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Junkins A, Kempf MC, Burkholder G, Ye Y, Chu DI, Wiener HW, Szychowski JM, Shrestha S. Sexual risk characteristics, social vulnerability, and anal cancer screening uptake among men living with HIV in the deep south. AIDS Care 2024; 36:762-770. [PMID: 38268443 PMCID: PMC11035097 DOI: 10.1080/09540121.2023.2299747] [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: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
ABSTRACTWithout standard guidelines, there is a critical need to examine anal cancer screening uptake in the South which has the highest HIV incidence in the U.S. We identified factors associated with screening among men living with HIV (MLHIV) at a large academic HIV outpatient clinic in Alabama. Relationships between sociodemographic, clinical, sexual risk characteristics and screening were examined using T-tests, Fisher's exact, Chi-square, and logistic regression analyses. Unadjusted and adjusted odds ratios (AOR) were computed to estimate the odds of screening. Among 1,114 men, 52% had received annual anal cytology (pap) screening. Men who were screened were more likely to have multiple sexual partners compared to men who were not screened (22.8% vs. 14.8%, p = 0.002). Among men with one partner, the youngest were almost five times more likely to be screened compared to middle-aged men (AOR = 4.93, 95% CI: 2.34-10.39). Heterosexual men had lower odds and men who reported unprotected anal sex had higher odds of screening. Our findings suggest a racial disparity, with older black MLHIV being the least likely to be screened. In the South, MLHIV who are older, black, heterosexual, or live in high social vulnerability counties may be less likely to receive annual anal cancer screening.
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Affiliation(s)
- Anna Junkins
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mirjam-Colette Kempf
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Greer Burkholder
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yuanfan Ye
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel I. Chu
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Howard W. Wiener
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeff M. Szychowski
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadeep Shrestha
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Balaji S, Chakraborty R, Aggarwal S. Neurological Complications Caused by Human Immunodeficiency Virus (HIV) and Associated Opportunistic Co-infections: A Review on their Diagnosis and Therapeutic Insights. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:284-305. [PMID: 37005520 DOI: 10.2174/1871527322666230330083708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/28/2022] [Accepted: 01/25/2023] [Indexed: 04/04/2023]
Abstract
Neurocognitive disorders associated with human immunodeficiency virus (HIV) infected individuals increase the risk of mortality and morbidity that remain a prevalent clinical complication even in the antiretroviral therapy era. It is estimated that a considerable number of people in the HIV community are developing neurological complications at their early stages of infection. The daily lives of people with chronic HIV infections are greatly affected by cognitive declines such as loss of attention, learning, and executive functions, and other adverse conditions like neuronal injury and dementia. It has been found that the entry of HIV into the brain and subsequently crossing the blood-brain barrier (BBB) causes brain cell damage, which is the prerequisite for the development of neurocognitive disorders. Besides the HIV replication in the central nervous system and the adverse effects of antiretroviral therapy on the BBB, a range of opportunistic infections, including viral, bacterial, and parasitic agents, augment the neurological complications in people living with HIV (PLHIV). Given the immuno-compromised state of PLHIV, these co-infections can present a wide range of clinical syndromes with atypical manifestations that pose challenges in diagnosis and clinical management, representing a substantial burden for the public health system. Therefore, the present review narrates the neurological complications triggered by HIV and their diagnosis and treatment options. Moreover, coinfections that are known to cause neurological disorders in HIV infected individuals are highlighted.
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Affiliation(s)
- Sivaraman Balaji
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
| | - Rohan Chakraborty
- Department of Medical Elementology and Toxicology, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
| | - Sumit Aggarwal
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research-Headquarters, Ansari Nagar, New Delhi, 110029, India
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Sawalma M, Shalash A, Wahdan Y, Nemer M, Khalawi H, Hijazi B, Abu-Rmeileh N. Sexual and reproductive health interventions geared toward adolescent males: A scoping review. J Pediatr Nurs 2023; 73:e19-e26. [PMID: 37474422 DOI: 10.1016/j.pedn.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
PROBLEM Male adolescent sexual and reproductive health (SRH) interventions are rare worldwide. The high prevalence of sexually transmitted infections and pregnancies among female and male adolescents worldwide highlights the need for comprehensive interventions that include both genders in the educational process. OBJECTIVE Our main focus is studying and analysing male-focused SRH interventions globally to include males in evidence-based interventions that improve SRH of adolescent males. ELIGIBILITY CRITERIA This Review was conducted using the PRISMA extension for scoping reviews. The following databases were searched: PubMed, Embase, Web of science, Scopus, CINAHL and PsycInfo. INCLUSION CRITERIA 1) No time or date limits; 2)all types of studies; 3)SRH campaign; 4)males; 5)10 to 19 years. SAMPLE Five thousand and sixty-eight articles were identified and 166 peer-reviewed articles met the inclusion criteria. RESULTS Family planning was identified as the primary domain covered for adolescents. While interactive activities was the most common method used to deliver information to adolescents about sexual health. SRH interventions for males were most prevalent in America. While in the Eastern Mediterranean region (EMR), no male interventions were found in our review. CONCLUSION This scoping review emphasizes the need to include adolescent males in sexual and reproductive health interventions, particularly in low- and middle-income countries (LMICs) and the EMR. Policymakers should develop comprehensive programs that address male-specific needs, improve training for intervention providers, and enhance reporting processes to identify gaps and barriers to male inclusion. IMPLICATION Future research should be directed toward the obstacles that prevent SRH interventions targeting males from being carried out.
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Affiliation(s)
- Mariam Sawalma
- Institute of Community and Public Health, Birzeit University, Palestine.
| | - Aisha Shalash
- Institute of Community and Public Health, Birzeit University, Palestine; School of Medicine, University of Limerick, Limerick, Ireland.
| | - Yasmeen Wahdan
- Institute of Community and Public Health, Birzeit University, Palestine
| | - Maysaa Nemer
- Institute of Community and Public Health, Birzeit University, Palestine.
| | - Hala Khalawi
- The Department of Social Sciences, Bethlehem University, Palestine
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Palestine.
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Bekele Z, Mussa I, Assefa Y, Abera N, Amerga EW, Girma A, Ayele AT, Mengesha MM. Risky sexual practice and associated factors among adult people living with HIV/AIDS in public hospitals of Kembata Tambaro Zone, Southern Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e072505. [PMID: 37463817 PMCID: PMC10357730 DOI: 10.1136/bmjopen-2023-072505] [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] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE This study assessed the magnitude of risky sexual practices and associated factors among adult people living with HIV (PLHIV) attending antiretroviral clinics in public hospitals in Kembata Tembaro Zone, southern Ethiopia. DESIGN A cross-sectional study was conducted. SETTING A hospital-based study was conducted among adult PLHIV in the Kambata Tambaro Zone, southern Ethiopia. PARTICIPANTS 300 men and women aged 15 years and older who had been receiving HIV/AIDS care and support in four public hospitals participated in this study. STUDY OUTCOME Risky sexual practice was the study outcome. It was defined based on responses to four items: multiple sexual partnerships, casual sex, consistent condom use and sex under the influence of alcohol. Risky sexual practice was defined based on a 'yes' response to any of the four items. RESULTS Of the adult PLHIV who were sexually active in the 6 months preceding the survey, 75.7% (95% CI: 70.5% to 80.2%) engaged in at least one risky sexual practice, with 3.3% (95% CI: 1.8% to 6.1%) engaged in three or more. A positive attitude towards condom use and being on antiretroviral therapy for over 10 years were correlated with low odds of risky sexual practices. There was a higher likelihood of risky sexual behaviour among those who kept their HIV status secret and did not bring up using a condom before sexual contact. Whereas, those with a positive attitude towards condom use had a reduced risk of engaging in risky sexual practices. CONCLUSION A considerable proportion of adult PLHIV engage in risky sexual practices. Efforts directed at removing barriers to disclosing HIV status to partners and promoting condom use discussion among sexual partners could reduce the burden of risky sexual practices and the onward transmission of HIV.
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Affiliation(s)
- Zelalem Bekele
- Clinical Governance and Quality Improvement Unit, Doctor Bogalech Gebre Memorial General Hospital, Durame, Ethiopia
| | - Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yonas Assefa
- Center of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Negash Abera
- Center of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ermias Woldie Amerga
- Center of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Addisu Girma
- Clinical Governance and Quality Improvement Unit, Doctor Bogalech Gebre Memorial General Hospital, Durame, Ethiopia
| | - Awugchew Teshome Ayele
- Environmental Health Sciences, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Melkamu Merid Mengesha
- Epidemiology and Biostatistics Unit, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
- Child and Family Health Research Group, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Luginaah NA, Konkor I, Lawson ES, Mkandawire P, Husbands W, Omorodion F, Etowa J, Antabe R, Wong J. Concurrent sexual partnerships and HIV testing among heterosexual Black men in Ontario, Canada: findings from the weSpeak study. ETHNICITY & HEALTH 2022; 27:1825-1840. [PMID: 34494926 DOI: 10.1080/13557858.2021.1976395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND African, Caribbean, and Black men constitute the second-highest category of males living with HIV in Ontario, which increased from 15.4% to 17% between 2011 and 2016. Previous studies have attributed this disproportionately higher rate to multiple concurrent sexual partnerships and low rates of HIV testing. Drawing on theoretical constructs of the health belief model (HBM), this study examined the relationship between multiple concurrent sexual partnerships and the uptake of HIV testing services among heterosexual Black men in Ontario. METHODS Using a cross-sectional sample data of 829 individuals from four cities in Ontario, we employed the multinomial logit analysis to examine the relationship between multiple sexual partnerships and the uptake of HIV testing services among heterosexual Black men. RESULTS The findings show that heterosexual Black men with multiple concurrent sexual partners were more than twice (RRR = 2.306, P < 0.01) as likely to test for HIV within the past 12 months when compared to those with one partner. Furthermore, being an immigrant, having good knowledge of HIV transmission, and earning lower annual income predicted higher odds of testing while sexual debut between the ages of 16 and 20 years, no visit to a healthcare provider in the past year and difficulty accessing healthcare significantly predicted lower likelihood of testing for HIV. CONCLUSIONS These findings align with the theoretical constructs of the health belief model but more importantly, they suggest heterosexual Black men with concurrent sexual partners may be aware of their HIV risk and are taking measures to know their serostatus. Hence, making HIV screening services accessible and at safer spaces could increase their use of HIV screening services.
