effect of stigma beliefs on unprotected sex is moderated by individual and regional-level exposure to mass media content. We first find that the effect of HIV stigma beliefs is harmful or associated with increases in the probability of unprotected sex. Second, contrary to past findings, individual-level mass media exposure is protective, or associated with declines in the likelihood of unprotected sex. Third, the harmful effect of stigma attitudes is weakest when individual and regional-level mass media exposure are low, but strongest when individual and regional-level mass media exposure are high. These findings suggest that stigma beliefs can shape the sexual behaviors of African T&YAs in counterintuitive ways. They also show that mass media exposure can be simultaneously protective and harmful for this population.

HIV-related stigma and its association with HIV transmission risk behaviors among boda boda motorcyclists in Mbarara Municipality, southwestern Uganda

Background: Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among boda boda (motorcycle taxi) riders, a key population in Uganda. Methods: We conducted a cross-sectional study among boda boda motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59 years who had been riding for at least 6 months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. Results: We enrolled 401 boda boda motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29 years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6 months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. Conclusions: HIV transmission risk behavior is common among boda boda motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.

How perceived Australian sexual norms shape sexual practices of East Asian and sub-Saharan African international students in Sydney

INTRODUCTION

Sexual norms, real or perceived, shape young people's sexual behaviour and may constitute one of the greatest challenges in HIV/STIs prevention among this population. This study used sexual script theory to explore how international students in Sydney, Australia - from traditional cultures of East Asian and sub-Saharan African countries - construct home backgrounds and Australian sexual norms and how this may shape their sexual practices during their studies in Australia.

METHODS

The study involved face-to-face and telephone semi-structured in-depth interviews. Data were provided by 20 international students who are enrolled in various universities in Sydney. Interviews were audio-recorded, transcribed, coded into NVivo and analysed using reflexive thematic analysis.

RESULTS

Identified patterns in the data showed three themes through which participants perceive sexual norms in Australia as distinctly different from their home country norms. First, participants stated that unlike their home country norms, sexual norms in Australia are permissive. Second, participants hold the view that compared to their home country norms, sex in Australia is largely casual as it is not always attached to love. Some participants revealed that this could shape their own sexual practices during their studies in Australia. Finally, participants noted that compared to their home countries' norm of sex talk taboo, Australia has an open sexual communication norm; which they believe, enables young people in western societies to easily acquire sexual health information.

CONCLUSIONS

Findings provide evidence to support a need for contextualized and effective sexual health services for international students that take account of perceptions around sexual norms and how they can be modified to ensure that sexual practices which these students may engage in, will be managed in a safe and responsible manner.

HIV stigma beliefs in context: Country and regional variation in the effects of instrumental stigma beliefs on protective sexual behaviors in Latin America, the Caribbean, and Southern Africa

Does the relationship between the expression of HIV stigma beliefs and the practice of protective sexual behaviors vary by social context? To answer this question, we apply multilevel techniques to Demographic and Health Survey data from seven low HIV prevalence Latin American and Caribbean countries and seven high HIV prevalence Southern African countries to examine contextual variation in this relationship. We examine whether the relationship between stigma beliefs and sexual behaviors differs across these two sets of countries and across regions within each set of countries. We first find that in high prevalence Southern African countries, one unit increases in HIV stigma beliefs are associated with 8% declines in the odds of practicing protective sexual behaviors. Conversely, in low prevalence Latin American and Caribbean countries, unit increases in HIV stigma beliefs are associated with 8% increases in the odds of those same sexual behaviors. Second, the relationship between stigma beliefs and protective sexual behaviors varies across regions within each set of countries, with a wider variance in regional stigma effects located in Southern Africa than in Latin America and the Caribbean. Third, in Southern Africa, the negative effect of stigma beliefs is even more negative in regions where conservative stigma beliefs are pronounced. Overall, our findings demonstrate the importance of taking country and regional context into account when examining the degree to which HIV beliefs affect personal sexual behaviors, which in turn, can contribute to the spread of HIV. Importantly, the implications of our results offer potential guidance to experts who wish to design policies and programs aimed at reducing the expression of negative HIV beliefs towards those infected with HIV.

Protective sexual behaviours among young adults in Nigeria: influence of family support and living with both parents

Background

Many studies have focused on risky sexual behaviour among adolescents and young adults; however, literature on protective sexual practices among this age cohort is still evolving. Since young adults are disproportionately burdened by sexually transmissible infections, including HIV, understanding factors that influence protective sexual behaviour among the age group is crucial in developing age-appropriate interventions. Drawing from a cross-sectional survey conducted among adolescents and young adults in two Nigerian universities, we examined gender differences in protective sexual behaviours and the influence of family support and living with both parents on these behaviours.

Methods

A total of 800 male and female university students in two Nigerian universities were recruited using stratified random sampling between February and April 2018. Analysis was, however, based on 599 participants aged between 15 and 24 . Adjusted and unadjusted multinomial logistic regression models were used to examine the influence of family support, and living with both parents on protective sexual behaviours at a 95% confidence interval.

Results

Findings show that the largest proportion of our participants engaged in protective sexual behaviours. We found no gender differences in protective sexual behaviours, including sexual abstinence, consistent condom use, and sexual fidelity. Family support and living with both parents were positively associated with protective sexual behaviours among adolescents and young adults.

Conclusion

This study found that a majority of adolescents and young adults in Nigerian Universities engage in protective sexual behaviours. Adequate family support and living with both parents are positively associated with protective sexual behaviours. The study however revealed that about one-fifth of our participants engaged in high-risk sexual behaviour. This suggests a need for behavioural change interventions, provision of sexual health services and empowerment of students who receive inadequate family support.