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Bhandari A, Burroway R. Hold the phone! A cross-national analysis of Women's education, mobile phones, and HIV infections in low- and middle-income countries, 1990-2018. Soc Sci Med 2023; 334:116217. [PMID: 37683500 DOI: 10.1016/j.socscimed.2023.116217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/13/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
Despite remarkable progress in the fight against HIV, the number of new infections remains unacceptably high, epidemics continue to grow in certain communities, and therefore AIDS continues to be one of the deadliest pandemics of our times. This study analyzes the rate of new HIV infections over almost 30 years in low- and middle-income countries. Previous research identifies two critical ways to address HIV prevention in developing countries: educating women and using mobile phones to improve health literacy and access to virtual healthcare. Our study bridges these literatures by evaluating how women's education and mobile technology work together to support the goals of HIV prevention in low- and middle-income countries. Using two-way panel fixed effects regression models of HIV incidence across 76 developing countries, we find that both increasing access to women's education and increasing access to mobile phones are associated with fewer HIV infections over time. Furthermore, we discover that women's education moderates the relationship between mobile phones and HIV. More specifically, mobile phones seem to be more beneficial for HIV prevention in cases where rates of formal schooling are low. However, at higher levels of women's education, the impact of mobile phones on new HIV infections is substantially reduced. Our findings have important policy implications for Information and Communications for Development (ICT4D) programs.
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Who is Exposed to HIV Prevention Interventions? An Assessment of Associated Factors Among Adolescent Girls and Young Women in South Africa. AIDS Behav 2023:10.1007/s10461-023-04023-1. [PMID: 36856934 PMCID: PMC10387118 DOI: 10.1007/s10461-023-04023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
This study examined the prevalence of HIV risk factors and their association with intervention exposure among adolescent girls and young women (AGYW) living in six South African districts in which a combination HIV-prevention intervention was being implemented. A cross-sectional household survey was conducted from 2017 to 2018 among a representative sample of AGYW aged 15-24 years living in the six districts. We used an electronic questionnaire for self-reported demographic and behavioural questions and blood samples were taken to confirm HIV status in the laboratory. Chi-Squared tests and multivariate binary logistic regression were used to examine associations between demographic characteristics, HIV acquisition and transmission risk factors and the likelihood of participating in any of the key components of the combination HIV-prevention intervention. Among the 4399 participants, 45.3% reported inconsistent condom use with casual partner and 46.6% with a main partner. Almost half of participants (47.8%) had participated in one or more components of the HIV-prevention intervention, and in a multivariate logistic regression, those reporting a higher number of HIV risk behaviours were no more (or less) likely to participate. Participants who were not in high school were significantly less likely to have participated in the intervention compared to those still in high school, when adjusting for age and HIV risk factors. The barriers to access and uptake of combination HIV prevention interventions among AGYW who are out of the education system need to be explored and combination HIV prevention interventions and implementation strategies need to be tailored to reach this population.
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Mwelase MP, Ntlantsana V, Tomita A, Chiliza B, Paruk S. HIV prevalence and access to HIV testing and care in patients with psychosis in South Africa. S Afr J Psychiatr 2023; 29:1918. [PMID: 36756542 PMCID: PMC9900311 DOI: 10.4102/sajpsychiatry.v29i0.1918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental illness often have limited or reduced access to HIV testing and care. Aim This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa. Setting A psychiatric hospital in Pietermaritzburg, KZN province, South Africa. Method A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020. Results A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients; HIV seropositivity was associated with the 25-49 age category (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] 1.27-7.50), female gender (aOR = 9.55, 95% CI 4.40-20.74), current alcohol and cannabis use (aOR = 3.43, 95% CI 1.01-11.62), family history of psychosis (aOR = 3.22, 95% CI 1.03-10.02) and no tertiary education (aOR = 3.7, 95% CI 0.14-0.99). All those living with HIV were on antiretroviral treatment. Conclusion This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high. Contribution The study findings suggest the importance of integrating mental health and HIV management.
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Affiliation(s)
- Mbalenhle P. Mwelase
- Discipline of Psychiatry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Vuyokazi Ntlantsana
- Discipline of Psychiatry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Lewis L, Kharsany ABM, Humphries H, Maughan-Brown B, Beckett S, Govender K, Cawood C, Khanyile D, George G. HIV incidence and associated risk factors in adolescent girls and young women in South Africa: A population-based cohort study. PLoS One 2022; 17:e0279289. [PMID: 36542645 PMCID: PMC9770356 DOI: 10.1371/journal.pone.0279289] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, high HIV incidence rates in adolescent girls and young women (AGYW) persist despite extensive HIV prevention efforts. METHODS A prospective cohort of 2,710 HIV-negative AGYW (15-24 years) in KwaZulu-Natal, South Africa were interviewed at baseline and followed-up approximately 18 months later (2014-2017). Associations between HIV seroconversion and socio-demographic and behavioural variables measured at baseline and follow-up were examined using Cox regression and a proximate determinants framework. Inter-relationships between determinants were measured using logistic regression. Separate models were built for 15-19 and 20-24-year-olds. RESULTS Weighted HIV incidence was 3.92 per 100 person-years (95% confidence interval: 3.27-4.69; 163 seroconversions over 4,016 person-years). Among 15-19-year-olds, absence of family support (adjusted hazards ratio (aHR): 3.82 (1.89-7.72)), having a circumcised partner (aHR: 0.5 (0.27-0.94)) or one who was HIV-positive and not on antiretroviral therapy (ART) (aHR: 6.21 (2.56-15.06)) were associated with HIV incidence. Those reporting an absence of family support were also more likely to report >1 partner during follow-up (odds ratio (OR): 2.7(1.11-6.57)). Among 20-24-year-olds, failure to complete secondary school (aHR: 1.89 (1.11-3.21)), inconsistent condom use (aHR: 3.01 (1.14-7.96)) and reporting partner(s) who were HIV-positive and not on ART (aHR: 7.75 (3.06-19.66)) were associated with HIV incidence. Failure to complete secondary school among 20-24-year-olds was associated with inconsistent condom use (OR: 1.82 (1.20-2.77)) and reporting an HIV-positive partner not on ART (OR: 3.53(1.59-7.82)) or an uncircumcised partner (OR: 1.39 (1.08-1.82). CONCLUSION Absence of family support and incomplete schooling are associated with risky sexual behaviours and HIV acquisition in AGYW. In addition, partner-level prevention-condom use, medical circumcision, and viral suppression-continue to play an important role in reducing HIV risk in AGYW. These findings support the use of combination HIV prevention programs that consider structural as well as biological and behavioural HIV risk factors in their design.
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Affiliation(s)
- Lara Lewis
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, Durban, South Africa,* E-mail:
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, Durban, South Africa,School of Laboratory Medicine and Medical Science, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu–Natal, Durban, South Africa,Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
| | - Sean Beckett
- HIV Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Kaymarlin Govender
- HIV Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDs Risk Management, Cape Town, South Africa
| | | | - Gavin George
- HIV Economics and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa,Division of Social Medicine and Global Health, Lund University, Lund, Sweden
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Rao A, Moorhouse L, Maswera R, Dadirai T, Mandizvidza P, Nyamukapa C, Nayagam S, Gregson S. Status of the HIV epidemic in Manicaland, east Zimbabwe prior to the outbreak of the COVID-19 pandemic. PLoS One 2022; 17:e0273776. [PMID: 36149912 PMCID: PMC9506661 DOI: 10.1371/journal.pone.0273776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Manicaland province in eastern Zimbabwe has a high incidence of HIV. Completion of the seventh round of the Manicaland Survey in 2018-2019 provided the opportunity to assess the state of the epidemic prior to the start of the COVID-19 pandemic. The study aims were to: a) estimate HIV seroprevalence and assess whether prevalence has declined since the last round of the survey (2012-2013), b) describe and analyse the socio-demographic and behavioural risk factors for HIV infection and c) describe the HIV treatment cascade. METHODS Participants were administered individual questionnaires collecting data on socio-demographic characteristics, sexual relationships, HIV prevention methods and treatment access, and were tested for HIV. Descriptive analyses were followed by univariate and multivariate analyses of risk factors for HIV seropositvity using logistic regression modelling based on the proximate-determinants framework. RESULTS HIV prevalence was 11.3% [95% CI; 10.6-12.0] and was higher in females than males up to 45-49 years. Since 2012-2013 HIV prevalence has significantly declined in 30-44 year-olds in males, and 20-44 year-olds in females. The HIV epidemic has aged since 2012-2013, with an increase in the mean age of HIV positive persons from 38 to 41 years. Socio-demographic determinants of HIV prevalence were church denomination in males, site-type, wealth-status, employment sector and alcohol use in females, and age and marital status in both sexes. Behavioural determinants associated with increased odds of HIV were a higher number of regular sexual partners (lifetime), non-regular sexual partners (lifetime) and condom use in both sexes, and early sexual debut and concomitant STIs in females; medical circumcision was protective in males. HIV status awareness among participants testing positive in our study was low at 66.2%. ART coverage amongst all participants testing positive for HIV in our study was 65.0% and was lower in urban areas than rural areas, particularly in males. CONCLUSIONS Prevalence has declined, and ART coverage increased, since 2012-2013. Majority of the associations with prevalence hypothesised by the theoretical framework were not observed in our data, likely due to underreporting of sexual risk behaviours or the treatment-as-prevention effect of ART curtailing the probability of transmission despite high levels of sexual risk behaviour. Further reductions in HIV incidence require strengthened primary prevention, HIV testing and linkage to risk behaviour counselling services. Our results serve as a valuable baseline against which to measure the impact of the COVID-19 pandemic on HIV prevalence and its determinants in Manicaland, Zimbabwe, and target interventions appropriately.
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Affiliation(s)
- Adya Rao
- Faculty of Medicine, Imperial College School of Medicine, Imperial College London, London, United Kingdom
- * E-mail:
| | - Louisa Moorhouse
- Faculty of Medicine, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Rufu Maswera
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tawanda Dadirai
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Phyllis Mandizvidza
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Constance Nyamukapa
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shevanthi Nayagam
- Faculty of Medicine, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Department of Metabolism, Section of Hepatology & Gastroenterology, Digestion & Reproduction, Imperial College London, London, United Kingdom
| | - Simon Gregson
- Faculty of Medicine, MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
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Abdella S, Demissie M, Worku A, Dheresa M, Berhane Y. HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique. EClinicalMedicine 2022; 51:101540. [PMID: 35813094 PMCID: PMC9256839 DOI: 10.1016/j.eclinm.2022.101540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country. METHODS This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. FINDINGS The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6). INTERPRETATION One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030. FUNDING The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.
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Affiliation(s)
- Saro Abdella
- HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Corresponding author.
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Aung S, Hardy N, Chrysanthopoulou S, Htun N, Kyaw A, Tun MS, Aung KW, Kantor R, Rana A. Evaluation of peer-to-peer HIV counseling in Myanmar: a measure of knowledge, adherence, and barriers. AIDS Care 2022; 34:762-770. [PMID: 33749465 PMCID: PMC10715989 DOI: 10.1080/09540121.2021.1902929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
In Myanmar, an Asian country with one of the highest HIV-1 prevalence rates, counseling prior to initiating antiretroviral therapy (ART) is standard care, either by a healthcare worker (standard counselor, SC) or trained counselor who is also living with HIV (peer counselor, PC). PC is commonly utilized in Myanmar and other resource-limited settings. However, its benefit over SC is unclear. We conducted a cross-sectional survey of people living with HIV (PLWH), who completed either only PC or only SC before treatment initiation across four cities in Myanmar. Participants were evaluated for HIV knowledge, stigma, antiretroviral adherence, barriers to care, social support satisfaction and attitudes regarding both counseling processes. Bivariate analyses and multivariable mixed effects modeling were conducted to compare differences in these measures among PC and SC participants. Among 1006 participants (49% PC; 51% SC), 52% were females and median age was 37 years in those receiving PC and 40 years in those receiving SC. More than 70% of participants in both groups achieved up to grade school education. The average duration since HIV diagnosis was 4.6 years for PC and 5.7 years for SC participants. HIV knowledge and attitudes regarding counseling were good in both groups and more PC participants credited their HIV counselor for knowledge (75% vs 63%, p < 0.001). Compared to SC, PC participants had lower enacted stigma (Incidence Rate Ratio (IRR) 0.75, Confidence Interval (CI) [0.65, 0.86]), mean internalized stigma (-0.24, CI [-0.34, -0.14]), and risk of antiretroviral therapy non-adherence (Odds Ratio 0.59, CI [0.40, 0.88]), while reporting higher levels of barriers to care (9.63, CI [8.20, 11.75]). Our findings demonstrate potential benefits of PC compared to SC, and support the utilization of PC to enhance HIV health outcomes within the unique societal and geographical context of Myanmar, and possibly beyond.