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Affiliation(s)
| | - Irenius Konkor
- Department of Geography, Geomatics and Environment, University of Toronto Mississauga, Mississauga, Canada
| | - Erica S Lawson
- Department of Women's Studies, Western University, London, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Carleton University, Ottawa, Canada
| | | | - Francisca Omorodion
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Canada
| | | | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Ontario, Canada
| | - Josephine Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
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Dzinamarira T, Kuupiel D, Vezi P, Mashamba-Thompson TP. A scoping review on health education programs for improving Men's engagement with health services in low- and middle- income countries. PUBLIC HEALTH IN PRACTICE 2021; 2:100177. [PMID: 36101570 PMCID: PMC9461485 DOI: 10.1016/j.puhip.2021.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives This study aimed to map evidence on health education programs (HEPs) for men engagement in health services in LMICs to guide future research. Study design A scoping review was conducted. Methods We searched Google Scholar, PubMed, EBSCOhost (CINAHL, MEDLINE, Health Source, Nursing, Academic Edition and Academic Search Complete) and WEB of Science electronic databases for publications from January 2000 to March 2019. We also searched Researchgate, the WHO library, and universities repositories for grey literature such as dissertations, theses, and reports. The search terms included “health,” “education,” “program,” “men”, with Boolean terms, AND and OR, being used to separate the keywords. Articles reporting evidence on HEPs for men aged 15 and older in LMICs and HEPs improving men's engagement in health services in LMICs published in any language between January 2000 to March 2019 were included in this review. We appraised included studies using the 2018 version of the Mixed Methods Appraisal Tool. We used thematic content analysis to extract emerging themes and presented a narrative account of the findings. Results Database search retrieved 8905 eligible articles. Of these, only six studies met the inclusion criteria and were included for data extraction. All included studies reported evidence of health education for men engagement in health services. The total number of men reported in the studies was 4372 with an age range of 15–54. Included studies were conducted in Uganda, Kenya, Ghana, and Zimbabwe. Included studies presented evidence on HEPs for men engagement in health services. Two main themes emerged from thematic content analysis of included studies: mode of health delivery (the process of enabling men and boys to become involved in health services as patients/clients) and health benefits to men (to achieve better health outcomes). Conclusion Our review revealed limited evidence of HEPs for men engagement in health service. Regardless of mode of health education delivery, notable health benefits to men were reported. We recommend implementation research on HEPs for men engagement in health services to better understand the social, cultural and economic influences in LMICs.
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Ren Z, Zhou Y, Liu Y. Factors associated with unsafe sexual behavior among sexually active Chinese University students, Hebei Province, 2019. BMC Public Health 2021; 21:1904. [PMID: 34670556 PMCID: PMC8529721 DOI: 10.1186/s12889-021-11992-2] [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: 04/17/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background Healthy sexual behavior is critical for controlling the HIV/AIDS epidemic among university students, particularly in regions with increasing infection rates among university students in China. Methods This study investigated the prevalence of unhealthy sexual behavior in the past 6 months and the associated demographic and psychosocial factors among sexually active Chinese university students. Self-identified sexually active Chinese university students were recruited for the study. Results The study found that most students used condoms inconsistently during sexual intercourse (54.8%), and logistic regression showed that condomless sex was associated with being raised by a single parent (AOR = 1.934, 95% CI 1.234–3.031) or by grandparents or others (AOR = 1.583, 95% CI 1.003–2.50) and with sometimes using dating apps (AOR = 1.496, 95% CI 1.106–2.024). The independent protective factors for condomless sex were HIV knowledge scores between 15 and 18 compared to scores of 0 to 4 (AOR = 0.434, 95% CI 0.244–0.771). Among sexually active university students, 15.5% reported that they had multiple sexual partners; having multiple sexual partners was associated with sometimes (AOR = 2.543, 95% CI 1.553–4.167) or always (AOR =4.048, 95% CI 2.177–7.527) using dating apps. Being female (AOR = 0.402, 95% CI 0.231–0.699) and in a relationship (AOR = 0.236, 95% CI 0.154–0.363) were protective factors against having multiple sexual partners. Conclusions There is an urgent need to promote HIV prevention and to implement psychosocial interventions by providing comprehensive sex education and access to condoms and health care on campuses to decrease the potential factors related to unhealthy sexual behaviors among university students.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical Psychology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuchu Zhou
- Daka Education Consulting Co. Ltd, Chengdu, Sichuan, China
| | - Yanhong Liu
- Department of Psychology, Hebei University of Chinese Medicine, Wuhan, Hebei, China
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Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094961. [PMID: 34066948 PMCID: PMC8125585 DOI: 10.3390/ijerph18094961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
Though the transmission of HIV is preventable, there were still 37,968 new documented cases in the United States in 2018. HIV incidence is disproportionate in sexual minority men of color. The purpose of this study was to examine sexual relationship power risk profiles to identify distinct subgroups within the profiles who carry the highest HIV risk. Latent class profile analysis was used to identify subgroups of sexual minority men of color at the highest risk for contracting HIV based on their sexual power profiles. Among 322 sexual minority men, we identified four latent profiles. Profile 1: Low transactional sex and high power (n = 133; 14.3%); Profile 2: Transactional sex, high decision-making in sexual relationships, and low control in sexual relationship (n = 99; 30.7%); Profile 3: Low transactional sex, low decision-making, and moderate control (n = 43; 13.4%); Profile 4: High transactional sex and low power (n = 47; 14.6%). LPA was useful to identify distinct subgroups based on measures of sexual risk and relationship sexual power. Findings carry significant implications for developing tailored strategies to increase HIV knowledge and related HIV prevention and risk reduction services for sexual minority men of color who engage in transactional sex.
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Krishnamoorthy Y, Majella MG, Rajaa S, Bharathi A, Saya GK. Spatial pattern and determinants of HIV infection among adults aged 15 to 54 years in India - Evidence from National Family Health Survey-4 (2015-16). Trop Med Int Health 2021; 26:546-556. [PMID: 33449438 DOI: 10.1111/tmi.13551] [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: 11/29/2022]
Abstract
OBJECTIVE To assess the spatial pattern and determinants of HIV infection in India. METHODS We conducted a secondary data analysis using the National Family Health Survey-4 data obtained from the Demographic Health Survey programme. We accounted for clustering and stratification in the sampling design using the svyset command. Spatial analysis was performed by generating the Moran's I statistic and local indicators for spatial association (LISA) maps. Logistic regression was performed to identify the determinants of HIV infection. RESULTS 230 213 individuals were included. Prevalence of HIV infection in India was 0.24% (95% CI: 0.21%-0.28%). Being separated/widowed/divorced (aOR = 2.58, 95% CI: 1.22-5.40), living in an urban area (aOR = 2.46, 95% CI: 1.79-3.37), being resident in the North-Eastern (aOR = 4.25, 95% CI: 2.60-6.93), Southern (aOR = 3.13, 95% CI: 1.99-4.91) or Western region (aOR = 2.17, 95% CI: 1.08-4.33), having a history of multiple sexual partners (aOR = 1.99, 95% CI:1.42-2.79), a suspected STI (aOR = 2.32, 95% CI: 1.38-3.90) or self-reported TB (aOR = 7.80, 95% CI: 2.52-24.05) were significantly in association with HIV infection. Moran's I was 0.377, suggesting positive spatial autocorrelation. The LISA cluster map indicated 60 hotspot districts in India, mostly in southern states such as Karnataka, Andhra Pradesh and Telangana followed by north-eastern states such as Nagaland, Manipur, Mizoram, Tripura and Assam. CONCLUSION HIV infection among adults aged 15-54 years in India is spatially clustered with the majority occurring in southern and north-eastern states. Hence, region- or district-specific strategies with focused interventions should be adopted.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Marie Gilbert Majella
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sathish Rajaa
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Arivarasan Bharathi
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ganesh Kumar Saya
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Shamu S, Shamu P, Khupakonke S, Farirai T, Chidarikire T, Guloba G, Nkhwashu N. Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two South African districts. Glob Health Action 2021; 14:1886455. [PMID: 33606603 PMCID: PMC7899653 DOI: 10.1080/16549716.2021.1886455] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective in reducing HIV incidence. However, more evidence of PrEP knowledge, willingness and distribution preferences is required for scale-up among young people at-risk. Objective: To understand young people PrEP awareness, willingness and roll-out preferences. Methods: Young people (18-24y) were selected through multi-stage sampling in a cross-sectional household survey in low-income communities. Self-administered interviews collected participants' data about PrEP awareness, attitudes, willingness and HIV-risk practices. Data were descriptively analysed by gender. Regression models assessed factors associated with PrEP awareness and willingness by district. Results: Of the 1917 participants interviewed 44.6% (men = 39.4% vs women = 49%, p = 0.001) were PrEP aware, 49.0% were willing to use PrEP. Participants most preferred PrEP distribution channels were public clinics (51.2%) and hospitals (23.8%). More men than women preferred distribution through schools (11.9% vs7.8%; p = 0.002) and NGOs (8.5%vs5.4%; p = 0.008). The biggest barrier to PrEP willingness was inadequate PrEP knowledge (10.0%) but more men than women disliked taking pills daily (4.1%vs2.0%; p-value = 0.007). Gendered determinants to use PrEP were side effects (51%; men = 47% vs women = 55%; p = 0.001) and pill effectiveness (29.5%; men = 26.4% vs women = 32.6%; p = 0.003). In both districts PrEP knowledge was associated with being female and media use. The associations between PrEP awareness and having multiple sexual partnerships, HIV knowledge, HIV self-test willingness and belonging to social clubs differed by district. PrEP willingness was positively associated with having TB and PrEP knowledge in each district but district differences were observed in media and occupation factors. Conclusions: The study shows young people's low levels of PrEP awareness. It also shows relatively increased willingness, gendered PrEP awareness and distribution preferences. Promoting youth's PrEP awareness requires a multifarious media strategy. Abbreviations: HIV: human immunodeficiency virus; AIDS: Acquired immunodeficiency syndrome; aOR: Adjusted Odds ratio; PLWH: People living with HIV; PrEP: Pre-exposure Prophylaxis; UNAIDS: Joint United Nations Programme on HIV and AIDS; uOR: Unadjusted odds ratio; TB: Tuberculosis; WHO: World health Organisation; MSM: Men who have sex with men.
