Vulnerability of wives of Nepalese labor migrants to HIV infection: Integrating quantitative and qualitative evidence

Cultural and religious determinants of HIV transmission: A qualitative study with people living with HIV in Belu and Yogyakarta, Indonesia

As a part of a larger qualitative study to understand HIV-risk factors and impacts on people living with HIV (PLHIV) (52 women and 40 men) in Belu and Yogyakarta, Indonesia, this paper reports the influences of cultural practices and religious beliefs on sexual relationships and behaviours of participants as contributors for HIV transmission. This study was conducted from June to December 2020. Data collection was conducted using one-one-one in-depth interviews. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. The findings showed that cultural practices in Belu related to the use of bride wealth, managing spousal disputes, marriage, and condom use, influenced spousal relationships and sexual behaviours or practices which contributed to HIV transmission. Javanese cultural practices and expectation of an ‘ideal wife’, Islamic religious beliefs about expected husband-wife relationships, forbidden premarital sex, and the participants’ individual interpretation of their religious beliefs about condom use spousal sexual relations, also influenced spousal sexual relations and behaviours, which supported HIV transmission among the participants. The findings indicate the need for HIV education programs that address cultural practices and religious beliefs for community members and population groups to enhance their understanding about HIV, condom use, and how cultural practices and religious beliefs play a role in HIV transmission. The findings also indicate the need for involvement of religious leaders in HIV education programs to bring insights to people and help them interpret their religious beliefs in health promoting ways. Future studies that explore different aspects of culture and religion which may contribute to HIV transmission are recommended.

Health and well-being issues of Nepalese migrant workers in the Gulf Cooperation Council countries and Malaysia: a systematic review

OBJECTIVE

To summarise the evidence on health and well-being of Nepalese migrant workers in the Gulf Cooperation Council (GCC) countries and Malaysia.

DESIGN

Systematic review.

DATA SOURCES

EMBASE, MEDLINE, Scopus and Global Health databases.

ELIGIBILITY CRITERIA

Studies were eligible if they: (1) included Nepalese migrant workers aged 18 or older working in the GCC countries or Malaysia or returnee migrant workers from these countries; (2) were primary studies that investigated health and well-being status/issues; and (3) were published in English language before 8 May 2020.

STUDY APPRAISAL

All included studies were critically appraised using Joanna Briggs Institute study specific tools.

RESULTS

A total of 33 studies were eligible for inclusion; 12 studies were conducted in Qatar, 8 in Malaysia, 9 in Nepal, 2 in Saudi Arabia and 1 each in UAE and Kuwait. In majority of the studies, there was a lack of disaggregated data on demographic characteristics of Nepalese migrant workers. Nearly half of the studies (n=16) scored as 'high' quality and the rest (n=17) as 'moderate' quality. Five key health and well-being related issues were identified in this population: (1) occupational hazards; (2) sexual health; (3) mental health; (4) healthcare access and (5) infectious diseases.

CONCLUSION

To our knowledge, this is the most comprehensive review of the health and well-being of Nepalese migrant workers in the GCC countries and Malaysia. This review highlights an urgent need to identify and implement policies and practices across Nepal and destination countries to protect the health and well-being of migrant workers.

Sex trafficking, prostitution, and increased HIV risk among women during and after the 2015 Nepal earthquake

Women might be at increased risk of HIV infection after a disaster situation due to several interlinked environmental and social factors, such as increased sex trafficking and prostitution, in resource-limited settings. However, this information has not been clearly understood. Based on the review of available gray and peer-reviewed evidence, the present debate paper summarizes potential factors for increasing women's HIV risk during/after two earthquakes that hit Nepal in 2015. Poverty and socio-economic crisis, displacement and reduced social capital, increased rate of sex trafficking and prostitution, and poor access to health care seem to be the factors to increase women's HIV risk in the earthquake-affected areas of Nepal. There is a lack of essential empirical evidence on environmental and social factors (e.g. increased sex trafficking and prostitution) that are linked with women's HIV risk in the post-disaster phase. Therefore, the factors and interactions discussed should be further studied potentially in disaster-affected areas so that locally and culturally salient and sustainable relief and reconstruction strategies, which include strategies for preventing HIV risk in post-disaster situations, can be developed.