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Affiliation(s)
- Su Aung
- Division of Infectious Diseases, University of California San Francisco, California, CA (USA)
| | - Nicole Hardy
- School of Public Health, Brown University, Providence, RI, United States
| | | | | | - Aung Kyaw
- National AIDS Programme, Yangon, Myanmar
| | | | | | - Rami Kantor
- Division of Infectious Diseases, Brown University Alpert Medical School, Providence, RI (USA)
| | - Aadia Rana
- Division of Infectious Diseases, University of Alabama-Birmingham School of Medicine, Birmingham, AL (USA)
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Hoffman S, Zhang A, Nguyen N, Tsong R, Chen I, Wei Y, Lutalo T, Nalugoda F, Kennedy CE, Grabowski MK, Santelli J. Incident HIV Infection Among Young Men Associated With Female Sexual Partner Types Identified Through Latent Class Analysis, Rakai, Uganda. J Acquir Immune Defic Syndr 2022; 90:124-131. [PMID: 35125472 PMCID: PMC9203866 DOI: 10.1097/qai.0000000000002928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual partner characteristics are important determinants of HIV acquisition, but little is known about partner types of young men in sub-Saharan Africa. METHODS Sexually active men aged 15-24 years from 5 rounds (2005-2013) of the Rakai Community Cohort Study in Uganda reported characteristics of up to 4 past-year female partners. Partner types were identified using latent class analysis. HIV incidence rates (IRs) were calculated by partner-type combinations, and individual-level risk adjusted IR ratios (aIRRs) relative to the lowest incidence type were estimated using the Poisson regression with generalized estimating equations. RESULTS Young men (N = 1771) reported 4539 past-year female sexual partners. Three partner types were identified: type A: noncohabiting, student, medium duration partnerships; type B: cohabiting, nonstudent, longer duration partnerships; and type C: noncohabiting, nonstudent shorter duration partnerships. Type C partners engaged in the most HIV-related risk behaviors. Many men (29%) had more than 1 partner type/round. IR overall was 9.8/1000 person-years [95% confidence interval (CI): 4.7 to 20.6]. IR was 4.0 (95% CI: 1.2 to 12.7) for men with type A partners alone (41% of men). Relative to them, IR for those with type B partners alone (25%) was not significantly different. Men with type C partners alone (5%) had higher risk (aIRR = 3.2; 95% CI: 1.0 to 9.9), as did men with >1 partner type, including men with both type A and type B partners (12%; aIRR = 6.3; 95% CI: 2.5 to 15.9) and men with type C and other partner types (17%; aIRR = 4.3; 95% CI: 1.7 to 10.8). CONCLUSIONS Partner-type combination was strongly associated with HIV incidence; type C partners and having more than 1 partner type were the riskiest patterns.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, United States
- Department of Epidemiology Columbia University Mailman School of Public Health, New York, United States
| | - Adina Zhang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, United States
| | - Rachel Tsong
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Ivy Chen
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, United States
| | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - M. Kate Grabowski
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - John Santelli
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, United States
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Mathur S, Heck CJ, Kishor Patel S, Okal J, Chipeta E, Mwapasa V, Chimwaza W, Musheke M, Mahapatra B, Pulerwitz J, Pilgrim N. Temporal shifts in HIV-related risk factors among cohorts of adolescent girls and young women enrolled in DREAMS programming: evidence from Kenya, Malawi and Zambia. BMJ Open 2022; 12:e047843. [PMID: 35105561 PMCID: PMC8808410 DOI: 10.1136/bmjopen-2020-047843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To assess temporal shifts in HIV risk factors among adolescent girls (AG, aged 15-19 years) and young women (YW, aged 20-24 years) in Kenya, Malawi and Zambia. DESIGN Prospective cohorts with two time points (Kenya: 2016/2017, 2018; Malawi: 2017, 2018; Zambia: 2016/2017, 2018) SETTING: Community-based programming. PARTICIPANTS 1247 AG (Kenya: 389, Malawi: 371, Zambia: 487) and 1628 YW (Kenya: 347, Malawi: 883, Zambia: 398) INTERVENTION: Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS), a multisectoral approach to reduce AGYW's HIV vulnerability by delivering a package of tailored, multilayered activities and services.Primary and secondary outcome measures: HIV testing, sexually transmitted infection (STI) symptom experience, number of sexual partners, condom use (consistently, at last sex), transactional sex, experience of physical violence (from intimate partners) and sexual violence (from intimate partners and strangers/non-partners). RESULTS Changes in HIV-related risk behaviours among DREAMS participants varied by age group and country. Among AG, HIV testing increased (Kenya and Zambia) and sexual violence from partners (in Kenya and Malawi) and non-partners (in Malawi) decreased. Among YW, HIV testing increased and STI experience decreased in Malawi; consistent condom use decreased in Kenya; transactional sex increased in Kenya and Zambia; and physical violence (in Malawi) and sexual violence from partners (in Kenya and Malawi) and non-partners (all three countries) decreased over time. CONCLUSIONS Improvements in HIV testing and reductions in experiences of sexual violence were coupled with variable shifts in HIV-related risk behaviours among DREAMS participants in Kenya, Malawi and Zambia. Additional consideration of AGYW's risk circumstances during key life transitions may be needed to address the risk heterogeneity among AG and YW across different contexts.
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Affiliation(s)
| | | | | | - Jerry Okal
- Population Council Kenya, Nairobi, Kenya
| | - Effie Chipeta
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
| | - Victor Mwapasa
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
| | - Wanangwa Chimwaza
- Centre for Reproductive Health, University of Malawi College of Medicine, Blantyre, Southern Region, Malawi
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Heck CJ, Mathur S, Alwang’a H, Daniel OM, Obanda R, Owiti M, Okal J. Oral PrEP Consultations Among Adolescent Girls and Young Women in Kisumu County, Kenya: Insights from the DREAMS Program. AIDS Behav 2022; 26:2516-2530. [PMID: 35099640 PMCID: PMC9252953 DOI: 10.1007/s10461-022-03590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/29/2022]
Abstract
Although Kenya nationally scaled up oral pre-exposure prophylaxis (PrEP) in May 2017, adolescent girls' (AG, aged 15-19 years) and young women's (YW, aged 20-24 years) PrEP use remains suboptimal. Thus, we analyzed PrEP consultations-interactions with a healthcare provider about PrEP-among Kenyan AGYW. In April-June 2018, AGYW enrolled in DREAMS in Kisumu County, Kenya self-reported their HIV-related knowledge, behaviors, and service use. Among HIV negative, sexually active AG (n = 154) and YW (n = 289), we examined associations between PrEP eligibility and PrEP consultations using prevalence ratios (PR, adjusted: aPR). Most AG (90.26%) and YW (94.12%) were PrEP-eligible due to inconsistent/no condom use, violence survivorship, or recent sexually transmitted infection symptoms. Between PrEP-eligible AG and YW, more YW were ever-orphaned (58.09%), ever-married (54.41%), ever-pregnant (80.88%), and out of school (78.31%); more PrEP-eligible YW reported PrEP consultations (41.18% vs. 24.46%, aPR = 1.51 [1.01-2.27]). AG who used PEP (post-exposure prophylaxis) reported more consultations (aPR = 5.63 [3.53-8.97]). Among YW, transactional sex engagers reported more consultations (58.62% vs. 39.09%, PR = 1.50 [1.06-2.12]), but only PEP use (aPR = 2.81 [2.30-3.43]) and multiple partnerships (aPR = 1.39 [1.06-1.82]) were independently associated with consultations. Consultations were lowest among those with 1 eligibility criterion (AG = 11.11%/YW = 27.18%). Comparatively, consultations were higher among AG and YW with 2 (aPR = 3.71 [1.64-8.39], PR = 1.60 [1.07-2.38], respectively) or ≥ 3 (aPR = 2.51 [1.09-5.78], PR = 2.05 [1.42-2.97], respectively) eligibility criteria. Though most AGYW were PrEP-eligible, PrEP consultations were rare and differed by age and vulnerability. In high-incidence settings, PrEP consultations should be conducted with all AGYW. PrEP provision guidelines must be re-assessed to accelerate AGYW's PrEP access.
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Affiliation(s)
- Craig J. Heck
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
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11
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Pereira LMS, Dos Santos França E, Costa IB, Lima IT, Freire ABC, de Paula Ramos FL, Monteiro TAF, Macedo O, Sousa RCM, Freitas FB, Costa IB, Vallinoto ACR. Epidemiological risk factors associated with primary infection by Epstein-Barr virus in HIV-1-positive subjects in the Brazilian Amazon region. Sci Rep 2021; 11:18476. [PMID: 34531433 PMCID: PMC8446016 DOI: 10.1038/s41598-021-97707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
To identify the prevalence and risk factors for primary Epstein–Barr virus (EBV) infection in human immunodeficiency virus (HIV)-1-positive adult treatment-naïve patients between January 2018 and December 2019 in a state of the Brazilian Amazon region. A total of 268 HIV-1 positive patients and 65 blood donors participated in the study. Epidemiological data were obtained from medical records and through a designed questionnaire. EBV infection was screened by the semiquantitative detection of anti-viral capsid antigen (VCA) EBV IgM and IgG, followed by molecular detection of the EBNA-3C gene. The plasma viral loads of HIV-1 and EBV were quantified using a commercial kit. The prevalence of primary coinfection was 7.12%. The associated risk factors were education level, family income, history of illicit drug use and sexually transmitted infections, homosexual contact and condom nonuse. Approximately 58.5% had late initiation of highly active antiretroviral therapy, which influenced the risk of HIV-EBV 1/2 multiple infection (odds ratio (OR): 4.76; 95% CI 1.51–15.04) and symptom development (p = 0.004). HIV viral load was associated with patient age (OR: 2.04; 95% CI 2.01–2.07; p = 0.026) and duration of illicit drug use (OR: 1.57; 95% CI 1.12–2.22; p = 0.0548). EBV viral load was associated with younger age (OR: 0.82; 95% CI 0.79–1.03; p = 0.0579). The replication of both viruses was associated with symptom development (HIV = OR: 2.06; 95% CI 1.22–3.50; p = 0.0073; EBV = OR: 8.81; 95% CI 1–10; p = 0.0447). The prevalence of HIV/EBV coinfection was lower than that observed in other studies, and social vulnerability and promiscuous sexual behavior were associated risk factors. A long time of HIV-1 infection, without therapy, influenced the risk of coinfection and disease progression. The viral loads of both viruses may be associated with some epidemiological aspects of the population.
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Affiliation(s)
| | - Eliane Dos Santos França
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Iran Barros Costa
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Igor Tenório Lima
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | | | | | | | - Olinda Macedo
- Laboratory of Retroviruses, Evandro Chagas Institute, Virology Section, Ananindeua, Pará, Brazil
| | - Rita Catarina Medeiros Sousa
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil.,School of Medicine, Federal University of Pará, Belém, Pará, Brazil
| | - Felipe Bonfim Freitas
- Laboratory of Retroviruses, Evandro Chagas Institute, Virology Section, Ananindeua, Pará, Brazil
| | - Igor Brasil Costa
- Epstein-Barr Virus Laboratory, Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil.,Graduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Antonio Carlos Rosário Vallinoto
- Laboratory of Virology, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil. .,Graduate Program in Biology of Infectious and Parasitic Agents, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil.