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Affiliation(s)
- Simukai Shamu
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Shamu
- Wits Health Research Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Sikhulile Khupakonke
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
| | - Thato Farirai
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
| | - Thato Chidarikire
- HIV, AIDS and STIs Cluster, National Department of Health, Pretoria, South Africa
| | - Geoffrey Guloba
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
| | - Nkhensani Nkhwashu
- Health Systems Strengthening Cluster , Foundation for Professional Development, Pretoria, South Africa
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Abstract
Emerging adulthood is a developmental period with high rates of sexual risk behavior. Effective parenting practices can reduce the likelihood of this behavior, but most research on the protective effects of parenting focuses on mothers. Research is needed to assess the role of paternal parenting in regards to their children's sexual risk behavior, particularly for children of teen mothers, who show a greater likelihood of risky sexual behaviors than those with older mothers. We investigated associations between residential fathers' parenting processes-communication, disapproval of teen sexual behavior, parental presence, and closeness-during adolescence and sexual risk behaviors reported by their children in emerging adulthood. Using multiple group structural equation modeling with data from 7399 participants at Wave I and Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined whether and how residential fathers' parenting relates to their children's sexual risk behavior independent of mothers' parenting processes, and whether these associations differ across children's sex and for children of teen and older mothers. We found that adolescents' perceptions of higher father disapproval of teen sexual behavior predicted lower levels of sexual risk behavior during emerging adulthood with no significant differences across emerging adults' sex or for children of teen relative to older mothers. Our findings suggest that teens' relationships with their fathers during adolescence are important for their future sexual health, despite a general understanding of emerging adulthood as a period characterized by independence and separation from parents. Additionally, our results suggest that even though children of teen mothers show greater likelihood of risky sexual behaviors than those of older parents, the processes through which fathers can support teens' sexual health may be similar.
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Ngoc Do H, Ngoc Nguyen D, Quynh Thi Nguyen H, Tuan Nguyen A, Duy Nguyen H, Phuong Bui T, Bich Thi Vu T, Thanh Le K, Tuan Nguyen D, Tat Nguyen C, Gia Vu L, Thu Vu G, Xuan Tran B, A. Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1903. [PMID: 32183402 PMCID: PMC7143552 DOI: 10.3390/ijerph17061903] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022]
Abstract
Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.
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Affiliation(s)
- Ha Ngoc Do
- Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam;
| | - Diep Ngoc Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
| | - Hoa Quynh Thi Nguyen
- Department of Research on Youth Culture and Lifestyle, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.Q.T.N.); (A.T.N.)
| | - Anh Tuan Nguyen
- Department of Research on Youth Culture and Lifestyle, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.Q.T.N.); (A.T.N.)
| | - Hiep Duy Nguyen
- Department of Research on Children’s issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.D.N.); (T.P.B.)
| | - Thanh Phuong Bui
- Department of Research on Children’s issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.D.N.); (T.P.B.)
| | - Thao Bich Thi Vu
- Department of Research on Youth’s Organisations and Youth Campaign, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (T.B.T.V.); (K.T.L.)
| | - Khiet Thanh Le
- Department of Research on Youth’s Organisations and Youth Campaign, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (T.B.T.V.); (K.T.L.)
| | - Dung Tuan Nguyen
- Department of Research on Youth and Legal issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam;
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Linh Gia Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.G.V.); (G.T.V.)
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.G.V.); (G.T.V.)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
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Stannah J, Silhol R, Elmes J, Owen B, Shacklett BL, Anton P, McGowan I, van der Straten A, Dimitrov D, Baggaley RF, Boily MC. Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis. AIDS Behav 2020; 24:667-681. [PMID: 31486008 PMCID: PMC7018785 DOI: 10.1007/s10461-019-02651-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Receptive anal intercourse (RAI) carries a greater per-act risk of HIV acquisition than receptive vaginal intercourse (RVI) and may influence HIV epidemics driven by heterosexual sex. This systematic review explores the association between RAI and incident HIV among women, globally. We searched Embase and Medline through September 2018 for longitudinal studies reporting crude (cRR) or adjusted (aRR) relative risks of HIV acquisition by RAI practice among women. Of 27,563 articles identified, 17 eligible studies were included. We pooled independent study estimates using random-effects models. Women reporting RAI were more likely to acquire HIV than women not reporting RAI (pooled cRR = 1.56 95% CI 1.03–2.38, N = 18, I2 = 72%; pooled aRR = 2.23, 1.01–4.92, N = 5, I2 = 70%). In subgroup analyses the association was lower for women in Africa (pooled cRR = 1.16, N = 13, I2 = 21%) than outside Africa (pooled cRR = 4.10, N = 5, I2 = 79%) and for high-risk (pooled aRR = 1.69, N = 4, I2 = 63%) than general-risk women (pooled aRR = 8.50, N = 1). Interview method slightly influenced cRR estimates (p value = 0.04). In leave-one-out sensitivity analyses pooled estimates were generally robust to removing individual study estimates. Main limitations included poor exposure definition, incomplete adjustment for confounders, particularly condom use, and use of non-confidential interview methods. More and better data are needed to explain differences in risk by world region and risk population. Women require better counselling and greater choice in prevention modalities that are effective during RVI and RAI.
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Abdallah I, Conserve D, Burgess TL, Adegbite AH, Oraka E. Correlates of HIV-related risk behaviors among self-identified heterosexual men who have sex with men (HMSM): national survey of family growth (2002, 2006-2010, and 2011-2017). AIDS Care 2020; 32:1529-1537. [PMID: 32024380 DOI: 10.1080/09540121.2020.1724254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-identified heterosexual men who have sex with men (HMSM) have unique sexual behaviors that may increase their risk of HIV infection. We assessed the correlates of recent sex with other men and HIV-related risk behaviors among HMSM by sex of their sex partners. We analyzed data from the 2002 and 2006-2017 National Survey of Family Growth limited to men who self-identified as heterosexual and reported any anal/oral sex with another man (N = 787). Prevalence ratios based on logistic regression models determined the association between sociodemographic and behavior variables with reporting a same-sex partner or at least one HIV-related risk behavior with a female sex partner in the last 12 months. Approximately 17.7% and 42.5% of HMSM with recent same-sex partners reported HIV-related risk behaviors with male and female sex partners, respectively. HMSM who reported a recent same-sex partner and an HIV-related risk behavior reported more annual male (Ave = 2.6:95%CI;1.6-3.7) and female (Ave = 5.0:95%CI;3.3-6.8) sex partners than HMSM with a recent same-sex partner who did not report an HIV-related risk behavior [male (Ave = 1.7:95%CI;1.2-2.1) and female (Ave = 1.6:95%CI;1.1-2.1)]. HMSM with recent same-sex partners may engage in HIV-related risk behaviors with men and women concurrently. Further studies should assess gender-specific risk of infection.
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Mthembu Z, Maharaj P, Rademeyer S. "I am aware of the risks, I am not changing my behaviour": risky sexual behaviour of university students in a high-HIV context. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2019; 18:244-253. [PMID: 31575340 DOI: 10.2989/16085906.2019.1655075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unprotected sexual activity increases the risk of pregnancy and HIV and AIDS. More than three decades into the AIDS pandemic, the condom remains the most effective strategy for protecting against the dual risks of pregnancy and HIV and AIDS, but data from national surveys suggest that condom use among young people aged 15-24 is on the decline in South Africa. This study uses qualitative data from 20 in-depth interviews and one focus group to examine the risk behaviours of university students aged 18-24 years old, with particular emphasis on understanding the decline in the use of condoms. It is well documented that South Africa has one of the highest prevalence rates of HIV and AIDS in the world, however the findings of this study suggest that even though students were well informed about the perceived risks associated with unsafe sexual behaviours, they continue to engage in risk behaviours including unprotected sexual intercourse, multiple sexual partners and the use of alcohol. Male students were more likely than female students to report risky sexual behaviours. Condom use is occurring but not consistently. The majority of students did not use condoms during their first sexual encounter because of a lack of preparedness. Negative attitudes towards condoms continue to discourage students from using them consistently, especially those provided by the government. In light of this, it is recommended that rigorous efforts are directed towards challenging inaccurate perceptions about, and attitudes towards, condom use to promote consistency.
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Affiliation(s)
- Zinhle Mthembu
- School of Built Environment and Development Studies, University of KwaZulu-Natal , Durban , South Africa
| | - Pranitha Maharaj
- DST/NRF South African Research Chair in Economic Development, School of Built Environment and Development Studies, University of KwaZulu-Natal , Durban , South Africa
| | - Shanaaz Rademeyer
- School of Built Environment and Development Studies, University of KwaZulu-Natal , Durban , South Africa
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Chime OH, Ndibuagu EO, Orji CJ. Rates and predictors of adherence and retention for antiretroviral therapy among HIV-positive adults in Enugu, Nigeria. Malawi Med J 2019; 31:202-211. [PMID: 31839890 PMCID: PMC6895390 DOI: 10.4314/mmj.v31i3.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/04/2018] [Accepted: 12/09/2018] [Indexed: 11/20/2022] Open
Abstract
Background HIV infection and AIDS are majorpublic health challenges in Nigeria, a country with one of the highest rates of new infection in sub-Saharan Africa and the second largest HIV epidemic in the world.Non-adherence to medication and defaulting from treatment are the two major challenges faced by anti-retroviral therapy (ART) programs in resource-constrained settings. This study was undertaken to determine the rate and predictors of adherence to medication and retention among people living with HIVin Enugu State, Nigeria. Methods This was a cross-sectionalretrospective study conducted among adults living with HIV(PLHIV) receiving ARTs in eightcomprehensive health facilities in Enugu, Nigeria. We used self-reported adherence and recorded clinic visits to assess adherence and retention, respectively. Descriptive statistics (frequencies, proportions, mean and standard deviation) and regression analysis were then conducted to identify the association between adherence, retention and demographic and health-related factors. Results The mean age of respondents was 38.5±9.8 years. Predictors of good adherence to medication includedbeing male(adjusted odds ratio [AOR]:2.08; 95% confidence interval [CI]:1.12-3.85), having been on anti-retroviral medications for more than 5 years (AOR:1.92; 95% CI: 1.17-3.16), the non-consumption of alcohol(AOR: 3.67; 95% CI: 2.01-6.70), not usingtraditional medicine (AOR: 2.76; 95% CI:1.33-5.73) and having a baseline CD4count exceeding 500 cells/µl (AOR: 5.67; 95% CI: 1.32-24.32).Adequate retention was predicted by being resident in the urban area (AOR: 1.90; 95% CI: 1.17-3.06). Being away from home (41.8%) and forgetfulness (35.0%) were reported as the major reasons for missing medication. Conclusion The rates of adherence and retention found in this study were similar to those reported forother resource-limited settings. Health education and behavioural modification interventions should be intensified to reduce the consumption of alcohol and the use of traditional medicine by people living with HIV. Identifying other factors may help to design effective strategies to ensure that people living with HIV adhere to their medications and remain in care.