Gender Differences and Psychosocial Factors Associated with Problem Drinking Among Adults Enrolling in HIV Care in Tanzania

Problem drinking is commonly reported among people living with HIV (PLWH), associated with suboptimal HIV care outcomes and differs by gender. Psychosocial factors associated with problem drinking among PLWH remain poorly understood, including whether they differ by gender. This analysis examines the relationship between psychosocial factors and problem drinking separately by gender among PLWH in Tanzania. Cross-sectional data were collected from 812 men and non-pregnant women living with HIV aged 18 or older enrolling in HIV care at four health facilities in Tanzania. Problem drinking was assessed with the CAGE Questionnaire and defined as responding yes to two or more items. Sex-stratified multivariable logistic regression modeled the association of social support, HIV-related stigma, and physical or sexual violence on problem drinking, controlling for age, relationship status, employment, having been away from home for more than  one month, and timing of first HIV-positive diagnosis. Thirteen percent of the sample reported problem drinking, with problem drinking significantly more commonly reported among men than non-pregnant women (17.6% vs. 9.5%). Among men and non-pregnant women, in multivariable analyses, enacted and internalized HIV-related stigma were significantly positively associated with problem drinking. Screening and treatment of problem drinking should be integrated into HIV care. Evidence-based substance abuse interventions should be adapted to address HIV-related stigma. Future research should longitudinally investigate the interrelationships between stigma, violence, and problem drinking among PLWH.

HIV/AIDS health education toward enhancing knowledge and HIV prevention efforts in household wife

OBJECTIVES

this study aimed to identify the influence of health education about HIV/AIDS towards enhancing knowledge and HIV prevention efforts in household wives.

METHOD

A quasy experimental design with pretest and posttest nonequivalent control group study was conducted among housewives in Rumbai Pekanbaru, Riau Province from March to August 2018. A systematic random sampling technique was used to select 144 housewives. A total of 72 intervention groups and 72 control groups. The intervention group was given health education with videos and leaflets. A questionnaire that it tested for validity and reliability has been applied. The Paired-Samples T-Test and Independent Samples T-Test were applied to analyze data.

RESULTS

There were differences in pretest and posttest preventive knowledge and prevention behavior scores on HIV in the intervention group (p-value=0.000). However, there was no significant difference in prevention behavior in the control group (p-value=0.0120). Based on this results, it can be concluded that health education can increase the knowledge and behavior of prevention of HIV/AIDS in household wives (p-value=0.000).

RECOMMENDATION

The health education on HIV/AIDS counseling and testing are key interventions for reducing number of HIV/AIDS cases. It is recommended that housewives to conduct HIV status on health services, and for HIV program holders are expected to increase the frequency of health education by using attractive media and VCT mobile services in order to reach more housewives.

Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study

Background

HIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care.

Methods

We conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding.

Results

Our theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure.

Conclusion

This theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.

HIV-Related Risk Behaviors Among Labor Migrants, Their Wives and the General Population in Nepal

Nepalese labor migrants and their wives are considered as at-risk populations for HIV infection. There may be a risk of HIV transmission from the labor migrant and their wives to the general population due to HIV-related risk behaviors, but so far empirical evidence to support this hypothesis is scarce. Therefore, this study was conducted to compare HIV-related risk behaviors between labor migrants, their wives, and males and females from the general population in the far-western region of Nepal. This was a cross-sectional study, in which structured face-to-face interviews were conducted with 261 male labor migrants, 262 wives of labor migrants, 123 males and 122 females from the general population. We found that the proportion of the labor migrants and their wives reporting having had extramarital sex in the previous year did not differ significantly with the males (11.9 vs. 13.4 %, p value 0.752) and females (2.0 vs. 1.7 %, p value 0.127) from the general population. However, the labor migrants compared with the males from the general population were 1.51 times and the wives of labor migrants compared with the females from the general population were 2.37 times more likely to have been tested for HIV. Both the males from the general population and the labor migrants are equally engaged in unprotected extramarital sex. Therefore, it is recommended that the prevention programs, including access to condoms and HIV testing, should be scaled up targeting a broader range of individuals in the far-western region of Nepal.