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Santelli JS, Chen I, Makumbi F, Wei Y, Nalugoda F, Lutalo T, Spindler E, Grilo SA, Deisher A, Grabowski K, Hoffman S, Kagaayi J, Chang LW, Gray R, Wawer M, Serwadda D. Household wealth and HIV incidence over time, rural Uganda, 1994-2018. AIDS 2021; 35:1835-1843. [PMID: 34132219 PMCID: PMC8373447 DOI: 10.1097/qad.0000000000002989] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between household wealth and HIV incidence in rural Uganda over time from 1994 to 2018. In research conducted early in the epidemic, greater wealth (i.e. higher socioeconomic status, SES) was associated with higher HIV prevalence in sub-Saharan Africa (SSA); this relationship reversed in some settings in later years. DESIGN Analysis of associations over time in a population-based open cohort of persons 15-49 years from 17 survey-rounds in 28 continuously followed communities of the Rakai Community Cohort Study (RCCS). METHODS The RCCS sample averaged 8622 individuals and 5387 households per round. Principal components analysis was used to create a nine-item asset-based measure of household wealth. Poisson regression with generalized estimating equation (GEE) and exchangeable correlation structure was used to estimate HIV incidence rate ratios (IRRs) by SES quartile, survey-round, sex, and age group. RESULTS From 1994 to 2018, SES rose considerably, and HIV incidence declined from 1.45 to 0.40 per 100 person-years (IRR = 0.39, 95% CI = 0.32--0.47, P < 0.001). HIV incidence was similar by SES category in the initial survey intervals (1994-1997); however, higher SES groups showed greater declines in HIV incidence over time. Multivariable analyses showed significant associations between HIV incidence and SES (IRR = 0.55 for highest compared with lowest quartile, 95% CI = 0.45--0.66, P < 0.001) controlling for time, sex, and age group. CONCLUSION Beyond the early years of the RCCS, higher SES was associated with lower HIV incidence and SES gradients widened over time. The poor, like other key populations, should be targeted for HIV prevention, including treatment as prevention.
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Affiliation(s)
- John S. Santelli
- Department of Population and Family Health, Mailman School of Public Health
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
| | - Ivy Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Fred Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Tom Lutalo
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Esther Spindler
- Department of Population and Family Health, Mailman School of Public Health
| | - Stephanie A. Grilo
- Department of Population and Family Health, Mailman School of Public Health
| | - Andrea Deisher
- Department of Population and Family Health, Mailman School of Public Health
| | - Katherine Grabowski
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Joseph Kagaayi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Larry W. Chang
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ronald Gray
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Maria Wawer
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - David Serwadda
- Rakai Health Sciences, Program, Kalisizo, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
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13
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Mulwa S, Chimoyi L, Agbla S, Osindo J, Wambiya EO, Gourlay A, Birdthistle I, Ziraba A, Floyd S. Impact of the DREAMS interventions on educational attainment among adolescent girls and young women: Causal analysis of a prospective cohort in urban Kenya. PLoS One 2021; 16:e0255165. [PMID: 34383805 PMCID: PMC8360512 DOI: 10.1371/journal.pone.0255165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND DREAMS promotes a comprehensive HIV prevention approach to reduce HIV incidence among adolescent girls and young women (AGYW). One pathway that DREAMS seeks to impact is to support AGYW to stay in school and achieve secondary education. We assessed the impact of DREAMS on educational outcomes among AGYW in Nairobi, Kenya. METHODS AND FINDINGS In two informal settlements in Nairobi, 1081 AGYW aged 15-22 years were randomly selected in 2017 and followed-up to 2019. AGYW reporting invitation to participate in DREAMS during 2017-18 were classified as "DREAMS beneficiaries". Our main outcome was being in school and/or completed lower secondary school in 2019. We used multivariable logistic regression to quantify the association between being a DREAMS beneficiary and the outcome; and a causal inference framework to estimate proportions achieving the outcome if all, versus no, AGYW were DREAMS beneficiaries, adjusting for the propensity to be a DREAMS beneficiary. Of AGYW enrolled in 2017, 79% (852/1081) were followed-up to 2019. In unadjusted analysis, DREAMS beneficiaries had higher attainment than non-beneficiaries (85% vs 75% in school or completed lower secondary school, Odds Ratio (OR) = 1.9; 95%CI: 1.3,2.8). The effect weakened with adjustment for age and other confounders, (adjusted OR = 1.4; 95%CI: 0.9,2.4). From the causal analysis, evidence was weak for an impact of DREAMS (estimated 83% vs 79% in school or completed lower secondary school, if all vs no AGYW were beneficiaries, difference = 4%; 95%CI: -2,11%). Among AGYW out of school at baseline, the estimated differences were 21% (95%CI: -3,43%) among 15-17 year olds; and 4% (95%CI: -8,17%) among 18-22 year olds. CONCLUSIONS DREAMS had a modest impact on educational attainment among AGYW in informal settlements in Kenya, by supporting both retention and re-enrolment in school. Larger impact might be achieved if more AGYW were reached with educational subsidies, alongside other DREAMS interventions.
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Affiliation(s)
- Sarah Mulwa
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- African Population and Health Research Center, Nairobi, Kenya
| | - Lucy Chimoyi
- Research Management Department, The Aurum Institute, Johannesburg, South Africa
| | - Schadrac Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Jane Osindo
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Annabelle Gourlay
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | - Sian Floyd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Xie Q, Liu L, Malik H, Chupradit S, Chupradit PW. The Influence of Entrepreneurial Characteristics on the Performance of Tourism Vlogger Entrepreneurs. Front Psychol 2021; 12:725545. [PMID: 34434154 PMCID: PMC8380778 DOI: 10.3389/fpsyg.2021.725545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
The current Internet revolution has changed the entrepreneurial opportunities and trends. This study explores the relationship between entrepreneurial characteristics (e.g., innovation, leadership, planning, and sociability) and the performance of entrepreneurial vloggers in India. In addition, this study considers the mediating effect of entrepreneurial intentions. This study is cross-sectional, and it considered 128 entrepreneurial vloggers for the analysis. The SmartPLS application was used to estimate the structural equation modeling (SEM) analysis for the estimation of reliability and validity along with the path relationship. The findings are more important as the entrepreneurial characteristics can meaningfully predict the performance of entrepreneurial vloggers in a positive direction. Moreover, the relationship between entrepreneurial characteristics and the performance of entrepreneurs is partially mediated by entrepreneurial intentions. These findings have important implications for vloggers in Indian or other countries with similar nature. This study has also put some future research directions at the end.
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Affiliation(s)
- Qing Xie
- School of Business and Economics, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- School of Economics and Management, Anshun University, Anshun, China
| | - Lisha Liu
- School of Business and Economics, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- Ecological Environment Monitoring Center of Chengdu, Chengdu, China
| | - Haider Malik
- National University of Computer and Emerging Sciences, Islamabad, Pakistan
| | - Supat Chupradit
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Priyanut Wutti Chupradit
- Educational Psychology and Guidance, Department of Educational Foundations and Development, Faculty of Education, Chiang Mai University, Chiang Mai, Thailand
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Bermudez LG, Mulenga D, Musheke M, Mathur S. Intersections of financial agency, gender dynamics, and HIV risk: A qualitative study with adolescent girls and young women in Zambia. Glob Public Health 2021; 17:1638-1651. [PMID: 34255608 DOI: 10.1080/17441692.2021.1951800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Recent research demonstrates that economic interventions may positively effect HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Some evidence reveals potential associations between financial decision-making and bargaining power in sexual relationships. However, this evidence is mixed, nuanced, and limited. This paper explores how AGYW in Zambia understand financial agency and its effect on intimate relationships. Methods: In-depth qualitative interviews were conducted with 30 females aged 15-24 years residing in Kalingalinga, a low income, high-density residential area in Lusaka. Data were analysed using thematic content analysis. Results: Participants spoke of the ability to earn and spend money as reality for some and aspirational for many others, intrinsic to cultural and religious caveats influencing perceptions of agency for women. The transfer of financial independence to sexual agency within relationships was viewed as a mechanism for HIV risk reduction; however, male sexual privilege was an obstacle irrespective of financial decision-making. Conclusions: Programmes aiming to enhance financial agency for AGYW have the potential to reduce HIV sexual risk. Yet, to be most effective, integration with gender-transformative programmes is needed to address norms of male dominance that keep AGYW in positions of vulnerability.
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Zizza A, Guido M, Recchia V, Grima P, Banchelli F, Tinelli A. Knowledge, Information Needs and Risk Perception about HIV and Sexually Transmitted Diseases after an Education Intervention on Italian High School and University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042069. [PMID: 33672540 PMCID: PMC7923805 DOI: 10.3390/ijerph18042069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
Sexually transmitted diseases (STDs) among adolescents and young people represent a significant public health problem that generates a pressing requirement of effective evidence-based education to promote primary and secondary prevention. The objective of the study is to evaluate how knowledge, information needs, and risk perception about HIV and STDs can change after targeted education interventions for students. A total of 436 subjects aged 15-24 attending high school (134 biomedical and 96 non-biomedical fields) and university courses (104 scientific and 102 non-scientific disciplines) were enrolled to respond to a questionnaire before and after the intervention. An improvement in knowledge was found in all groups, with statistically significant knowledge score differences between the four groups in 60% of the items. More than 94% of the students consider it useful to promote information on these issues. Receiving this information generated awareness and safety in more than 85% of high-school students and 93% of University students. Students widely perceived a great risk being infected with HIV/STDs, although pregnancy was seen as a more hazardous consequence of unprotected sex. This study shows that educational interventions are effective in improving knowledge, apart from findings about key knowledge topics, information needs, and risk perception, which provide significant insights to design future targeted education programs.
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Affiliation(s)
- Antonella Zizza
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy; (A.Z.); (V.R.)
| | - Marcello Guido
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy;
| | - Virginia Recchia
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy; (A.Z.); (V.R.)
| | - Pierfrancesco Grima
- Infectious Diseases Operative Unit, Vito Fazzi Hospital, 73100 Lecce, Italy;
| | - Federico Banchelli
- Department of Medical and Surgical Science, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, “Veris delli Ponti” Hospital, Scorrano, 73020 Lecce, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, 73100 Lecce, Italy
- Correspondence: ; Tel.: +39-339-2074078
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Nwimo IO, Elom NA, Ilo CI, Ojide RN, Ezugwu UA, Eke VU, Ezugwu LE. HIV/AIDS knowledge and attitude towards people living with HIV/AIDS (PLWHA): a cross-sectional study of primary school teachers. Afr Health Sci 2020; 20:1591-1600. [PMID: 34394219 PMCID: PMC8351812 DOI: 10.4314/ahs.v20i4.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Teachers are in advantage position to propagate correct information with regard to HIV/AIDS thereby influencing attitude towards PLWHA. With correct information stigmatization leading to spread of the scourge might be prevented. Aims & Objectives The study was conducted to determine knowledge and attitude of primary school teachers towards PLWHA. Methods & Materials The cross-sectional survey was used to study a sample of 400 primary school teachers in Ebonyi State, Nigeria. The instrument used for data collection was researchers' designed questionnaire. Out of 400 copies of questionnaire administered; 394 representing 98.5% return rate, were used for analysis of data. Results Results showed respondents had moderate (57.4%) knowledge concerning HIV/AIDS and positive attitude (3.09 ± 0.98) to PLWHA. Female teachers' dispositions to PLWHA were better than the males based on their attitude scores and the difference was not significant in general knowledge of HIV/AIDS and attitude to PLWHA. Conclusion Our findings underscore the need for a universal health education programme, focusing on HIV/AIDS education, in education institutions that train teachers in Nigeria so as to possibly mitigate the discrepancy in knowledge regarding curability of AIDS and any undesirable attitude towards PLWHA that may arise among teachers.
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Affiliation(s)
- Ignatius O Nwimo
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Nigeria
| | - Nwamaka A Elom
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Nigeria
| | - Cajetan I Ilo
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Nigeria
| | - Rita N Ojide
- Department of Human Kinetics and Health Education, Ebonyi State University, Abakaliki, Nigeria
| | - Uchechukwu A Ezugwu
- Department of Medical Rehabilitation, University of Nigeria, Nsukka, Nigeria
| | - Vitalis U Eke
- Department of Vocational and Special Education, University of Calabar, Calabar, Nigeria
| | - Lazaus E Ezugwu
- College of Health Technology, Oji-River, Enugu State, Nigeria
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An unrecognized key population? Traditional treatment practices associated with HIV risk among traditional healers in rural South Africa. AIDS 2020; 34:2313-2317. [PMID: 33048882 DOI: 10.1097/qad.0000000000002710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To understand the risk of HIV acquisition through occupational exposure among rural South African traditional healers, notably via the practice of traditional skin incisions with razors. DESIGN A random sample of traditional healers living in South Africa participated in a cross-sectional survey that included a rapid HIV test. SETTING Rural Bushbuckridge district of Mpumalanga, South Africa. PARTICIPANTS Traditional healers. INTERVENTION Pretest counseling, posttest counseling, and referral to care if HIV seropositive. MAIN OUTCOME MEASURE(S) HIV infection. RESULTS Among healers who reported a previous positive test result or accepted an HIV test (96%), HIV prevalence was 30% (95% confidence interval: 23-37%). During their careers, 98% of healers reported conducting at least one 'vaccination' (as traditional incisions are called), 32% reported always using gloves when conducting these procedures, 29 (14%) reported patient blood touching their bare skin. Healers who reported exposure to patient blood had a higher HIV prevalence than their nonexposed colleagues (adjusted risk ratio: 2.35, 95% confidence interval: 1.55-3.56, P = 0.001). CONCLUSION Nearly all traditional healers are routinely performing minimally invasive skin incisions that could expose them to patient blood. The lack of training and access to personal protective equipment increase their risk of acquisition of blood-borne pathogens, including HIV. Given the widespread practice of traditional skin incisions across southern Africa, and the higher levels of HIV among traditional healers exposed to patient blood, it is likely that traditional healers are a hitherto unrecognized key population at disproportionate risk of acquiring HIV.