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Affiliation(s)
- Onyinye Hope Chime
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria
| | - Edmund Onyemaechi Ndibuagu
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria
| | - Chinonyelu Jennie Orji
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
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Abstract
Leveraging 2.5 years of weekly data from the Relationship Dynamics and Social Life Study, we investigate the relationship between young women's sexual concurrency and their contraceptive behavior. Specifically, we (1) examine whether young women changed their contraceptive use when switching from one to multiple concurrent sexual partners in the same week; (2) explore the uniformity of contraceptive responses to concurrency across relationship context; and (3) compare the contraceptive behaviors of never-concurrent women with those of ever-concurrent women in weeks when they were not concurrent. Nearly one in five sexually active young women had sex with two or more people in the same week. When they were concurrent, these women's odds of using any contraception increased threefold, and their odds of using condoms increased fourfold. This pattern of contraceptive adjustments was the same across relationship characteristics, such as duration and exclusivity. Yet when they were not concurrent, ever-concurrent women were less likely to use any contraception and used condoms less consistently than women who were never concurrent. We discuss these findings in the context of ongoing debates about the role of sexual concurrency in STI transmission dynamics.
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Affiliation(s)
- Abigail Weitzman
- Population Research Center, University of Texas at Austin, 305 E. 23rd Street, RLP 2.602, Mail Stop G1800, Austin, TX, 78712-1699, USA.
- Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, A1700, RLP 3.306, Austin, TX, 78712-1086, USA.
| | - Jennifer Barber
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Yasamin Kusunoki
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
- Department of Nursing, University of Michigan, Ann Arbor, MI, USA
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Sexual Risk Behaviors of Patients with HIV/AIDS over the Course of Antiretroviral Treatment in Northern Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061106. [PMID: 29844289 PMCID: PMC6025123 DOI: 10.3390/ijerph15061106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 01/18/2023]
Abstract
Antiretroviral therapy (ART) improves the health and well-being of people living with the human immunodeficiency virus (HIV, PLWH), and reduces their risk of transmitting the virus to sexual partners. However, patterns of sexual risk behavior among HIV-positive patients taking ART in Vietnam remain largely unknown. In this study, we sought to examine sexual risk behaviors and their associated factors among HIV-positive patients receiving ART in northern Vietnam. The socio-demographic characteristics, ART use, health status, and sexual behaviors of 1133 patients taking ART in the Hanoi and Nam Dinh provinces were explored through face-to-face interviews. There were 63.5% of patients who had one sex partner, while 3.6% and 5.6% of patients had sexual intercourse with casual partners or sex workers, respectively, in the previous 12 months. Most participants tended to use condoms more often with commercial sex partners (90.2%) and intimate partners (79.7%), and less often with casual partners (60.9%). Higher age (odds ratio, OR = 1.0; 95% CIs = 1.0, 1.1) or suffering pain/discomfort (OR = 1.7; 95% CIs = 1.2, 2.4) were factors more likely to be associated with multiple sex partners. Patients who were self-employed were more likely to have sexual intercourse with casual partners/sex workers (OR = 2.1; 95% CIs = 1.1, 4.0). Meanwhile, a higher score on the EuroQol visual analog scale (EQ-VAS), an unknown HIV stage, and a longer duration of ART were adversely associated with not using condoms with casual partners/sex workers. Patients with longer durations of ART had a lower likelihood of not using a condom with casual partners/sex workers (OR = 0.5; 95% CIs = 0.3, 0.8). Our study underscored a relatively high rate of unsafe sexual behaviors among HIV-positive patients. Continuing to improve the physical and psychological well-being of HIV-positive patients in Vietnam is important in reducing the spread of HIV via risky sexual behaviors. In addition, safe-sex education should be provided to older people, and to those who are self-employed.
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Mayaphi SH, Martin DJ, Olorunju SAS, Williams BG, Quinn TC, Stoltz AC. High risk exposure to HIV among sexually active individuals who tested negative on rapid HIV Tests in the Tshwane District of South Africa-The importance of behavioural prevention measures. PLoS One 2018; 13:e0192357. [PMID: 29394288 PMCID: PMC5796711 DOI: 10.1371/journal.pone.0192357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/20/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess the prevalence of HIV risk behaviour among sexually active HIV sero-negative individuals in the Tshwane district of South Africa (SA). METHODS Demographic and HIV risk behaviour data were collected on a questionnaire from participants of a cross-sectional study that screened for early HIV infection using pooled nucleic acid amplification testing (NAAT). The study enrolled individuals who tested negative on rapid HIV tests performed at five HIV counseling and testing (HCT) clinics, which included four antenatal clinics and one general HCT clinic. RESULTS The study enrolled 9547 predominantly black participants (96.6%) with a median age of 27 years (interquartile range [IQR]: 23-31). There were 1661 non-pregnant and 7886 pregnant participants largely enrolled from the general and antenatal HCT clinics, respectively. NAAT detected HIV infection in 61 participants (0.6%; 95% confidence interval [CI]: 0.4-0.8) in the whole study. A high proportion of study participants, 62.8% and 63.0%, were unaware of their partner's HIV status; and also had high prevalence, 88.5% and 99.5%, of recent unprotected sex in the general and pregnant population, respectively. Consistent use of condoms was associated with protection against HIV infection in the general population. Trends of higher odds for HIV infection were observed with most demographic and HIV risk factors at univariate analysis, however, multivariate analysis did not show statistical significance for almost all these factors. A significantly lower risk of HIV infection was observed in circumcised men (p <0.001). CONCLUSIONS These data show that a large segment of sexually active people in the Tshwane district of SA have high risk exposure to HIV. The detection of newly diagnosed HIV infections in all study clinics reflects a wide distribution of individuals who are capable of sustaining HIV transmission in the setting where HIV risk behaviour is highly prevalent. A questionnaire that captures HIV risk behaviour would be useful during HIV counselling and testing to ensure that there is a systematic way of identifying HIV risk factors and that counselling is optimised for each individual. HIV risk behaviour surveillance could be used to inform relevant HIV prevention interventions that could be implemented at a community or population level.
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Affiliation(s)
- Simnikiwe H. Mayaphi
- Department of Medical Virology, University of Pretoria, City of Tshwane, South Africa
- National Health Laboratory Service-Tshwane Academic Division (NHLS-TAD), City of Tshwane, South Africa
| | - Desmond J. Martin
- Department of Medical Virology, University of Pretoria, City of Tshwane, South Africa
- Toga Laboratories, Johannesburg, South Africa
| | | | - Brian G. Williams
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
| | - Thomas C. Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Anton C. Stoltz
- Division of Infectious Diseases, Department of Internal Medicine, University of Pretoria, City of Tshwane, South Africa
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Kyilleh JM, Tabong PTN, Konlaan BB. Adolescents' reproductive health knowledge, choices and factors affecting reproductive health choices: a qualitative study in the West Gonja District in Northern region, Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:6. [PMID: 29361947 PMCID: PMC5782392 DOI: 10.1186/s12914-018-0147-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Ghana, adolescents constitute about a quarter of the total population. These adolescents make reproductive health decisions and choices based on their knowledge and the availability of such choices. These reproductive health decisions and choices can either negatively or positively affect their lives. This study therefore explored adolescents' reproductive health knowledge and choices, the type of choices they make and the factors that affect these choices. METHODS This qualitative study adopted a narrative approach to qualitative enquiry. Eight focus group discussions (N = 80) were conducted among both in-school and out-of-school adolescents aged 10-19 years. The discussions were stratified by sex and studentship. In addition, nine in-depth interviews were conducted with various stakeholders in reproductive health services and community opinion leaders. Both the focus group discussions and in-depth interviews were recorded, transcribed and analysed using NVivo 11. Thematic analysis was employed in analysing data. RESULTS The study found that knowledge on reproductive health choices was low among respondents with majority of them relying on their peers for information on sexual and reproductive health. Having a sexual partner(s) and engaging in premarital sex was common and viewed as normal. Adolescents engaged in unprotected sexual practices as a way of testing their fertility, assurance of love, bait for marriage and for livelihood. Inserting herbs into the vagina, drinking concoctions and boiled pawpaw leaves were identified as local methods employed by adolescents to induce abortion. Reproductive health services were available in the community but received low utilization because of perceived negative attitude of health workers, confidentiality and social norms. CONCLUSIONS Adolescents in this study generally engaged in risky reproductive health choices that can negatively affect their reproductive health. Adolescents in this part of Ghana have challenges utilizing available reproductive health services because of socio-cultural and health system barriers.
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Affiliation(s)
| | | | - Benson Boinkum Konlaan
- Department of Community Health and Family Medicine, University for Development Studies, Tamale, Ghana
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HIV-Risk Behaviors and Social Support Among Men and Women Attending Alcohol-Serving Venues in South Africa: Implications for HIV Prevention. AIDS Behav 2017; 21:144-154. [PMID: 28710711 DOI: 10.1007/s10461-017-1853-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Alcohol use is associated with increased HIV-risk behaviors, including unprotected sex and number of sex partners. Alcohol-serving venues can be places to engage in HIV-related sexual risk behaviors, but are also important sites of social support for patrons, which may mitigate risks. We sought to examine the relationship between alcohol-serving venue attendance, social support, and HIV-related sexual risk behavior, by gender, in South Africa. Adult patrons (n = 496) were recruited from six alcohol-serving venues and completed surveys assessing frequency of venue attendance, venue-based social support, and recent sexual behaviors. Generalized estimating equations tested associations between daily venue attendance, social support, and sexual behaviors, separately by gender. Interaction effects between daily attendance and social support were assessed. Models were adjusted for venue, age, education, and ethnicity. Daily attendance at venues was similar across genders and was associated with HIV-related risk behaviors, but the strength and direction of associations differed by gender. Among women, daily attendance was associated with greater number of partners and higher proportion of unprotected sex. Social support was a significant moderator, with more support decreasing the strength of the relationship between attendance and risk. Among men, daily attendance was associated with a lower proportion of unprotected sex; no interaction effects were found for attendance and social support. Frequent venue attendance is associated with additional HIV-related risks for women, but this risk is mitigated by social support in venues. These results were not seen for men. Successful HIV interventions in alcohol-serving venues should address the gendered context of social support and sexual risk behavior.