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Muñoz IG, Baker DP, Peters E. Explaining the Education-Health Gradient in Preventing STIs in Andean Peru: Cognitive Executive Functioning, Awareness and Health Knowledge. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 46:113-124. [PMID: 32701061 PMCID: PMC7889290 DOI: 10.1363/46e9320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of preventive behavior (e.g., condom use); however, evidence supporting this mechanism has been limited. METHODS Survey data were collected in 2010 from a sample of 247 adults aged 30-62 living in an isolated Andean district of Peru; these individuals had widely varying exposure to schooling, and their community had recently experienced elevated risks of STIs. Structural equation modeling was used to estimate the degree to which schooling is associated with cognitive resources, STI awareness and sexual health knowledge, and how these jointly are associated with ever-use of condoms. RESULTS Thirty-two percent of respondents reported ever-use of condoms. One additional year of schooling was associated with a 2.7-percentage-point increase in the probability of condom use, after adjustment for covariates. The pathway between education and condom use was mediated by cognitive executive functioning (CEF) skills (0.26 standard deviations), STI awareness (0.09) and sexual health knowledge (0.10); CEF skills were associated with condom use both directly and indirectly, through STI awareness and sexual health knowledge, and accounted for two-thirds of the education-condom use gradient. CONCLUSIONS The relationship between education and STI prevention may be more complex than is often assumed and is mediated by CEF skills, STI awareness and sexual health knowledge. Studies should examine whether STI prevention interventions are more effective if they enhance cognitive skills used to translate information into protective behaviors.
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Affiliation(s)
- Ismael G Muñoz
- Graduate research assistant, Department of Education Policy Studies, The Pennsylvania State University, University Park, PA, USA,
| | - David P Baker
- Professor, Departments of Sociology, Education and Demography, The Pennsylvania State University, University Park, PA, USA
| | - Ellen Peters
- Professor, School of Journalism and Communication, University of Oregon, Eugene, OR, USA
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Comins CA, Rucinski KB, Baral S, Abebe SA, Mulu A, Schwartz SR. Vulnerability profiles and prevalence of HIV and other sexually transmitted infections among adolescent girls and young women in Ethiopia: A latent class analysis. PLoS One 2020; 15:e0232598. [PMID: 32407394 PMCID: PMC7224533 DOI: 10.1371/journal.pone.0232598] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background Adolescent girls and young women (AGYW) aged 15–24 years have among the highest risk for HIV and other sexually transmitted infections (STI) across sub-Saharan Africa. A latent class analysis (LCA) was conducted to identify intersecting social- and structural-level determinants of HIV/STI acquisition among AGYW in Ethiopia. Methods AGYW were recruited from venues using time-location sampling, completing an interviewer-administered behavioral survey and biological testing for HIV, syphilis, and chlamydia. LCA was used to identify distinct groups, defined by social- and structural-level determinants of HIV/STI risk, among AGYW. Prevalence ratios (PR) and 95% confidence intervals (CI) compared differences in HIV/STI prevalence by group. Results A total of 1,501 AGYW were enrolled across Addis Ababa (March–May 2018) and Gambella (June–July 2019). We identified three patterns of vulnerability defined by schooling status, migration history, food insecurity, orphan status, social support, and employment. We labeled these groups as “highly vulnerable” (representing ~21% of the population), “stable, out-of-school, migrated” (~42%), and “stable, in-school, never migrated” (~37%). STI prevalence was nearly two-fold higher among AGYW in the “highly vulnerable” group compared to AGYW in the “stable, in-school, never migrated” group (PR 1.93; 95% CI 1.33, 2.80). Conclusions Characterizing patterns of vulnerability among AGYW that reflect higher-level social and structural factors can help facilitate early identification of AGYW at the highest risk of HIV/STI acquisition, thus differentiating groups of AGYW who may most benefit from targeted HIV prevention interventions during adolescence and early adulthood.
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Affiliation(s)
- Carly A. Comins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Katherine B. Rucinski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Sheree R. Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Burke HM, Chen M, Murray K, Bezuidenhout C, Ngwepe P, Bernholc A, Medina-Marino A. The effects of the integration of an economic strengthening and HIV prevention education programme on the prevalence of sexually transmitted infections and savings behaviours among adolescents: a full-factorial randomised controlled trial in South Africa. BMJ Glob Health 2020; 5:e002029. [PMID: 32355569 PMCID: PMC7179044 DOI: 10.1136/bmjgh-2019-002029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/15/2020] [Accepted: 02/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background Multisectoral approaches are thought necessary to prevent HIV among adolescents. We examined whether an economic strengthening (ES) and an HIV-prevention education intervention improved outcomes when combined versus separately. Methods We conducted a full-factorial randomised controlled study to randomise participants into all possible intervention groups based on the two interventions: economic strengthening only (ES-only), HIV-prevention only (HIV-only), both interventions combined (ES+HIV) and no intervention (control). We measured sexually transmitted infections (STIs), self-reported economic and sexual behaviours/knowledge, and pregnancy at a pre-intervention and two post-intervention assessments. Eligible participants were adolescents 14 to 17 years old from a programme supporting vulnerable families in Gauteng Province, South Africa. We estimated intervention effects using repeated measures, generalised linear mixed models. Results A total of 1773 adolescents participated (57% female). ES+HIV adolescents had the lowest STI prevalence at first endline; however, the comparison with the control was not significant (OR 0.62, 95% CI 0.27 to 1.41). ES-only or HIV-only groups were not significantly better than the control on STI prevalence (OR 1.53, 95% CI 0.73 to 3.20 and OR 1.47, 95% CI 0.69 to 3.12, respectively). STI prevalence became more similar among the groups at second endline.ES-only adolescents were more likely to participate in savings groups (p=0.004) and plan to save for education (p=0.001) versus the control. ES+HIV adolescents were more likely to plan to save for education versus the control (p=0.001) and HIV-only groups (p=0.002) but did not differ significantly from the ES-only group (p=0.803). The ES+HIV intervention's effect on HIV knowledge was significant compared with the control (p=0.03) and ES-only groups (p<0.001), but not when compared with the HIV-only group (p=0.091). Effects on pregnancy, sexual behaviours or other economic behaviours were not significant. Conclusions We could not confirm the ES and HIV interventions, separately or combined, were effective to reduce STI prevalence. Evaluations of multicomponent interventions should use full-factorial designs to fully assess effects. Trial registration number NCT02888678.
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Affiliation(s)
- Holly M Burke
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, North Carolina, USA
| | - Mario Chen
- Biostatistics, FHI 360, Durham, North Carolina, USA
| | - Kate Murray
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, Durham, North Carolina, USA
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Phuti Ngwepe
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | | | - Andrew Medina-Marino
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Grépin KA, Poirier MJ, Fox AM. The socio-economic distribution of exposure to Ebola: Survey evidence from Liberia and Sierra Leone. SSM Popul Health 2020; 10:100472. [PMID: 31788533 PMCID: PMC6880008 DOI: 10.1016/j.ssmph.2019.100472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/04/2022] Open
Abstract
Socio-economic factors are widely believed to have been an important driver of the transmission of Ebola Virus Disease (EVD) during the West African outbreak of 2014–16, however, studies that have investigated the relationship between socio-economic status (SES) and EVD have found inconsistent results. Using nationally representative household survey data on whether respondents knew a close friend or family member with Ebola, we explore the SES determinants of EVD exposure along individual, household, and community lines in Liberia and Sierra Leone. While we find no overall association between household wealth and EVD exposure, we find that pooled data mask important differences observed within countries with higher wealth households more likely to have been exposed to EVD in Sierra Leone and the opposite relationship in Liberia. Finally, we also generally find a positive association between education and EVD exposure both at the individual and the community levels in the full sample. There is an urgent need to better understand these relationships to examine both why the outbreak spread and to help prepare for future outbreaks. Socio-economic status (SES) was believed to be an important driver of exposure Ebola in the West African outbreak. Previous studies of the relationship between SES and Ebola show inconsistent associations. We find that higher wealth households were more likely to be exposed to Ebola in Sierra Leone but not Liberia. We also find higher SES communities were less likely to have been exposed. We also find a positive association with education at the individual and community levels.
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Gibbs A, Reddy T, Dunkle K, Jewkes R. HIV-Prevalence in South Africa by settlement type: A repeat population-based cross-sectional analysis of men and women. PLoS One 2020; 15:e0230105. [PMID: 32182255 PMCID: PMC7077822 DOI: 10.1371/journal.pone.0230105] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/21/2020] [Indexed: 01/08/2023] Open
Abstract
To assess i) whether there is an independent association between HIV-prevalence and settlement types (urban formal, urban informal, rural formal, rural informal), and, ii) whether this changes over time, in South Africa. We draw on four (2002; 2005; 2008; 2012) cross-sectional South African household surveys. Data is analysed by sex (male/female), and for women by age categories (15-49; and 15-24; 25-49) at all-time points, for men in 2012 data is analysed by age categories (15-24; 25-49). By settlement type and sex/age combinations, we descriptively assess the association between socio-demographic and HIV-risk factors; HIV-prevalence; and trends in HIV-prevalence by time. Relative risk ratios assess unadjusted and adjusted risk for HIV-prevalence by settlement type. All estimates are weighted, and account for survey design. In all survey years, and combinations of sex/age categorisations, HIV-prevalence is highest in urban informal settlements. For men (15-49) an increasing HIV-prevalence over time in rural informal settlements was seen (p = 0.001). For women (15-49) HIV-prevalence increases over time for urban informal, rural informal, rural formal, and women (15-24) decreases in urban formal and urban informal, and women (25-49) increases urban informal and rural informal settlements. In analyses adjusting for potential socio-demographic and risk factors, compared to urban formal settlements, urban informal settlements had consistently higher relative risk of HIV for women, in all age categorisations, for instance in 2012 this was RR1.89 (1.50, 2.40) for all women (15-49), for 15-24 (RR1.79, 1.17-2.73), and women 25-49 (RR1.91, 1.47-2.48). For men, in the overall age categorization, urban informal settlements had a higher relative risk for HIV in all years. In 2012, when this was disaggregated by age, for men 15-24 rural informal (IRR2.69, 1.28-5.67), and rural formal (RR3.59, 1.49-8.64), and for men 25-49 it was urban informal settlements with the highest (RR1.68, 1.11-2.54). In 2012, rural informal settlements also had higher adjusted relative risk for HIV-prevalence for men (15-49) and women (15-49; 15-24; 25-49). In South Africa, HIV-prevalence is patterned geographically, with urban informal settlements having a particularly high burden. Geographical targeting of responses is critical for the HIV-response.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Bermudez LG, Yu G, Lu L, Falb K, Eoomkham J, Abdella G, Stark L. HIV Risk Among Displaced Adolescent Girls in Ethiopia: the Role of Gender Attitudes and Self-Esteem. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:137-146. [PMID: 29767281 DOI: 10.1007/s11121-018-0902-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Adolescent girls in sub-Saharan Africa have been deemed one of the most critical populations to address in the campaign for an HIV-free generation. Experiences of intimate partner violence (IPV), harmful gender norms, diminished personal agency, and age-disparate sex have been identified as factors in the increasing rate of new infections among this population. Using baseline data from a cluster-randomized controlled trial in three refugee camps in Benishangul-Gumuz Regional State in Ethiopia, our study quantitatively examined the associations between HIV risk factors, attitudes on gender inequality, IPV acceptability, and self-esteem for female adolescent refugees primarily from Sudan and South Sudan (n = 919). In multivariate models, adjusting for age and education, results showed girls who were more accepting of gender inequitable norms and IPV had greater odds of ever experiencing forced (OR 1.40, CI 1.15-1.70; OR 1.66, CI 1.42-1.94) or transactional sex (OR 1.28, CI 1.05-1.55; OR 1.59, CI 1.37-1.85) compared to girls who demonstrated less approval. Higher self-esteem was associated with increased odds of condom use (OR 1.13, CI 1.02-1.24) as well as decreased odds of adolescent marriage (OR 0.93, CI 0.90-0.95), age-disparate sex (OR 0.90, CI 0.86-0.94), and transactional sex (OR 0.96, CI 0.93-0.99). The findings suggest acceptance of inequitable gender norms (including those that perpetuate violence against women) and low self-esteem to be associated with common HIV risk factors among refugee adolescents living in Ethiopia. Greater attention towards the intersections of gender equality and self-valuation is needed when seeking to understand HIV risk among refugee adolescent girls in sub-Saharan Africa.
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Affiliation(s)
- Laura Gauer Bermudez
- Columbia University School of Social Work , 1255 Amsterdam Ave., New York, NY, 10027, USA
| | - Gary Yu
- Columbia University School of Social Work , 1255 Amsterdam Ave., New York, NY, 10027, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA
- NYU Rory Meyers College of Nursing, 433 First Avenue, 7th Floor, New York, NY, 10010, USA
| | - Lily Lu
- Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA
| | - Kathryn Falb
- The International Rescue Committee, 1730 M St NW, Washington, DC, 20036, USA
| | - Jennate Eoomkham
- The International Rescue Committee, TK International Bldg. 6th Floor, Bole Rd, Addis Ababa, Ethiopia
| | - Gizman Abdella
- The International Rescue Committee, TK International Bldg. 6th Floor, Bole Rd, Addis Ababa, Ethiopia
| | - Lindsay Stark
- Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, NY, 10032, USA.
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Mekonnen FA, Lakew AM, Muchie KF, Teshome DF. Sero-positive HIV result disclosure to sexual partner in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2019; 19:1743. [PMID: 31881867 PMCID: PMC6935207 DOI: 10.1186/s12889-019-8097-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background The infection of HIV continues to be an important public health problem in Ethiopia. Disclosing own HIV positive result is crucial, and considered as a good indicator of behavior change towards HIV/AIDs. A systematic review and meta-analysis was conducted to pool the prevalence of positive HIV status disclosure to sexual partners and determine the influence of selected factors. Methods This systematic review and meta-analysis was conducted in Ethiopia among HIV positive people receiving health care at health facilities. In this review, primary studies were searched in Medline via PubMed, Google scholar and Google up to November, 2018. Data on disclosure of HIV positive result, knowledge of partner’s HIV status and prior discussion on HIV were extracted, and effect sizes like proportion and odds ratios were pooled. Heterogeneity and publication bias were assessed by chi-square and I2, and Egger test, respectively. Results A total of 12 studies with 4528 participants were included in to this review to estimate the prevalence of disclosure of HIV positive result to sexual partner, and 10 and 7 studies were included to determine the associations of the outcome variable with knowledge of sexual partner’s HIV status and with prior discussion on HIV, respectively. The pooled prevalence of HIV status disclosure to sexual partner was 73% (95% CI: 64, 82%). Having the knowledge of sexual partner’s HIV status [OR: 95%CI; 17.63 (7.88, 39.45)], and previous discussion on HIV [OR: 95% CI; 9.24 (5.56, 15.37)] increased the disclosure of own HIV positive result to sexual partner. The sub-group analysis indicated a prevalence of 74% in Oromia, 86% in Southern Nations Nationalities and Peoples (SNNPR), 87% in Amhara, 73% in Addis Ababa, and 54% in Tigray. Conclusions Disclosure of HIV status to sexual partner is lower than expected. Knowledge of partner’s HIV status and previous discussion on HIV were strong predictors of HIV positive status disclosure. Strategies helpful for encouraging open HIV discussion need to be strengthened to increase HIV positive result disclosure. Furthermore, since the heterogeneity of studies is high, large nationally representative study is suggested.
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Affiliation(s)
- Fantahun Ayenew Mekonnen
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 96, Gondar, Ethiopia.
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 96, Gondar, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 96, Gondar, Ethiopia
| | - Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O.BOX: 96, Gondar, Ethiopia
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Mensch BS, Grant MJ, Soler-Hampejsek E, Kelly CA, Chalasani S, Hewett PC. Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi. POPULATION STUDIES 2019; 74:241-261. [PMID: 31619138 PMCID: PMC7162723 DOI: 10.1080/00324728.2019.1656282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14-17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills-numeracy and Chichewa literacy-on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys. School enrolment and academic skills are not significantly associated with sexually transmitted infections (STIs) for boys or girls in our final models. Efforts to encourage school progression in high-prevalence settings in sub-Saharan Africa could well reduce, or at least postpone, acquisition of STIs.
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Birri Makota R, Musenge E. Factors Associated With HIV Infection in Zimbabwe Over a Decade From 2005 to 2015: An Interval-Censoring Survival Analysis Approach. Front Public Health 2019; 7:262. [PMID: 31620418 PMCID: PMC6759818 DOI: 10.3389/fpubh.2019.00262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: The main objective of this study was to compare results from two approaches for estimating the effect of different factors on the risk of HIV infection and determine the best fitting model. Study design: We performed secondary data analysis on cross-sectional data which was collected from the Zimbabwe Demographic Health Survey (ZDHS) from 2005 to 2015. Methods: Survey and cluster adjusted logistic regression was used to determine variables for use in survival analysis with HIV status as the outcome variable. Covariates found significant in the logistic regression were used in survival analysis to determine the factors associated with HIV infection over the 10 years. The data for the survival analysis were modeled assuming age at survey imputation (Model 1) and interval-censoring (Model 2). Results: Model goodness of fit test based on the Cox-Snell residuals against the cumulative hazard indicated that Model 1 was the best model. On the contrary, the Akaike Information Criterion (AIC) indicated that Model 2 was the best model. Factors associated with a high risk of HIV infection were being female, number of sexual partners, and having had an STI in the past year prior to the survey. Conclusion: The difference between the results from the Cox-Snell residuals graphical method and the model estimates and AIC value maybe due to the lack of adequate methods to test the goodness-of -fit of interval-censored data. We concluded that Model 2 with interval-censoring gave better estimates due to its consistency with the published results from literature. Even though we consider the interval-censoring model as the superior model with regards to our specific data, the method had its own set of limitations.
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Affiliation(s)
- Rutendo Birri Makota
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Gender Differences in HIV/HSV-2: Evidence from a School Support Randomized Controlled Trial Among Orphaned Adolescents in Kenya. AIDS Behav 2019; 23:2396-2406. [PMID: 31041623 DOI: 10.1007/s10461-019-02518-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Women and girls are disproportionately affected by HIV and other sexually transmitted infections (STIs) such as Herpes Simplex Virus type-2 (HSV-2) in Sub-Saharan Africa (SSA). Given this gender disparity and women's vulnerability to HIV/STIs, prevention efforts often target women, but relatively little attention has been paid to compare whether HIV interventions produce equal program effects across gender. The purpose of this study is to examine whether the school support intervention had equal program effects on study outcomes and biomarkers by gender among orphaned adolescents in Kenya. A randomized controlled trial was conducted to test whether keeping orphaned boys and girls in school reduced risky sexual behaviors and prevented HIV/HSV-2 infection in Kenya (N = 835). We collected four annual surveys and biomarkers measures of HIV and HSV-2 at Time 1 and Time 4. Regression analysis and multi-level linear mixed models were conducted, and t test with Satterthwaites' method for each regression coefficients was used to compare program effects by gender. There were substantial gender differences on risky sexual behaviors, HSV-2 infection, and gendered ideologies prior to intervention implementation. The school support intervention had significant gender-specific program impacts on HSV-2. The intervention females experienced a 36% increase in HSV-2 infection while intervention males experienced a 23% decrease after 3 years of program implementation. Differential program effects by gender on attitudes toward abstaining from sex were also found. More scientific research is needed to test whether HIV interventions produce equal program impacts by gender. Prevention programs should recognize gender-specific program effects and address individual, relational, and contextural factor that reinforce the gender disparity in HIV/HSV-2 risk.
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Chakalisa U, Wirth K, Bennett K, Kadima E, Manyake K, Gaolathe T, Bachanas P, Marukutira T, Lebelonyane R, Dryden-Peterson S, Butler L, Mmalane M, Makhema J, Roland ME, Pretorius-Holme M, Essex M, Lockman S, Powis KM. Self-reported risky sexual practices among adolescents and young adults in Botswana. South Afr J HIV Med 2019; 20:899. [PMID: 31308965 PMCID: PMC6620511 DOI: 10.4102/sajhivmed.v20i1.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Adolescents and young adults account for more than one-third of incident Human Immunodeficiency Virus (HIV) infections globally. Understanding sexual practices of this high-risk group is critical in designing HIV targeted prevention programming. Objectives To describe self-reported risky sexual practices of adolescents and young adults aged 16–24 years from 30 Botswana communities. Methods Cross-sectional, self-reported age at sexual debut; number of sexual partners; condom and alcohol use during sex; intergenerational sex; and transactional sex data were collected. Modified Poisson estimating equations were used to obtain univariate and multivariate-adjusted prevalence ratios (PR) and 95% confidence intervals (CI) comparing engagement in different sexual practices according to gender, accounting for the clustered design of the study. Results Among the 3380 participants, 2311 reported being sexually active with more females reporting being sexually active compared to males (65% vs. 35%, respectively; p < 0.0001). In univariate analyses, female participants were more likely to report inconsistent condom use (PR 1.61; 95% CI 1.44–1.80), intergenerational sex (PR 9.00; 95% CI 5.84–13.88) and transactional sex (PR 3.46; 95% CI 2.07–5.77) than males, yet less likely to report engaging in sex before age 15 years (PR 0.59; 95% CI: 0.41–0.85), using alcohol around the time of intercourse (PR: 0.59; 95% CI 0.45–0.76) or having ≥ two partners in the last 12 months (PR 0.65; 95% CI 0.57–0.74). Conclusions Self-reported risky sexual practices of adolescents and young adults in Botswana differed significantly between males and females. Gender-specific risky sexual practices highlight the importance of developing tailored HIV prevention programming.
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Affiliation(s)
- Unoda Chakalisa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kathleen Wirth
- Harvard T.H. Chan School of Public Health, Boston, United States
| | - Kara Bennett
- Bennett Statistical Consulting, Ballston Lake, United States
| | - Etienne Kadima
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kutlo Manyake
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Pam Bachanas
- Centers for Disease Control and Prevention, Division of Global HIV/AIDS and TB, Atlanta, United States
| | | | | | | | - Lisa Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, United States
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | | | - Max Essex
- Harvard T.H. Chan School of Public Health, Boston, United States
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Chabata ST, Hensen B, Chiyaka T, Mushati P, Mtetwa S, Hanisch D, Napierala S, Busza J, Floyd S, Fearon E, Birdthistle I, Hargreaves JR, Cowan FM. Changes Over Time in HIV Prevalence and Sexual Behaviour Among Young Female Sex-Workers in 14 Sites in Zimbabwe, 2013-2016. AIDS Behav 2019; 23:1494-1507. [PMID: 30788641 PMCID: PMC6535417 DOI: 10.1007/s10461-019-02410-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Young female sex-workers (FSW) aged 18–24 are at high risk of HIV due to high numbers of sexual partners, difficulty negotiating condom use, increased risk of gender-based violence, and limited access to services. Here we describe changes in sexual behaviours among young FSW across Zimbabwe between 2013 and 2016, and risk factors for prevalent HIV in 2013 and 2016. FSW ≥ 18 years were recruited using respondent-driven sampling in 14 sites across Zimbabwe in 2013 and 2016 as part of the SAPPH-IRe trial. We collected data on socio-demographics and sexual behaviour and offered HIV testing. Statistical analyses were RDS-II weighted. Characteristics of young FSW aged 18–24 were described, stratified by age. Logistic regression was used to assess difference in sexual behaviours by reported HIV status between 2013 and 2016, and to explore associations with prevalent HIV in 2013 and 2016. 656 young FSW were recruited in 2013 and 503 in 2016. Characteristics of young FSW were similar across both surveys. HIV prevalence was similar at both time points (35% vs 36%) and rose steeply with age. Compared to young FSW in 2013, reported condom-less sex with a steady partner and condom-less sex with clients was higher in 2016 among women self-reporting HIV negative status (OR = 6.41; 95%CI: 3.40-12.09; P<0.001) and (OR = 1.69; 95%CI: 1.14-2.51, P = 0.008), respectively, but not among young FSW self-reporting HIV positive status (OR = 2.35; 95%CI: 0.57-9.76; P = 0.236) and (OR = 1.87; 95%CI: 0.74-4.74; P = 0.186). After adjusting for age in 2016, young FSW who had ever been married had increased odds of testing HIV positive (OR = 1.88; 95% CI 1.04–3.39; P = 0.036) compared with those who had never married. Young FSW who completed secondary education or higher were less likely to test HIV positive (OR = 0.41; 95% CI 0.20–0.83; P = 0.012) compared with those with primary education or less. Young FSW remain at very high risk of HIV. Strategies to identify young FSW when they first start selling and refer them into services that address their economic, social and sexual vulnerabilities are critical.