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Muchiri E, Odimegwu C, Banda P, Ntoimo L, Adedini S. Ecological correlates of multiple sexual partnerships among adolescents and young adults in urban Cape Town: a cumulative risk factor approach. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017. [PMID: 28639475 DOI: 10.2989/16085906.2017.1318762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Studies in South Africa have reported unsafe levels of risky sexual behvaiours among adolescents and young adults, with the country reporting the highest burden of HIV/AIDS globally, as well as a high rate of teenage pregnancy. While determinants of risky sexual behaviours have been investigated for factors occurring at the individual and household levels, not fully explored in the literature is the effect of community level factors. Furthermore, it is unclear whether risk factors occurring within the ecology of adolescents and young adults act cumulatively to influence their sexual practices. This article aims to address this knowledge gap using a case study of the Cape Area Panel Study of adolescents and young adults in urban Cape Town, South Africa. The ecological framework was adopted to guide the selection of risk factors at the individual, household, and community levels. Multivariate linear discriminant function analyses were used to select significant risk factors for multiple sexual partnerships and used to produce risk indices for the respondents. The cumulative risk approach was applied to test whether significant risk factors acted cumulatively. Findings point to the importance of ecological factors in influencing outcomes of multiple sexual partnerships among respondents and further demonstrate that ecological risk factors may act cumulatively. These findings are important for South Africa that is grappling with teenage pregnancy and disproportionate HIV epidemic among the youth.
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Affiliation(s)
- Evans Muchiri
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Clifford Odimegwu
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Pamela Banda
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lorreta Ntoimo
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Demography and Social Statistics , Federal University Oye-Ekiti , Oye-Ekiti , Ekiti State , Nigeria
| | - Sunday Adedini
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa.,c Demography and Social Statistics Department, Faculty of Social Sciences , Obafemi Awolowo University , Ile-Ife , Nigeria
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McCloskey LA, Boonzaier F, Steinbrenner SY, Hunter T. Determinants of Intimate Partner Violence in Sub-Saharan Africa: A Review of Prevention and Intervention Programs. ACTA ACUST UNITED AC 2016. [DOI: 10.1891/1946-6560.7.3.277] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intimate partner violence (IPV) in sub-Saharan Africa affects 36% of the population. Several African countries rank among the highest globally. In this article, we present evidence on the prevalence, determinants, and impact of IPV across several sub-Saharan African countries interpreted against the backdrop of social ecological theory. We also describe prevention or intervention programs tested in different regions of Africa, selecting only those programs which were published in a journal outlet and which met a high criteria of implementation and methodology (n = 7). Based on our review of the empirical literature, some risk factors for violence documented in Western societies are the same in Africa, including poverty, drinking, a past history of child abuse or posttraumatic stress disorder, and highly traditional gender role beliefs. Low education is also associated with IPV for both women and men. In Africa, partner abuse intersects with the HIV pandemic, making violence prevention especially urgent. African programs to prevent IPV are often incorporated with HIV prevention; community building and community engagement are emphasized more in Africa than in North America or Europe, which invoke more individually focused approaches. Some programs we review lowered HIV exposure in women; others contributed to reduced violence perpetration among men. The programs show sufficient promise to recommend replication and dissemination in sub-Saharan Africa.
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Chilisa B, Mohiemang I, Mpeta KN, Malinga T, Ntshwarang P, Koyabe BW, Heeren GA. Contextualized theory-based predictors of intention to practice monogamy among adolescents in Botswana junior secondary schools: Results of focus group sessions and a cross-sectional study. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2015; 26:533-540. [PMID: 28090169 PMCID: PMC5231395 DOI: 10.1080/10911359.2015.1114820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Culture and tradition influences behaviour. Multiple partner and concurrent relationships are made responsible for the increase of HIV infection in Sub-Saharan Africa. A contextualized "Theory of Planned Behaviour" was used to identify predictors of intention to practice monogamy. A mixed method design using qualitative data from focus groups, stories and a survey were analyzed for quantitative data. The qualitative data added to the behavioural beliefs a socio-cultural belief domain as well as attitudes, subjective norms, and perceived behavioural control predicted the intention to practice monogamy. The adolescents showed a tendency towards having more than one sexual partner. The normative beliefs and the socio cultural beliefs also predicted intentions while hedonistic belief and partner reaction did not. In contextualizing theory-based interventions, it is important to draw from stories and the langauage that circulate in a community about a given behaviour. More studies are needed on ways to combine qualitative approaches with quantitative approaches to inform the development of theory based culturally appropriate and context specific intervention strategies to reduce the risk of HIV.
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Affiliation(s)
- Bagele Chilisa
- Department of Educational Foundations, University of Botswana,
Gaborone, Botswana
| | - Irene Mohiemang
- Department of Educational Foundations, University of Botswana,
Gaborone, Botswana
| | | | - Tumane Malinga
- Department of Social Work, University of Botswana, Gaborone,
Botswana
| | - Poloko Ntshwarang
- Department of Social Work, University of Botswana, Gaborone,
Botswana
| | | | - G. Anita Heeren
- Department of Statistics, University of Fort Hare, Alice, South
Africa
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Mtenga SM, Pfeiffer C, Merten S, Mamdani M, Exavery A, Haafkens J, Tanner M, Geubbels E. Prevalence and social drivers of HIV among married and cohabitating heterosexual adults in south-eastern Tanzania: analysis of adult health community cohort data. Glob Health Action 2015; 8:28941. [PMID: 26432785 PMCID: PMC4592501 DOI: 10.3402/gha.v8.28941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background In sub-Saharan Africa, the prevalence of HIV among married and cohabiting couples is substantial. Information about the underlying social drivers of HIV transmission in couples is critical for the development of structural approaches to HIV prevention, but not readily available. We explored the association between social drivers, practices, and HIV status among stable couples in Ifakara, Tanzania. Design Using a cross-sectional design, we analyzed data from a sample of 3,988 married or cohabiting individuals, aged 15 years and older from the MZIMA adult health community cohort study of 2013. Sociodemographic factors (sex, income, age, and education), gender norms (perceived acceptability for a wife to ask her partner to use a condom when she knows he is HIV positive), marriage characteristics (being in a monogamous or a polygamous marriage, being remarried), sexual behavior practices (lifetime number of sexual partners and concurrent sexual partners), health system factors (ever used voluntary HIV counseling and testing), and lifestyle patterns (alcohol use) were used to explore the odds of being HIV positive, with 95% confidence intervals. Results Prevalence of HIV/AIDS was 6.7% (5.9% males and 7.1% females). Gender norms, that is, perception that a woman is not justified to ask her husband to use a condom even when she knows he has a disease (adjusted odds ratio AOR=1.51, 95% CI 1.06–2.17), marital characteristics, that is, being remarried (AOR=1.49, 95% CI 1.08–2.04), and sexual behavior characteristics, that is, lifetime number of sexual partners (2–4: AOR=1.47, 95% CI 1.02–2.11; 5+: AOR=1.61, 95% CI 1.05–2.47) were the main independent predictors of HIV prevalence. Conclusions Among married or cohabiting individuals, the key social drivers/practices that appeared to make people more vulnerable for HIV are gender norms, marriage characteristics (being remarried), and sexual behavior practices (lifetime number of sexual partners). Married and cohabiting couples are an important target group for HIV prevention efforts in Tanzania. In addition to individual interventions, structural interventions are needed to address the gender norms, remarriage, and sexual practices that shape differential vulnerability to HIV in stable couples.
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Affiliation(s)
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland
| | | | | | - Joke Haafkens
- Centre for Social Science and Global Health, Amsterdam Institute of Advanced Labour Studies, University of Amsterdam, Amsterdam, The Netherlands.,Department of General Practice AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,Department of Epidemiology & Public Health (EPH), University of Basel, Basel, Switzerland
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N WC, A S. Associated Risk Factors of STIs and Multiple Sexual Relationships among Youths in Malawi. PLoS One 2015; 10:e0134286. [PMID: 26248328 PMCID: PMC4527764 DOI: 10.1371/journal.pone.0134286] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Having unprotected sex with multiple sexual partners (MSP) is the greatest risk factor for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) among youths. Young people with MSPs are less likely to use a condom and the greater the risk for STIs. This study examines the associated risk factors of STIs and multiple sexual partnerships among youths aged 15-24 years. DATA AND METHODS The Malawi Demographic Health Survey 2010 data was used. Out of a sample of 2,987 males and 9,559 females aged 15-24 years, 2,026 males and 6,470 females were considered in the study. Chi square test and logistic regression techniques were performed. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 22. FINDINGS The results indicate that 1,399 (69.0%) males and 2,290 (35.4%) females reported multiple sexual partnerships (MSP). Within the rural area, females (n = 1779) were more likely to report MSP than males (n = 1082) and within the urban areas, a higher proportion of females (n = 511) still reported MSP, with males (n = 316). About 78% rural females aged 20-24 years, and about 79% rural males aged 15-19 years reported MSP. The likelihood of MSP was higher among females in the poorest households (OR = 1.31), being married (OR = 5.71) and Catholic males (OR = 1.63), who were married (OR = 1.59). Catholic males (OR = 1.82) in the rural areas, who were married (OR = 1.80) and rural females in the northern region (OR = 1.26) were more likely to have MSP. The odds ratios were higher among urban females in the poorest (OR = 3.45) households who were married (OR = 4.22). CONCLUSIONS Having more than one sexual partner increases the risk of STIs and sexuality education programs should be introduced that emphasize the danger that surrounds MSP.
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Affiliation(s)
- Wilson Chialepeh N
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - Sathiyasusuman A
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
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Partner Characteristics Associated With HIV Acquisition Among Youth in Rakai, Uganda. J Acquir Immune Defic Syndr 2015; 69:75-84. [PMID: 25622058 DOI: 10.1097/qai.0000000000000539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND HIV risk is influenced by multiple factors including the behaviors and characteristics of sexual partners. We examined the association between partner characteristics and HIV acquisition among young people in rural Uganda, controlling for individual-level risk factors. METHODS We used self-reported data from 15- to 24-year-olds (n = 1969 male participants and n = 2826 female participants) from a population-based cohort (2005-2011) in Rakai, Uganda. Respondents could report characteristics for up to 4 sexual partners in the last year. Poisson regression was used to estimate HIV incidence rate ratios (IRRs). RESULTS In regression analyses controlling for marital status, young women's risk of HIV acquisition increased if their partner was a truck driver, drank alcohol before sex, and used condoms inconsistently. In young men, the risk of HIV acquisition increased with partners who were not enrolled in school, in partnerships with higher coital frequency, and in partnerships where respondents were unable to assess the HIV risk of their partner. Mixed-model regressions adjusting for respondent's individual-level risk factors showed that young women's risk of HIV acquisition increased with each nonmarital sexual partner [IRR: 1.54 (1.20 to 1.98)], each partner who drank alcohol before sex [IRR: 1.60 (1.11 to 2.32)], and each partner who used condoms inconsistently [IRR: 1.99 (1.33 to 2.98)]. Among young men, having nonmarital partnerships increased HIV acquisition [IRR for each partner: 1.54 (1.20 to 1.98)]. IMPLICATIONS Partner characteristics predicted HIV acquisition among youth. HIV prevention programs should emphasize awareness of partner's risk characteristics to avoid high-risk relationships.