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Affiliation(s)
- Sungai T Chabata
- Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) Zimbabwe, 09 Monmouth Road, Avondale West, Harare, Zimbabwe.
| | - Bernadette Hensen
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tarisai Chiyaka
- Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) Zimbabwe, 09 Monmouth Road, Avondale West, Harare, Zimbabwe
| | - Phillis Mushati
- Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) Zimbabwe, 09 Monmouth Road, Avondale West, Harare, Zimbabwe
| | - Sibongile Mtetwa
- Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) Zimbabwe, 09 Monmouth Road, Avondale West, Harare, Zimbabwe
| | | | - Sue Napierala
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Joanna Busza
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Fearon
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Isolde Birdthistle
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - James R Hargreaves
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances M Cowan
- Centre for Sexual Health, HIV/AIDS Research (CeSHHAR) Zimbabwe, 09 Monmouth Road, Avondale West, Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Palomino González R, Kadengye DT, Mayega RW. The knowledge-risk-behaviour continuum among young Ugandans: what it tells us about SRH/HIV integration. BMC Public Health 2019; 19:604. [PMID: 31138182 PMCID: PMC6538546 DOI: 10.1186/s12889-019-6809-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background With a human immunodeficiency virus (HIV) prevalence of 2.1% among 15–24 year olds, opportunities for further integration of sexual and reproductive health (SRH) and HIV prevention services for young people in Uganda exist. We examine a range of factors that contribute to variance in risky sexual behaviour among young Ugandans. Methods A cross-sectional, nationally representative household survey was conducted between February and March 2016. The questionnaire used assessed knowledge, attitudes and practices related to SRH among young people aged 10–24 years. A composite indicator was constructed to assess risky sexual behaviour, defined as being involved in sexual relations under the influence of alcohol or drugs, engaging in sexual activities without a condom, and having multiple sexual partners in the 6 months preceding the survey. Exploratory analysis was conducted to provide descriptive statistics. Logistic regression was conducted to determine the factors associated with risky sexual behaviour. This analysis focuses on the sub-category aged 15–24 years, comprised of 2725 respondents. Results Knowledge levels of family planning (FP), sexually transmitted infections (STIs) and HIV across all respondents were high (above 82%). Self-reported perceived risk of STIs and pregnancy was consistently higher among 20–24 year old respondents, with 61.5% feeling at risk of STIs compared to 46.2% of 15–19 year olds. A total of 22.7% of respondents reported having been involved in risky sexual behaviour. Factors associated with risky sexual behaviour among the 15–19 years group included gender, single orphanhood, casual work, schooling status, FP knowledge and self-perceived risk of STIs/HIV. For the 20–24 year old respondents, significantly associated factors included gender, educational level, relationship to head of household, place of residence, and self-perceived risk of pregnancy. Conclusions Despite high general SRH/HIV knowledge and perceived risk of pregnancy and HIV, risky sexual behaviour among young Ugandans remains high. Effectiveness gaps in the integrated SRH/HIV response for young people should be addressed and targeted interventions focused on holistic prevention at individual level through information, risk awareness, and skill development should be combined with interventions targeting social structures affecting individual behaviour. Electronic supplementary material The online version of this article (10.1186/s12889-019-6809-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Damazo Twebaze Kadengye
- African Population and Health Research Center, Manga Cl, Nairobi, Kenya. .,School of Statistics and Planning, Makerere University, Kampala, Uganda.
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Intimate partner violence, HIV and sexually transmitted infections in fishing, trading and agrarian communities in Rakai, Uganda. BMC Public Health 2019; 19:594. [PMID: 31101045 PMCID: PMC6525432 DOI: 10.1186/s12889-019-6909-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV), HIV and sexually transmitted infections (STI) can contribute to disparities in population health, depending on the individual, social and environmental factors characterizing a setting. To better understand the place-based determinants and patterns of these key interrelated public health problems in Uganda, we compared risk factors for IPV, HIV and STI in fishing, trading and agrarian communities in Rakai, Uganda by gender. METHOD This study used cross-sectional data collected from 14,464 sexually active men (n = 6531) and women (n = 7933) as part of the Rakai Community Cohort Study, a population-based open cohort study of men and women aged 15-49 years. We used multilevel modified poisson regression models, which incorporated random intercepts for community and households. Factors associated with IPV, HIV and STI were assessed separately for men and women in fishing, trading and agrarian communities. RESULTS A larger proportion of participants in the fishing communities than those in trading and agrarian communities were HIV positive, engaged in HIV risk behaviors, had STI symptoms and reported perpetration of or victimization by IPV. Female gender was a shared correlate of IPV, HIV and STI in the fishing communities. Engagement in multiple sexual relationships or partner's engagement in multiple relationships were shared correlates of IPV, and HIV in agrarian communities and IPV and STI in trading communities. CONCLUSION Programs should target factors at multiple levels to reduce risk for syndemic conditions of HIV, STI and IPV in Rakai, Uganda particularly among men and women in fishing communities.
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Woldu DO, Haile ZT, Howard S, Walther C, Otieno A, Lado B. Association between substance use and concurrent sexual relationships among urban slum dwellers in Nairobi, Kenya. AIDS Care 2019; 31:1454-1460. [PMID: 30894010 DOI: 10.1080/09540121.2019.1595519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
While the overall incidence and prevalence of HIV/AIDS are declining in Africa, substance use-related HIV/AIDS is on the rise. The main objectives of this study were to elicit the types of commonly used substances and to examine the association between substance use and concurrent sexual relationships among slum dwellers in Kenya. Freelisting elicitation techniques were used to identify the most commonly used substances using 53 key informants. This was followed by a self-administered, structured questionnaire using a convenience sample of 506 participants. Findings from our freelisting analysis produced 27 substances that were used in the community. Analysis of the survey data shows that participants who reported using substances in the past three months were more likely to be involved in concurrent sexual relationships than those who did not (86.2% vs. 74.0%; p = .002). In the multivariable model, the odds of ever having concurrent sexual relationships were higher among participants who used any substance in the past three months (aOR 2.46; 95% CI 1.37-4.42, p < .01). The observed association between substance use and concurrent sexual relationships may be influenced by social and economic factors such as poverty and lack of opportunity among urban slum dwellers.
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Affiliation(s)
- Dawit Okubatsion Woldu
- Department of Anthropology and Cross-cultural Studies, College of Human Sciences and Humanities, University of Houston-Clear Lake , Houston , TX , USA
| | - Zelalem T Haile
- Department of Social Medicine, Ohio University, Heritage College of Osteopathic Medicine , Athens , OH , USA
| | - Steve Howard
- School of Media Arts and Studies, Ohio University , Athens , OH , USA
| | - Christine Walther
- Department of Psychology, College of Human Sciences and Humanities, University of Houston-Clear Lake , Houston , TX , USA
| | | | - Bennet Lado
- Department of Social and Public Health, College of Health Sciences and Profession, Ohio University , Athens , OH , USA
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Durevall D, Lindskog A, George G. Education and HIV incidence among young women in KwaZulu-Natal: An association but no evidence of a causal protective effect. PLoS One 2019; 14:e0213056. [PMID: 30830933 PMCID: PMC6398860 DOI: 10.1371/journal.pone.0213056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/14/2019] [Indexed: 11/18/2022] Open
Abstract
We examine the relationship between school attendance and HIV incidence among young women in South Africa. Our aim is to distinguish a causal effect from correlation. Towards this end, we apply three methods to population-based longitudinal data for 2005–2012 in KwaZulu-Natal. After establishing a negative association, we first use a method that assesses the influence of omitted variables. We then estimate models with exclusion restrictions to remove endogeneity bias, and finally we estimate models that control for unobserved factors that remain constant over time. All the three methods have strengths and weaknesses, but none of them suggests a causal effect. Thus, interventions that increase school attendance in KwaZulu-Natal would probably not mechanically reduce HIV risk for young women. Although the impact of school attendance could vary depending on context, unobserved variables are likely to be an important reason for the common finding of a negative association between school attendance and HIV incidence in the literature.
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Affiliation(s)
- Dick Durevall
- Department of Economics, School of Business, Economics and Law, University of Gothenburg, Sweden
| | - Annika Lindskog
- Department of Economics, School of Business, Economics and Law, University of Gothenburg, Sweden
- * E-mail:
| | - Gavin George
- HEARD, University of KwaZulu-Natal, Durban, South Africa
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Price J, Pettifor A, Selin A, Wagner RG, MacPhail C, Agyei Y, Gómez-Olivé FX, Kahn K. The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study. PLoS One 2019; 14:e0210632. [PMID: 30653540 PMCID: PMC6336295 DOI: 10.1371/journal.pone.0210632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/29/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To characterise perceived household support for female education and the associations between educational support and HIV prevalence, HSV-2 prevalence and sexual risk behaviours. METHODS This cross-sectional study used baseline survey data from the Swa Koteka HPTN 068 trial undertaken in Mpumalanga, South Africa. The study included 2533 young women aged 13-20, in grades 8-11 at baseline. HIV and HSV-2 status were determined at baseline. Information about patterns of sexual behaviour and household support for education was collected during the baseline survey. Linear regression and binary logistic regression were used to determine associations between household support for education and both biological and behavioural outcomes. RESULTS High levels of educational support were reported across all measures. HIV prevalence was 3.2% and HSV-2 prevalence was 4.7%, both increasing significantly with age. Over a quarter (26.6%) of young women reported vaginal sex, with 60% reporting condom use at last sex. The median age of sexual debut was 16 years. Household educational support was not significantly associated with HIV or HSV-2; however, the odds of having had vaginal sex were significantly lower in those who reported greater homework supervision (OR 0.82, 95%CI: 0.72-0.94), those who engaged in regular discussion of school marks with a caregiver (OR 0.82, 95%CI: 0.71-0.95) and when caregivers had greater educational goals for the young woman (OR 0.82, 95%CI: 0.71-0.96). In contrast, greater caregiver disappointment at dropout was significantly associated with reported vaginal sex (OR 1.29, 95%CI: 1.14-1.46). CONCLUSION Young women in rural South Africa report experiencing high levels of household educational support. This study suggests that greater household educational support is associated with lower odds of having vaginal sex and engaging in risky sexual behaviour, though not with HIV or HSV-2 prevalence.
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Affiliation(s)
- Jessica Price
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Audrey Pettifor
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amanda Selin
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yaw Agyei
- Johns Hopkins University, School of Medicine, Department of Pathology, HPTN Laboratory Center, Baltimore, Maryland, United States of America
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: A comprehensive approach to preventing HIV among adolescent girls and young women. PLoS One 2018; 13:e0208167. [PMID: 30532210 PMCID: PMC6285267 DOI: 10.1371/journal.pone.0208167] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In sub-Saharan Africa, adolescent girls and young women (AGYW) are 5 to 14 times more likely to be infected with HIV than their male peers. Every day, more than 750 AGYW are infected with HIV. Many factors make girls and young women particularly vulnerable to HIV, including gender-based violence, exclusion from economic opportunities, and a lack of access to secondary school. The President's Emergency Plan for AIDS Relief (PEPFAR) is dedicating significant resources through the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) partnership to impact the lives of women and girls based on PEPFAR's mission to help countries achieve epidemic control of HIV/AIDS. The data show that new HIV infections must be reduced in AGYW, or the global community risks losing the extensive progress made towards reaching epidemic control. With support from PEPFAR and private sector partners-the Bill & Melinda Gates Foundation, Gilead Sciences, Girl Effect, Johnson & Johnson and ViiV Healthcare, DREAMS works together with partner governments to deliver a core package of interventions that combines evidence-based approaches that go beyond the health sector, addressing the structural drivers that directly and indirectly increase girls' HIV risk. Not only is DREAMS an effort to reduce new HIV infections, but it aims to reduce other critical vulnerabilities such as gender-based violence. When girls and young women thrive, the effects are felt throughout their families, communities and countries.
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Affiliation(s)
- Janet Saul
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Gretchen Bachman
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Shannon Allen
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Nora F. Toiv
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Caroline Cooney
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
| | - Ta’Adhmeeka Beamon
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America
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Cockcroft A, Marokoane N, Kgakole L, Kefas J, Andersson N. The Inter-ministerial National Structural Intervention trial (INSTRUCT): protocol for a parallel group cluster randomised controlled trial of a structural intervention to reduce HIV infection among young women in Botswana. BMC Health Serv Res 2018; 18:822. [PMID: 30376834 PMCID: PMC6208099 DOI: 10.1186/s12913-018-3638-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Wide recognition that structural factors are important in the HIV epidemic has not generated much evidence of impact of structural interventions. Few randomised controlled trials of structural interventions for HIV prevention have an HIV endpoint, and most of those did not show a significant impact. It has proved difficult to prevent new HIV infections in Botswana, especially among young women, many of whom are unable to act on HIV preventive choices. Proposed by a government think tank in Botswana, the Inter-ministerial National Structural Intervention trial (INSTRUCT) tests whether addressing social and economic factors, including gender inequality, gender violence, poverty, and poor access to education, can lower HIV infection rates among young women. Focussed on increasing access by marginalised young women to government support programs, the intervention seeks to change their structural position, reducing their vulnerability to transactional sex, and thus to HIV infection. Methods This parallel group cluster randomised controlled trial compares HIV rates among young women in districts with and without the structural interventions. The 30 administrative districts in the country, stratified by HIV prevalence and development status, will be randomly assigned to 5-district implementation waves. The intervention in the first-wave districts will include: (i) recruiting and preparing vulnerable young women to apply to government support programs, (ii) making the support programs more accessible to young women by engaging local program officers and young women in co-evaluation of programs and co-design of solutions; and (iii) generating an enabling environment for change in communities through an audio-drama edutainment program. In year five, an impact survey will measure HIV rates among vulnerable young women (15–29 years) in a random sample of communities in the five intervention districts and in the five second-wave (control) districts. Fieldworkers will undertake rapid HIV screening and interview young women and young men, collecting information on secondary outcomes of attitudes and behaviours. Discussion This is the first step in a planned stepped-wedge design that will roll out the intervention, modified as necessary, to all districts. Strong government commitment provides an important opportunity to reduce new HIV cases in Botswana, and guide prevention efforts in other countries. Trial registration Registration number: ISRCTN 54878784. Registry: ISRCTN. Date of registration: 11 June 2013.
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Affiliation(s)
- Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Canada. .,CIET Trust Botswana, PO Box 1240, Gaborone, Botswana.
| | | | | | - Joseph Kefas
- National AIDS Coordinating Agency, Gaborone, Botswana
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Paid staff or volunteers - does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi. Glob Health Action 2018; 10:1381462. [PMID: 29214899 PMCID: PMC5727430 DOI: 10.1080/16549716.2017.1381462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Globally, and in low and middle income countries (LMIC) specifically, there is a critical shortage of workers. The use of volunteers to support such care delivery systems has been examined, there is scant literature on the impact of volunteers on child outcome in high human immunodeficiency virus (HIV)-affected communities. Objectives: To examine the differential impact of paid versus volunteer workforce in Community Based Organisations (CBOs) providing care to children and families affected by the HIV epidemic in South Africa and Malawi on child outcomes over time. Methods: This study compared child outcomes for 989 consecutive children attending CBOs (0.7% refusal) at baseline and 854 at follow-up (86.3% response rate). Results: Children attending CBOs with paid staff had higher self-esteem, fewer emotional/behavioural problems and less perceived stigma. Likewise, children attending CBOs with paid staff had fewer educational risks, and 20 heightened cognitive performance, and the digit-span memory test. After controlling for outcome at baseline, gender, age, HIV status, and disability, attending a CBO with paid staff remained a significant independent predictor of higher self-esteem scores, less perceived stigma, as well as fewer educational risks and better performance on the drawing test. We found no associations between CBO attendance – paid or volunteer – and children’s depressive and trauma symptoms. Conclusions: Our findings show that in order to most optimally impact on child outcome 30 community-based workers (CBWs) should ideally be paid with trained staff. Specialised input for more severe child difficulties is needed.
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Rasmussen DN, Unger HW, Bjerregaard-Andersen M, da Silva Té D, Vieira N, Oliveira I, Hønge BL, Jespersen S, Gomes MA, Aaby P, Wejse C, Sodemann M. Political instability and supply-side barriers undermine the potential for high participation in HIV testing for the prevention of mother-to-child transmission in Guinea-Bissau: A retrospective cross-sectional study. PLoS One 2018; 13:e0199819. [PMID: 30067793 PMCID: PMC6070169 DOI: 10.1371/journal.pone.0199819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends HIV testing is included in routine screening tests for all pregnant women in order to prevent mother-to-child-transmission of HIV and reduce maternal morbidity and mortality. OBJECTIVES To assess the proportion of women approached and tested for HIV at delivery and factors associated with non-testing at the maternity ward of the Simão Mendes National Hospital (HNSM) in Bissau, Guinea-Bissau. METHODS We conducted a retrospective cross-sectional study among women presenting for delivery from June 2008 until May 2013. During the study period, national policy included opt-out HIV-testing at delivery. Modified Poisson regression models were used to examine the association of maternal characteristics with HIV testing. Time trends were determined using Pearson's χ2 test. RESULTS Seventy-seven percent (24,217/31,443) of women presenting for delivery were counselled regarding PMTCT, of whom 99.6% (24,107/24,217) proceeded with HIV testing. The provision of opt-out HIV testing at labour increased from 38.1% (1,514/3973) in 2008 to 95.7% (2,021/2,113) in 2013, p<0.001. There were four distinct periods (two or more consecutive calendar months) when less than 50% of women delivering at HNSM were tested. Periods of political instability were significantly associated with not testing for HIV (adjusted prevalence ratio [APR] 1.79; 95% CI 1.73-1.84), as was a lower educational status (APR 1.05; 95% CI 1.00-1.10), admission during evenings/nights (APR 1.05; 95% CI 1.01-1.09) and on Sundays (APR 1.14; 95% CI 1.07-1.22) and Mondays (APR 1.12; 95% CI 1.05-1.19). CONCLUSIONS Rapid scale-up of PMTCT HIV testing services and high testing coverage was possible in this resource-limited setting but suffered from regular interruptions, most likely because of test stock-outs. Establishing proper stock management systems and back-up plans for periods of political instability is required to ensure the maintenance of health system core functions and increase health system resilience.
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Affiliation(s)
- Dlama Nggida Rasmussen
- Center for Global Health, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- * E-mail:
| | - Holger Werner Unger
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Obstetrics and Gynaecology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Australia
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Department of Endocrinology, Hospital of South West Denmark, Esbjerg, Denmark
| | - David da Silva Té
- National HIV Programme, Secretariado Nacional de Luta Contra Sida, Ministry of Health, Bissau, Guinea-Bissau
| | - Noel Vieira
- Association Ceu e Terras, Bissau, Guinea-Bissau
| | - Inés Oliveira
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Bo Langhoff Hønge
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Sanne Jespersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Wejse
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Morten Sodemann
- Center for Global Health, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
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Bekker LG, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, Dybul M, Eholie S, Esom K, Garnett G, Grimsrud A, Hakim J, Havlir D, Isbell MT, Johnson L, Kamarulzaman A, Kasaie P, Kazatchkine M, Kilonzo N, Klag M, Klein M, Lewin SR, Luo C, Makofane K, Martin NK, Mayer K, Millett G, Ntusi N, Pace L, Pike C, Piot P, Pozniak A, Quinn TC, Rockstroh J, Ratevosian J, Ryan O, Sippel S, Spire B, Soucat A, Starrs A, Strathdee SA, Thomson N, Vella S, Schechter M, Vickerman P, Weir B, Beyrer C. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission. Lancet 2018; 392:312-358. [PMID: 30032975 PMCID: PMC6323648 DOI: 10.1016/s0140-6736(18)31070-5] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Linda-Gail Bekker
- International AIDS Society, Geneva, Switzerland; Desmond Tutu HIV Centre, University of Cape Town, South Africa.
| | - George Alleyne
- NCD Alliance, Office of the Director, Pan American Health Organization, Washington, DC, USA
| | - Stefan Baral
- Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | | | - David Dowdy
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Dybul
- Centre for Global Health and Quality, Georgetown University School of Medicine, Washington, DC, USA
| | - Serge Eholie
- Department of Dermatology and Infectious Diseases, Medical School, Felix Houphouet Boigny Universty Abidjan, Cote d'Ivoire
| | - Kene Esom
- HIV, Health and Development Group, United Nations Development Programme, New York, NY, USA
| | - Geoff Garnett
- HIV Delivery, Bill & Melinda Gates Foundation, Washington, DC, USA
| | | | - James Hakim
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California-San Francisco, San Fransisco, CA, USA
| | | | - Leigh Johnson
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Parastu Kasaie
- Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Michel Kazatchkine
- UNAIDS and Global Health Center, Graduate Institute, Geneva, Switzerland
| | - Nduku Kilonzo
- National AIDS Control Council for Kenya, Nairobi, Kenya
| | - Michael Klag
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Marina Klein
- Division of Infectious Diseases, Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Chewe Luo
- HIV/AIDS Section, United Nations Children's Fund, New York City, NY, USA
| | - Keletso Makofane
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Kenneth Mayer
- The Fenway Institute, Harvard Medical School, Boston, MA, USA
| | | | - Ntobeko Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Loyce Pace
- Global Health Council, Washington, DC, USA
| | - Carey Pike
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anton Pozniak
- HIV Services, Chelsea and Westminster NHS Foundation Trust Hospital, London, UK
| | - Thomas C Quinn
- Centre for Global Health, Johns Hopkins University, Baltimore, MD, USA; International AIDS Society-National Institute for Drug Abuse, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, MD, USA
| | - Jurgen Rockstroh
- HIV Clinic, Department of Medicine, University Hospital Bonn, Bonn, Germany
| | - Jirair Ratevosian
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Owen Ryan
- International AIDS Society, Geneva, Switzerland
| | - Serra Sippel
- Center for Health and Gender Equity, Washington DC, USA
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Agnes Soucat
- Health Systems, Governance and Financing, World Health Organisation, Geneva, Switzerland
| | | | - Steffanie A Strathdee
- Global Health Sciences, Department of Medicine, University of California-San Diego, San Diego, CA, USA
| | - Nicholas Thomson
- Centre for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Mauro Schechter
- Department of Preventative Medicine, Universidade Federal do Rio de Janeiro, Rio de Janerio, Brazil
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brian Weir
- Department of Health, Behaviour and Society, Johns Hopkins University, Baltimore, MD, USA
| | - Chris Beyrer
- International AIDS Society, Geneva, Switzerland; Centre for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Mee P, Fearon E, Hassan S, Hensen B, Acharya X, Rice BD, Hargreaves JR. The association between being currently in school and HIV prevalence among young women in nine eastern and southern African countries. PLoS One 2018; 13:e0198898. [PMID: 29924827 PMCID: PMC6010266 DOI: 10.1371/journal.pone.0198898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/27/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Interventions to keep adolescent girls and young women in school, or support their return to school, are hypothesised to also reduce HIV risk. Such interventions are included in the DREAMS combination package of evidence-based interventions. Although there is evidence of reduced risky sexual behaviours, the impact on HIV incidence is unclear. We used nationally representative surveys to investigate the association between being in school and HIV prevalence. METHODS We analysed Demographic and Health Survey data from nine DREAMS countries in sub-Saharan Africa restricted to young women aged 15-19 (n = 20,429 in total). We used logistic regression to assess cross-sectional associations between being in school and HIV status and present odds ratios adjusted for age, socio-economic status, residence, marital status, educational attainment and birth history (aOR). We investigated whether associations seen differed across countries and by age. RESULTS HIV prevalence (1.0%-9.8%), being currently in school (50.0%-72.6%) and the strength of association between the two, varied between countries. We found strong evidence that being currently in school was associated with a reduced odds of being HIV positive in Lesotho (aOR: 0.37; 95%CI: 0.17-0.79), Swaziland (aOR: 0.32; 95%CI: 0.17-0.59), and Uganda (aOR: 0.48: 95%CI: 0.29-0.80) and no statistically significant evidence for this in Kenya, Malawi, Mozambique, Tanzania, Zambia or Zimbabwe. CONCLUSIONS Although the relationship is not uniform across countries or over time, these data are supportive of the hypothesis that young women in school are at lower risk of being HIV positive than those who leave school in some sub-Saharan African settings. There is a possibility of reverse causality, with pre-existing HIV infection leading to school drop-out. Further investigation of the contextual factors behind this variation will be important in interpreting the results of HIV prevention interventions promoting retention in school.