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Niragire F, Achia TNO, Lyambabaje A, Ntaganira J. Bayesian mapping of HIV infection among women of reproductive age in Rwanda. PLoS One 2015; 10:e0119944. [PMID: 25811462 PMCID: PMC4374935 DOI: 10.1371/journal.pone.0119944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
HIV prevalence is rising and has been consistently higher among women in Rwanda whereas a decreasing national HIV prevalence rate in the adult population has stabilised since 2005. Factors explaining the increased vulnerability of women to HIV infection are not currently well understood. A statistical mapping at smaller geographic units and the identification of key HIV risk factors are crucial for pragmatic and more efficient interventions. The data used in this study were extracted from the 2010 Rwanda Demographic and Health Survey data for 6952 women. A full Bayesian geo-additive logistic regression model was fitted to data in order to assess the effect of key risk factors and map district-level spatial effects on the risk of HIV infection. The results showed that women who had STIs, concurrent sexual partners in the 12 months prior to the survey, a sex debut at earlier age than 19 years, were living in a woman-headed or high-economic status household were significantly associated with a higher risk of HIV infection. There was a protective effect of high HIV knowledge and perception. Women occupied in agriculture, and those residing in rural areas were also associated with lower risk of being infected. This study provides district-level maps of the variation of HIV infection among women of child-bearing age in Rwanda. The maps highlight areas where women are at a higher risk of infection; the aspect that proximate and distal factors alone could not uncover. There are distinctive geographic patterns, although statistically insignificant, of the risk of HIV infection suggesting potential effectiveness of district specific interventions. The results also suggest that changes in sexual behaviour can yield significant results in controlling HIV infection in Rwanda.
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Affiliation(s)
- François Niragire
- Department of Applied Statistics, College of Business and Economics, University of Rwanda, Kigali, Rwanda
- * E-mail:
| | - Thomas N. O. Achia
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Alexandre Lyambabaje
- Department of Human Nutrition and Dietetics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Heeren GA, Icard LD, O'Leary A, Jemmott JB, Ngwane Z, Mtose X. Protective factors and HIV risk behavior among South African men. AIDS Behav 2014; 18:1991-7. [PMID: 24722765 DOI: 10.1007/s10461-014-0767-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed.
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Affiliation(s)
- G Anita Heeren
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Suite 520, Philadelphia, PA, 19104-3309, USA
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Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Ann Behav Med 2014; 46:285-94. [PMID: 23690283 DOI: 10.1007/s12160-013-9514-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings. PURPOSE We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance. METHODS We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda. RESULTS Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners. CONCLUSIONS Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.
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Onoya D, Zuma K, Zungu N, Shisana O, Mehlomakhulu V. Determinants of multiple sexual partnerships in South Africa. J Public Health (Oxf) 2014; 37:97-106. [PMID: 24639477 DOI: 10.1093/pubmed/fdu010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This paper aims to examine determinants of multiple sexual partnerships (MSPs) among South African men and women using a nationally representative sample. METHODS Quantitative and qualitative data from a 2008 population-based cross-sectional survey were used. The analysis focused on the 6990 (33.6% of total sample) who were 15 years and older and reported sexual activity in the prior 12 months. The qualitative component consisted of 15 focus group interviews investigating values underlying MSP behaviors. RESULTS Predictors of MSP common across gender were race, having a history of STI, being in a short relationships (<1 year) and suspecting the current partner of infidelity. MSP among men enjoyed greater community acceptance and was mainly done for social status. Furthermore, men reporting MSP were mostly younger (15-24 years old) and use condom at last sex. Among women, determinants of MSP included economic vulnerability, younger age at sexual debut and living in formal urban rather than formal rural areas. CONCLUSIONS The data presented in this paper reinforces the importance of MSP as a risk factor for HIV and outline factors that should strongly be considered in strengthening condom use promotion and of partner reduction programs messaging in South Africa.
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Affiliation(s)
- Dorina Onoya
- HIV/AIDS, STI and TB Program, Human Sciences Research Council, 13th Floor, Plein Park Building, 69-83 Plein Street, Cape Town 8000, South Africa
| | - Khangelani Zuma
- Research Methodology Centre (RMC) Human Sciences Research Council, 134 Pretorius street, Pretoria, 0001, South Africa
| | - Nompumelelo Zungu
- Office of the CEO, Human Sciences Research Council, 134 Pretorius street, Pretoria, 0001, South Africa
| | - Olive Shisana
- Office of the CEO, Human Sciences Research Council, 134 Pretorius street, Pretoria, 0001, South Africa University of Cape Town, Private bag X3, Rondebosch, Cape Town, 7701, South Africa
| | - Vuyelwa Mehlomakhulu
- HIV/AIDS, STI and TB Program, Human Sciences Research Council, 13th Floor, Plein Park Building, 69-83 Plein Street, Cape Town 8000, South Africa
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Mishra SR, Joshi MP, Khanal V. Family planning knowledge and practice among people living with HIV in Nepal. PLoS One 2014; 9:e88663. [PMID: 24551132 PMCID: PMC3923813 DOI: 10.1371/journal.pone.0088663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/14/2014] [Indexed: 11/23/2022] Open
Abstract
Unsafe sexual behavior is common among the HIV infected. This exposes them to the risks of unintended pregnancy, HIV transmission to uninfected partners and super-infection. Studies on the use of family planning measures among People Living with HIV (PLHIV) are scarce in Nepal. The aim of this study was to explore the knowledge and practice of family planning (FP) in PLHIV. A cross sectional survey was conducted during July-December 2012 in Kaski district of Nepal. A total of 120 PLHIVs were recruited using snowball sampling from three HIV clinics within the Pokhara sub-metropolitan city area. This study found that nine in ten PLHIV had heard about family planning. Two thirds of respondents were using at least one FP method. The majority (65.8%) used condoms and had received FP counseling (67.5%). Less than one percent used condoms in addition to another contraceptive. Being single, being female and having received the counselling sessions were associated with the use of FP. The individuals who received FP counseling were more likely [OR 4.522; 95% CI (1.410-14.504)] to use FP. Females were more likely [OR 4.808; 95% CI (1.396-16.556)] to use FP than males. The individuals who were single/de-facto widowed were more likely [OR 7.330; 95% CI (2.064-26.028)] to use FP than the married individuals. Our findings suggest that there is a need to focus on FP counseling if the HIV prevention program is to increase FP use among the PLHIV population. Use of dual contraceptives need to be promoted through counseling sessions and other health promotion programs focusing in HIV prevention.
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Affiliation(s)
- Shiva Raj Mishra
- Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Vishnu Khanal
- Curtin University, School of Public Health, Perth, Australia
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Pace CA, Lioznov D, Cheng DM, Wakeman SE, Raj A, Walley AY, Coleman SM, Bridden C, Krupitsky E, Samet JH. Sexually transmitted infections among HIV-infected heavy drinkers in St Petersburg, Russia. Int J STD AIDS 2013; 23:853-8. [PMID: 23258823 DOI: 10.1258/ijsa.2012.012004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex, we conducted a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and serological testing for infection with Treponema pallidum. Data on potential demographic and behavioural predictors of STI were obtained from surveys administered at study entry. Of 682 participants, 12.8% (95% confidence interval [CI] 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (adjusted odds ratio [AOR] 2.00, 95% CI 1.13, 3.55). Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits re-evaluation.
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Affiliation(s)
- C A Pace
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA 02118, USA.
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Limaye RJ, Babalola S, Kennedy CE, Kerrigan DL. Descriptive and injunctive norms related to concurrent sexual partnerships in Malawi: implications for HIV prevention research and programming. HEALTH EDUCATION RESEARCH 2013; 28:563-573. [PMID: 23784077 DOI: 10.1093/her/cyt069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Concurrent sexual partnerships are hypothesized to be a contributing factor to Malawi's HIV epidemic. As social norms influence health behavior and have been found to influence sexual behavior, the purpose of this study was to explore two types of norms, descriptive and injunctive norms, toward concurrent sexual partnerships in Malawi. Data from 40 focus group discussions and 20 in-depth interviews conducted in five districts in Malawi, which included 318 participants aged 18-55 years, were analyzed. Participants perceived that concurrent sexual partnerships were extremely common, and believed that very few individuals in their communities were not in concurrent sexual partnerships. However, participants perceived that others in their communities heavily disapproved of concurrent sexual partnerships outside of polygamy, as polygamy was viewed as an acceptable type of partnership because it was conducted in the open. Participants asserted that there were no traditional practices that promoted concurrent sexual partnerships, and perceived that those that engaged in the behavior were for the most part stigmatized by community members. Further research is needed to obtain a thorough understanding of the way in which the perceived actions and beliefs of peers influence the beliefs, feelings and actions of individuals to strengthen HIV programming efforts in the region.
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Affiliation(s)
- Rupali J Limaye
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Center for Communication Programs, 111 Market Place, Suite 310 Baltimore, MD, USA 21202, USA.
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Olowookere SA, Adeleke NA, Fatiregun AA, Abioye-Kuteyi EA. Pattern of condom use among clients at a Nigerian HIV Counseling and Testing Centre. BMC Res Notes 2013; 6:289. [PMID: 23883623 PMCID: PMC3726365 DOI: 10.1186/1756-0500-6-289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 07/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background Studies in Nigeria have shown that the main route of HIV transmission is sexual intercourse and that effective condom use protects people against infection. The objective of this study was to determine the pattern of condom use among clients of a friendly HIV Counseling and Testing (HCT) Centre in Osogbo southwestern Nigeria. Methods This was a review of the HCT Centre records from 2006 to 2010 retrieving socio-demographic information, sexual behaviour, condom use and result of HIV testing. Data obtained were analyzed using descriptive and inferential statistics. Results One thousand nine hundred and twenty-one client records were reviewed. The mean age of the study population was 35.4 (SD 10.5) years. The majority (53%) of the respondents were females, 232 (12%) were HIV positive, and 38.2% had multiple sexual partners. Only heterosexual vaginal sex was reported among the clients. Overall 45.2% of the clients did not use a condom in their last sexual act. Factors identified to be significantly associated with non-use of condoms were; younger age, having had higher education and positive HIV status. Conclusion Unprotected heterosexual intercourse was common among the study population, indicating a need to step up HIV preventive programme through behavioural change communication strategy.