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Affiliation(s)
- Paul Mee
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Elizabeth Fearon
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Syreen Hassan
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bernadette Hensen
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Xeno Acharya
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brian D. Rice
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James R. Hargreaves
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Cockcroft A, Marokoane N, Kgakole L, Tswetla N, Andersson N. Access of choice-disabled young women in Botswana to government structural support programmes: a cross-sectional study. AIDS Care 2018; 30:24-27. [PMID: 29848044 DOI: 10.1080/09540121.2018.1468009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Structural factors like poverty, poor education, gender inequality, and gender violence are important in the HIV epidemic in southern Africa. Such factors constrain many people from making choices to protect themselves against HIV. The INSTRUCT cluster randomised controlled trial of a structural intervention for HIV prevention includes workshops for young women which link them with existing government structural support programmes. Fieldworkers identified all young women aged 15-29 years in each intervention community, not in school and not in work, interviewed them, and invited them to a workshop. Choice-disability factors were common. Among the 3516 young women, 64% had not completed secondary education, 35% did not have enough food in the last week, 21% with a partner had been beaten by their partner in the last year, and 8% reported being forced to have sex. Of those aged 18 and above, 45% had applied to any government support programme and 28% had been accepted into a programme; these rates were only 33% and 10% when Ipelegeng, a part-time minimum wage rotating employment scheme with no training or development elements, was excluded. Multivariate analysis considering all programmes showed that women over 20 and very poor women with less education were more likely to apply and to be accepted. But excluding Ipelegeng, young women with more education were more likely to be accepted into programmes. The government structural support programmes were not designed to benefit young women or to prevent HIV. Our findings confirm that programme use by marginalised young women is low and, excluding Ipelegeng, the programmes do not target choice disabled young women.
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Affiliation(s)
- Anne Cockcroft
- a CIET Trust Botswana , Gaborone , Botswana.,b CIET/PRAM, Department of Family Medicine , McGill University , Montreal , QC , Canada
| | | | | | | | - Neil Andersson
- a CIET Trust Botswana , Gaborone , Botswana.,b CIET/PRAM, Department of Family Medicine , McGill University , Montreal , QC , Canada.,d Centro de Investigacion de Enfermedades Tropicales (CIET) , Universidad Autonoma de Guerrero, Acapulco , Guerrero , Mexico
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Early school failure predicts teenage pregnancy and marriage: A large population-based cohort study in northern Malawi. PLoS One 2018; 13:e0196041. [PMID: 29758040 PMCID: PMC5951561 DOI: 10.1371/journal.pone.0196041] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/05/2018] [Indexed: 11/19/2022] Open
Abstract
Background School dropout has been linked to early pregnancy and marriage but less is known about the effect of school performance. We aimed to assess whether school performance influenced age at sexual debut, pregnancy and marriage, and from what age school drop-out and performance were associated with these later life events. Methods Data from 2007–2016 from a demographic surveillance site in northern Malawi with annual updating of schooling status and grades, and linked sexual behaviour surveys, were analysed to assess the associations of age-specific school performance (measured as age-for-grade) and status (in or out of school) on subsequent age at sexual debut, pregnancy and marriage. Landmark analysis with Cox regression was used to estimate hazard ratios of sexual debut, pregnancy and marriage by schooling at selected (landmark) ages, controlling for socio-economic factors. Results Information on at least one outcome was available for >16,000 children seen at ages 10–18. Sexual debut was available on a subset aged ≥15 by 2011. For girls, being out of school was strongly associated with earlier sexual debut, pregnancy and marriage. For example, using schooling status at age 14, compared to girls in primary, those who had dropped out had adjusted hazard ratios of subsequent sexual debut, pregnancy and marriage of 5.39 (95% CI 3.27–8.86), 2.39 (1.82–3.12), and 2.76 (2.08–3.67) respectively. For boys, the equivalent association with sexual debut was weak, 1.92 (0.81–4.55), but that with marriage was strong, 3.74 (2.28–6.11), although boys married later. Being overage-for-grade was not associated with sexual debut for girls or boys. For girls, being overage-for-grade from age 10 was associated with earlier pregnancy and marriage (e.g. adjusted hazard ratio 2.84 (1.32–6.17) for pregnancy and 3.19 (1.47–6.94) for marriage, for those ≥3 years overage compared to those on track at age 10). For boys, overage-for-grade was associated with earlier marriage from age 12, with stronger associations at older ages (e.g. adjusted hazard ratio 2.41 (1.56–3.70) for those ≥3 years overage compared to those on track at age 14). For girls ≥3 years overage at age 14, 39% were pregnant before they were 18, compared to 18% of those who were on track. The main limitation was the use of reported ages of sexual debut, pregnancy and marriage. Conclusions School progression at ages as young as 10 can predict teenage pregnancy and marriage, even after adjusting for socio-economic factors. Early education interventions may reduce teenage pregnancy and marriage as well as improving learning.
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Evaluations of Structural Interventions for HIV Prevention: A Review of Approaches and Methods. AIDS Behav 2018; 22:1253-1264. [PMID: 29273945 DOI: 10.1007/s10461-017-1997-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Structural interventions alter the social, economic, legal, political, and built environments that underlie processes affecting population health. We conducted a systematic review of evaluations of structural interventions for HIV prevention in low- and middle-income countries (LMICs) to better understand methodological and other challenges and identify effective evaluation strategies. We included 27 peer-reviewed articles on interventions related to economic empowerment, education, and substance abuse in LMICs. Twenty-one evaluations included clearly articulated theories of change (TOCs); 14 of these assessed the TOC by measuring intermediary variables in the causal pathway between the intervention and HIV outcomes. Although structural interventions address complex interactions, no evaluation included methods designed to evaluate complex systems. To strengthen evaluations of structural interventions, we recommend clearly articulating a TOC and measuring intermediate variables between the predictor and outcome. We additionally recommend adapting study designs and analytic methods outside traditional epidemiology to better capture complex results, influences external to the intervention, and unintended consequences.
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Yates TA, Ayles H, Leacy FP, Schaap A, Boccia D, Beyers N, Godfrey-Faussett P, Floyd S. Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa. Trop Med Int Health 2018; 23:375-390. [PMID: 29432669 PMCID: PMC6022780 DOI: 10.1111/tmi.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective To describe the associations between socio‐economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era. Methods The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio‐economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients. Results The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33–0.92) times and 0.70 (95% CI 0.54–0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university‐educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12–0.54) and 0.42 (95% CI 0.25–0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status. Conclusion These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics.
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Affiliation(s)
- Tom A Yates
- Institute for Global Health, University College London, London, UK
| | - Helen Ayles
- ZAMBART, School of Medicine, University of Zambia, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Finbarr P Leacy
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Schaap
- ZAMBART, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Delia Boccia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Peter Godfrey-Faussett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Van der Wal R, Loutfi D. Pre-exposure prophylaxis for HIV prevention in East and Southern Africa. Canadian Journal of Public Health 2018; 108:e643-e645. [PMID: 29356678 DOI: 10.17269/cjph.108.6254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 11/22/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has proven to be highly effective in preventing HIV in uninfected persons when properly adhered to. East and Southern African countries that suffer from high HIV prevalence and incidence are increasingly adopting PrEP as an HIV prevention strategy for their high-risk populations, including for young women. Structural factors such as poverty, lack of education, and gender-based violence may compromise their PrEP uptake and adherence, however. Choice-disabled young women are most at risk of HIV infection and least able to apply HIV prevention choices. For successful rollout of this biomedical solution, we need structural interventions that address these underlying drivers of the HIV epidemic.
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Affiliation(s)
- Ran Van der Wal
- Department of Family Medicine, McGill University, Montreal, QC.
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Kidman R, Heymann J. Prioritising action to accelerate gender equity and health for women and girls: Microdata analysis of 47 countries. Glob Public Health 2018; 13:1634-1649. [PMID: 29345212 DOI: 10.1080/17441692.2018.1427272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Sustainable Development Goals set ambitious targets for health. Meeting such will require drastic improvements in the social conditions for women and girls. Understanding which social conditions have the greatest impact on health can help prioritise action, yet there is little comparative data. We use microdata from 338,580 women in 47 low- and middle-income countries to estimate the relative contributions of improved social determinants in bringing about maternal and child health gains over the past 20 years. Regression analyses examine determinants related to education, work, health services, family, and violence; the potential health benefit that could be derived from improving conditions is calculated. Secondary education and child marriage emerge as the strongest and most consistent predictors of health. The largest impact is seen on adolescent births: we estimate that achieving universal completion of secondary schooling for young women could lower adolescent births by 18 percentage points; eliminating child marriages could lower adolescent births by 11 points. Intervening in these two areas could also bring about substantial reductions in the unmet need for family planning, past-year intimate partner violence, and child mortality. Thus, we suggest prioritising policies targeting secondary education and child marriage in order to accelerate gender equity and health.
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Affiliation(s)
- Rachel Kidman
- a Program in Public Health, Department of Family, Population & Preventative Medicine , Stony Brook University, Health Sciences Center , Stony Brook , NY , USA
| | - Jody Heymann
- b UCLA Fielding School of Public Health, Dean's Office, Center for Health Sciences , Los Angeles , CA , USA
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HIV EPIDEMIC HETEROGENEITY IN ZIMBABWE: EVIDENCE FROM SUCCESSIVE DEMOGRAPHIC AND HEALTH SURVEYS. J Biosoc Sci 2018; 50:840-852. [PMID: 29332615 DOI: 10.1017/s0021932017000657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Zimbabwe has one of the worst HIV epidemics in the world. This study investigated data from two successive Zimbabwe Demographic and Health Surveys (ZDHS) conducted in 2005-06 and 2010-11. A random representative sample of 30,000 men aged 15-59 and women aged 15-49 was selected from the two surveys. The HIV prevalence was mapped with a flexible, coherent regression framework using a geo-additive semi-parametric mixed model. HIV indicator prevalence maps were constructed at the regional level, and at the administrative level relevant for policy design, planning and decision-making. Substantial regional variation was found, not only in the burden of HIV, but also in its risk factors. The results suggest that responses/policies should vary at the regional level to ensure that the often diverse needs of populations across a country are met and incorporated into planning the HIV response. The use of geographically referenced data in two successive ZDHS provides crucial new insights into the spatial characteristics of the HIV epidemic in Zimbabwe. In particular, it highlights the HIV heterogeneity across Zimbabwe, with substantial regional variation, not only in the burden of HIV, but also in its risk factors.
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Swahn MH, Buchongo P, Kasirye R. Risky Behaviors of Youth Living in the Slums of Kampala: A Closer Examination of Youth Participating in Vocational Training Programs. VULNERABLE CHILDREN AND YOUTH STUDIES 2018; 13:276-290. [PMID: 31452668 PMCID: PMC6709978 DOI: 10.1080/17450128.2018.1489168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Obtaining formal education is associated with a decreased risk of HIV transmission among youth in sub-Saharan Africa. However, little is known about the role vocational skills training programs may have on risk behaviors linked to HIV transmission among vulnerable youth in sub-Saharan Africa. This study examined the characteristics and risk behaviors among vulnerable youth who receive vocational skills training by a community-based organization. Empirical analyses were conducted using a cross-sectional survey administered in 2014 to youth (ages 12 to 18 years) in the slums of Kampala (N=1134). Five multivariable logistic regression models were computed to determine the association between participating in a vocational training program and self-reported risk behaviors pertaining to alcohol use, lack of condom use, sex with multiple partners, and transactional sex. In our study, 29.6% of youth attended a vocational training program. Our findings show that youth who participated in vocational training were more likely to report often feeling hopeful (AOR: 1.7; 95% CI: 1.1, 3.0) and less likely to report alcohol use (AOR: 0.4; 95% CI: 0.2, 0.7) than those not attending vocational training programs, in multivariable analyses. Overall, findings varied for males and females. These findings, while preliminary, indicate that self-reported behaviors associated with risk for HIV transmission vary in some respects for youth participating in vocational training versus those who do not. However, additional research is needed, as are evaluations of the benefits and potential impact of vocational training in both the short and long-term for vulnerable youth in resource-poor settings and with limited access to formal education.
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Affiliation(s)
- Monica H. Swahn
- Distinguished Professor, Division of Epidemiology and Biostatistics Partnership for Urban Health Research School of Public Health, Georgia State University 140 Decatur St. SE Atlanta, GA 30303,
| | - Portia Buchongo
- Georgia State University School of Public Health, 140 Decatur St. SE Atlanta, GA 30303
- Corresponding:
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