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Affiliation(s)
- Samuel A Olowookere
- Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
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Cannon Poindexter C. HIV stigma and discrimination in medical settings: stories from African women in New Zealand. SOCIAL WORK IN HEALTH CARE 2013; 52:704-727. [PMID: 24028736 DOI: 10.1080/00981389.2013.808726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Recent changes in New Zealand's HIV and immigration situations have sparked a need to understand the experiences of HIV-positive African newcomers there. Here a narrative lens was brought to a previous qualitative study to harvest stories about discrimination in medical settings in New Zealand, told by four HIV-positive African women. Despite describing positive experiences with specialist HIV providers, their accounts shed light on weaknesses within the health care system regarding the rights and treatment of immigrants living with HIV. Participants reported inappropriate use of universal precautions, violations of confidentiality rights, discriminatory comments about Africans or persons with HIV, and misinformation about HIV transmission. Interventions must include enforcement of The Privacy Law and consistent training and monitoring of employee behavior in health care organizations.
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Wang N, Sun X, Yin L, Liu H, Ruan Y, Shao Y, Qian HZ, Vermund SH. Meta-Analysis of Interventions for Reducing Number of Sexual Partners and Drug and Alcohol Abuse among People Living with HIV/AIDS. ACTA ACUST UNITED AC 2013; 4. [PMID: 24224118 DOI: 10.4172/2155-6113.1000213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of the efficacy of risk reduction interventions on HIV-related risk behaviors among people living with HIV/AIDS (PLWHA). METHODS Studies included in the meta-analysis were randomized clinical trials (RCTs) of risk reduction interventions, which targeted PLWHA aged 18 year or older and assessed the changes of number of sexual partners, drug use, needle sharing, and/or alcohol abuse between pre- and post-intervention. The standardized mean differences (SMD) between study arms as well as between baseline and post-intervention, defined as the effect sizes (ES), were calculated in random effects models. Heterogeneity of studies was estimated by the I2 statistic. RESULTS Twelve RCTs involving 3993 PLWHA were included in our analysis: seven reported impacts on the number of sexual partners, and three reported impacts on drug use, needle sharing, and alcohol abuse, respectively. There were no statistically significant impacts of risk reduction interventions on the number of total sexual partners (mean ES, -0.10; 95% confidence interval [CI], -0.26, 0.06; P=0.22) or on the subset of HIV-negative or unknown-status sexual partners (mean ES, 0.003; 95% CI, -0.54, 0.54; P=0.99). Overall, risk reduction intervention studies documented a reduction of drug abuse (mean ES: -0.26; 95% CI: -0.51, -0.01; P=0.04) among HIV-infected drug users, but this impact was mainly attributable to one study. Risk reduction interventions did not show a reduction of needle sharing (mean ES, -0.15; 95% CI, -0.43, 0.13; P=0.29) or of alcohol abuse (mean ES, -0.10; 95% CI, -0.36, 0.17; P=0.47). No heterogeneity or publication bias was found across individual studies. CONCLUSIONS Our meta-analysis did not find a positive impacts of risk reduction interventions on number of sexual partners, drug use, needle sharing, or alcohol abuse among PLWHA, but the small number of studies meeting our review criteria limits these findings.
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Affiliation(s)
- Na Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Dessie Y, Deresa M. Sexual practices of HIV-positive individuals attending antiretroviral treatment (ART) in Addis Ababa public hospitals: findings from in-depth interview. Pan Afr Med J 2012; 13:80. [PMID: 23396866 PMCID: PMC3567419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 12/10/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The rollout of Antiretroviral Treatment (ART) and improved health care services contributed in recuperating the quality of life and the functional status of HIV-positive people. These clinical effects of the treatment and cares are believed to bring a change on their sexual practices. The objective of this study was to explore the sexual practices of the HIV-positive people who were getting ART in selected Addis Ababa public hospitals. METHODS A qualitative in-depth interview was conducted. The interviews were made by trained nurse counselors of the same sex and were tape recorded. Verbatim transcription was made before the analysis. Thematic categorizations were made to present the findings. RESULTS Most participants expressed regained sexual desires with initiation of ART while some others didn't appreciate the regains. Not using condoms or inconsistently using them was identified risky sexual practices. Sero-discordances and sero-status non-disclosure were common issues among the partners. CONCLUSION Sero-status non-disclosure, non-use of condom and inconsistent using them were common sexual issues. These hinder the efforts that are being made to reduce new HIV infections and re-infections. Interventions against these problems can be made when clients come for their ART treatment and clinical care follow up.
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Affiliation(s)
- Yadeta Dessie
- Department of Public Health, Colleges of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Corresponding author: Yadeta Dessie, Department of Public Health, Colleges of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Deresa
- School of Nursing and Midwifery, Colleges of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Vu L, Andrinopoulos K, Mathews C, Chopra M, Kendall C, Eisele TP. Disclosure of HIV status to sex partners among HIV-infected men and women in Cape Town, South Africa. AIDS Behav 2012; 16:132-8. [PMID: 21197600 DOI: 10.1007/s10461-010-9873-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examines factors influencing HIV sero-status disclosure to sex partners among a sample of 630 HIV-infected men and women with recent sexual contact attending anti-retroviral therapy (ART) clinics in Cape Town, South Africa, with a focus on sex partner type, HIV-related stigma, and ART as potential correlates. About 20% of the sample had not disclosed their HIV status to their most recent sex partners. HIV disclosure to sex partner was more likely among participants who had a steady sex partner [Adjusted odds ratio (AOR) = 2.7; 95% CI: 1.6-4.6], had a partner with known-HIV status [AOR = 7.8; 95% CI: 3.2-18.7]; perceived less stigma [AOR = 1.9; 95% CI: 1.2-2.9]; and were on ART [AOR = 1.6; 95% CI: 1.1-2.3]. Stratified analyses by the type of sex partner further reveals that stigma and ART were significantly associated with HIV disclosure within steady relationships but were not significant correlates of HIV disclosure with casual sex partners. The findings support a positive prevention strategy that emphasizes increased access to ART, and behavioral interventions to reduce casual sex partnerships for persons who are HIV-positive. Mitigating the influence of HIV stigma on HIV status disclosure particularly within steady sex partnerships is also important and may be accomplished through individual and couple counseling.
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Affiliation(s)
- Lung Vu
- HIV and AIDS Program, Population Council, Washington, DC 20008, USA.
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Nyembezi A, Funani I, Sifunda S, Ruiter RA, van den Borne B, Reddy P. The psychosocial determinants of the intention to reduce the number of sexual partners among recent traditionally initiated and circumcized men in the Eastern Cape Province, South Africa. J Health Psychol 2011; 17:664-75. [DOI: 10.1177/1359105311424469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study focuses on the factors associated with the intention to reduce the number of sexual partners. An individual face-to-face interview was used to collect data amongst 2337 traditionally initiated and circumcized men in the rural areas of Eastern Cape Province, South Africa. About 55.5% reported having a main sexual partner and of those 41.4% indicated having other sexual partners. The strongest association with intention was found for self-efficacy towards having one sexual partner, which accounted for almost 49% of the variance. These findings provide specific information for the development of a focused cultural sensitive STI/HIV prevention programme in sexually active young men, which can be integrated into the initiation and health education practices.
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Affiliation(s)
- Anam Nyembezi
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
| | - Itumeleng Funani
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
| | - Sibusiso Sifunda
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
| | | | | | - Priscilla Reddy
- Medical Research Council, Health Promotion Research & Development Unit, Tygerberg, South Africa
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Changes in sexual risk behavior before and after HIV seroconversion in Southern African women enrolled in a HIV prevention trial. J Acquir Immune Defic Syndr 2011; 57:435-41. [PMID: 21546849 DOI: 10.1097/qai.0b013e318220379b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examine changes in sexual risk behaviors before and after HIV seroconversion in southern African women enrolled in the Methods for Improving Reproductive Health in Africa trial. METHODS HIV testing and counseling, and assessment of sexual behaviors by audio computer-assisted self-interviewing were performed approximately every 3 months. We compared the following sexual behaviors: being sexually active, coital frequency, consistent male condom use, use of any female condoms, anal sex, and >1 sex partner, at study visits before and after HIV seroconversion. RESULTS During the trial, 327 women seroconverted to HIV, contributing 718 pre-HIV and 1110 post-HIV study visits. Women were significantly more likely to report consistent condom use at visits after HIV seroconversion compared with visits before HIV infection [adjusted odds ratio, (AOR): 1.36 (95% confidence interval (CI): 1.11 to 1.67)] and were less likely to have >1 male sex partner after serconversion [AOR: 0.66 (95% CI: 0.48 to 0.91)]. Women reported less frequently being sexually active [AOR: 0.63 (95% CI: 0.39 to 1.02)], fewer episodes of sex [>4 sex acts over the past week AOR: 0.74 (95% CI: 0.60 to 0.91)], and a reduction in anal sex [AOR: 0.58 (95% CI: 0.36 to 0.95)] at visits after HIV seroconversion. The observed reductions in sexual risk behaviors persisted over time. CONCLUSIONS Women significantly decreased their sexual risk behaviors after HIV seroconversion, but these changes were relatively modest, suggesting the need for further secondary prevention. Timely notification of HIV status coupled with prevention messages can contribute to reductions in sexual risk behaviors.
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Venkatesh KK, Flanigan TP, Mayer KH. Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviors in the developing world. AIDS 2011; 25:1939-49. [PMID: 21811137 PMCID: PMC7295031 DOI: 10.1097/qad.0b013e32834b4ced] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
There have been dramatic increases in access to antiretroviral therapy (ART) across the developing world, and growing public health attention has focused on the possibility of utilizing ART as a means of slowing the global HIV epidemic. The preventive impact of ART will likely depend on decreasing levels of sexual risk behaviors following treatment initiation. The current review study examines the impact of wider access to ART on sexual risk behaviors among HIV-infected individuals in the developing world. The observational studies to date demonstrate that ART is associated with a significant reduction in unprotected sex following treatment initiation. Although data on the impact of ART on possible risk compensation are rapidly expanding across the developing world, more evidence is still needed before we can safely conclude expanded treatment will result in durable decreases in sexual risk behaviors.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University, Miriam Hospital, Providence, Rhode Island, USA.
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Abstract
We examined normative beliefs about multiple sexual partners and social status in China and their association with risky sexual behaviors and sexually transmitted infections (STIs). Self-reported and biological markers of sexual risk were examined among 3,716 market vendors from a city in eastern China. Men who were older or with less education believed having multiple sexual partners was linked to higher social status. Adjusting for demographic characteristics, normative beliefs were significantly associated with having multiple sexual partners, while having multiple sexual partners was significantly associated with STIs. Normative beliefs regarding sexual behaviors may play an important role in individual risk behaviors. Future HIV/STI interventions must address community beliefs about the positive meaning of sexual risks, particularly among men with traditional beliefs about gender roles.
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Affiliation(s)
- Li Li
- Center for Community Health, UCLA Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024, USA.
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Pettifor A, MacPhail C, Corneli A, Sibeko J, Kamanga G, Rosenberg N, Miller WC, Hoffman I, Rees H, Cohen MS. Continued high risk sexual behavior following diagnosis with acute HIV infection in South Africa and Malawi: implications for prevention. AIDS Behav 2011; 15:1243-50. [PMID: 20978833 DOI: 10.1007/s10461-010-9839-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Understanding sexual behavior following diagnosis of acute HIV infection (AHI) is key to developing prevention programs targeting individuals diagnosed with AHI. We conducted separate qualitative and quantitative interviews with individuals newly diagnosed (n = 19) with AHI at 1-, 4- and 12-weeks post-diagnosis and one qualitative interview with individuals who had previously been diagnosed with AHI (n = 18) in Lilongwe, Malawi and Johannesburg, South Africa between October 2007 and June 2008. The majority of participants reported engaging in sexual activity following diagnosis with AHI with a significant minority reporting unprotected sex during this time. Most participants perceived to have changed their behavior following diagnosis. However, participants reported barriers to condom use and abstinence, in particular, long term relationships and the need for disclosure of sero-status. Understanding of increased infectiousness during AHI was limited. Participants reported a desire for a behavioral intervention at the time of AHI diagnosis, however, there were differences by country in the types of interventions participants found acceptable. Studies are underway to determine the feasibility, acceptability and potential effectiveness of interventions designed for individuals with AHI.
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Affiliation(s)
- Audrey Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, CB #7435, McGavran-Greenberg Bldg, Chapel Hill, NC 27599-7435, USA.
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Individual and Structural Factors Associated With HIV Status Disclosure to Main Partner in Cameroon: ANRS 12-116 EVAL Survey, 2006–2007. J Acquir Immune Defic Syndr 2011; 57 Suppl 1:S22-6. [DOI: 10.1097/qai.0b013e31821fcfa8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dessie Y, Gerbaba M, Bedru A, Davey G. Risky sexual practices and related factors among ART attendees in Addis Ababa Public Hospitals, Ethiopia: a cross-sectional study. BMC Public Health 2011; 11:422. [PMID: 21631935 PMCID: PMC3138456 DOI: 10.1186/1471-2458-11-422] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 06/01/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Many HIV-positive persons avoid risky sexual practices after testing HIV sero-positive. However, a substantial number continue to engage in risky sexual practices that may further transmit the virus, put them at risk of contracting secondary sexually transmitted infections and lead to problems with drug resistance. Thus, this study was intended to assess risky sexual practices and related factors among HIV- positive ART attendees in public hospitals of Addis Ababa. METHODS A cross-sectional study was conducted among ART attendees from February to March, 2009. Questionnaire-based face-to-face interviews were used to gather data. SPSS software was used to perform descriptive and logistic regression analyses. RESULTS Six hundred and one ART attendees who fulfilled the inclusion criteria was included in the study and interviewed. More than one-third (36.9%) had a history of risky sexual practices in the three months prior to the study. The major reasons given for not using condoms were: partner's dislike of them, both partners being positive for HIV and the desire to have a child. Factors associated with risky sexual practices included: lack of discussion about condom use (Adjusted Odds Ratio (AOR = 7.23, 95% CI: 4.14, 12.63); lack of self-efficacy in using condoms (AOR = 3.29, 95% CI: 2.07, 5.23); lack of sexual pleasure when using a condom (AOR = 2.39, 95% CI: 1.52, 3.76); and multiple sexual partners (AOR = 2.67, 95% CI: 1.09, 6.57). Being with a negative sero-status partner (AOR = 0.33, 95% CI: 0.14, 0.80), or partners of unknown sero-status (AOR = 0.19, 95% CI: 0.09, 0.39) were associated with less risky practice. CONCLUSIONS A considerable proportion (36.9%) of respondents engaged in unprotected sexual intercourse, potentially resulting in re-infection by a new virus strain, other sexually transmitted infections and onward transmission of the HIV virus. Health education and counseling which focuses on the identified factors has to be provided. The health education and counseling can be provided to these people at ART appointments on follow- up care. It can be provided in a one-on-one basis or through patient group educational discussions at the clinics.
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Affiliation(s)
- Yadeta Dessie
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mulusew Gerbaba
- Department of Population and Family Health, Faculty of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Abdo Bedru
- Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gail Davey
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Xu H, Luke N, Msiyaphazi Zulu E. Concurrent sexual partnerships among youth in urban Kenya: Prevalence and partnership effects. Population Studies 2011; 64:247-61. [PMID: 20865631 DOI: 10.1080/00324728.2010.507872] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Research on concurrent sexual partnerships is hindered by lack of accurate partnership data. Using unique life-history calendar data from a population-based sample of youths aged 18-24 in urban Kenya, we estimated the prevalence and correlates of concurrency. In the sixth month before the survey, 3.5 per cent of females and 4.0 per cent of males were engaged in concurrent sexual partnerships. In the previous 9.5 years, males experienced more concurrent partnerships than females and they were of shorter duration. Using survival analysis, we find that the characteristics of initial partnerships affect entry into a second (concurrent) relationship. For females, geographic separation from a partner increases the risk of concurrency, while concurrency is positively associated with the duration of the initial relationship for males. For both sexes, the perception of partner infidelity increases the risk, suggesting that concurrency expands individuals' sexual networks and bridges additional networks involving partners' other sexual partners.
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Affiliation(s)
- Hongwei Xu
- Department of Sociology, Brown University, Box 1916, 112 George Street, Providence, RI 02912, USA
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Peltzer K, Tabane C, Matseke G, Simbayi L. Lay counsellor-based risk reduction intervention with HIV positive diagnosed patients at public HIV counselling and testing sites in Mpumalanga, South Africa. EVALUATION AND PROGRAM PLANNING 2010; 33:379-385. [PMID: 20416948 DOI: 10.1016/j.evalprogplan.2010.03.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 03/20/2010] [Accepted: 03/28/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the feasibility, fidelity, and effect of a human immunodeficiency virus (HIV) risk reduction intervention delivered to HIV-infected patients by lay counsellors during routine HIV counselling and testing (HCT) public service in Mpumalanga, South Africa. METHODS A total of 488 HIV-infected patients, aged 18 years and older, receiving HCT service at clinics in Mpumalanga, received an "Options for Health" intervention delivered by clinic lay counsellors. Intervention lay counsellors implemented a brief risk reduction intervention at on average 2.3 sessions to help patients reduce their unprotected sexual behaviour. Questionnaires were administered at baseline and 4 months following the intervention to assess HIV risk behaviour in previous 3 months. RESULTS A significant increase in AIDS knowledge, behavioural intentions and risk reduction efficacy among participants at follow-up was found. Participants at 4-month follow-up reported a significant reduction of multiple partners, unprotected sex, alcohol or drug use in a sexual context, and transactional sex. In addition, sexual abstinence increased and alcohol use decreased, in the past 3 months. CONCLUSIONS A lay counsellor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African HCT setting and promising at reducing risk behaviour.
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Affiliation(s)
- Karl Peltzer
- Health Promotion Research Unit, Social Aspect of HIV/AIDS and Health, Human Sciences Research Council, Pretoria, South Africa.
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Chaiyamahapurk S, Pannarunothai S, Nopkesorn T. Sexual practice among Thai HIV-infected patients: prevalence and risk factors for unprotected sex. ACTA ACUST UNITED AC 2010; 9:278-83. [PMID: 20739591 DOI: 10.1177/1545109710373831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positive prevention which focuses on prevention of HIV transmission from those already infected to those uninfected is an important issue for HIV prevention. A self-administered questionnaire on sexual practice survey of HIV-infected patients attending HIV clinics was undertaken. Of the 1160 patients, 53% knew their HIV status after being ill and 59% believed that they got infection from their regular sexual partner. In 3 months prior to the survey, 18% reported unprotected sex. Unprotected sex significantly decreased in people having adequate condoms but increased in those who believed that their sexual partners were already infected. Effect of disclosure of HIV status on unprotected sex depended on whether patients were men or women. Non-disclosure HIV-positive men claimed to have less unprotected sex than their counterpart, HIV-positive women. Factors related to unprotected sex should be addressed and sexual health must be integrated and promoted in HIV health care.
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Wechsberg WM, Luseno WK, Kline TL, Browne FA, Zule WA. Preliminary findings of an adapted evidence-based woman-focused HIV intervention on condom use and negotiation among at-risk women in Pretoria, South Africa. J Prev Interv Community 2010; 38:132-46. [PMID: 20391060 DOI: 10.1080/10852351003640799] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article presents the results of a randomized trial in South Africa of an adapted evidence-based Woman-Focused intervention on condom use with primary sex partners. The preliminary findings show that regardless of HIV status, condom negotiation was significantly associated with condom use at the 3- and 6-month follow-ups. By intervention group, significant intervention effects were found at 6-month follow-up for HIV-positive and HIV-unknown status women in the Woman-Focused intervention who were more likely than women in the Standard intervention to report condom use with a primary male partner. Among HIV-positive women, those in the Woman-Focused group and those with greater sexual control were more likely to report condom use at the 6-month follow-up. The findings indicate that gender-based interventions for women may result in increased condom negotiation skills.
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Affiliation(s)
- Wendee M Wechsberg
- Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC 27709-2194, USA.
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