Patterns of knowledge and condom use among population groups: results from the 2005 Ethiopian behavioral surveillance surveys on HIV

Comprehensive Knowledge, Attitudes, Behaviors, and Associated Factors of HIV/AIDS in Gondar City Public Health Facilities Among HIV Testing and Counselling Service Users, Northwest Ethiopia, 2022; an Ordinal Logistic Regression Analysis

BACKGROUND

The primary cause of HIV transmission is a failure to deliver proper HIV/AIDS information, which is a major public health issue in low- and middle-income nations. While global health coverage continues, there is still little understanding of HIV/AIDS in Ethiopia, and there is a data gap. As a result, the aim of this study was to investigate the factors that influence comprehensive HIV/AIDS knowledge among HIV testing and counselling (HTC) service users in Gondar, northwest Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from June to July 2022. About 423 clients were included. Data on HIV/AIDS knowledge, attitude, and behavior were collected. Stata 17 was used to analyze. A pre-tested questionnaires were used. Using ordinal logistic regression model, variables having p values of 0.2 and <0.05 were chosen as a candidate variable in binary and final model.

RESULTS

The total knowledge, favorable attitude, and good behaviors of HIV/AIDS were approximately 258 (61%), 220 (52%), and 210 (49.5%), respectively. Being male (AOR = 1.39, 95% CI = 1.28-3.01), age from 31 to 35 years (AOR = 2.13, 95% CI = 1.88-4.18), and above 36 years old (AOR = 2.21, 95% CI = 1.98-3.44), primary (AOR = 1.21, 95% CI = 1.67-3.20), and higher education (AOR = 1.19, 95% CI = 1.03-3.01), employed (AOR = 1.33, 95% CI = 1.09, 3.37), and media exposure (AOR = 2.02, 95% CI = 1.21, 3.61) were factors associated with comprehensive knowledge of HIV/AIDS, respectively.

CONCLUSION

The study participants' knowledge, attitudes, and behaviors regarding HIV/AIDS were rather low. Since HIV/AIDS is still a major public health issue, if the concerned body uses and designs media effectively, encouraging females to attend school, it will have a better chance of combating HIV/AIDS by increasing their knowledge.

Predictors of Comprehensive Knowledge of HIV/AIDS Among People Aged 15-49 Years in Ethiopia: A Multilevel Analysis

BACKGROUND

HIV/AIDS has been a big public health problem in sub-Saharan African countries including Ethiopia. Comprehensive knowledge is a basis for the prevention, control and treatment of HIV/AIDS. Several studies were focused only on the individual-level characteristics. However, comprehensive knowledge of HIV/AIDS is a multi-factorial understanding on a different level. Thus, the aim of this study was to identify the individual- and community-level factors that determine comprehensive knowledge of HIV/AIDS in Ethiopia.

METHODS

This study used data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A total of 25,927 (weighted) people aged 15-49 years were included in the study. A two-stage stratified cluster was used. Data were analyzed using Stata version 14. Multilevel mixed effect logistic regression was used to identify predictors of comprehensive knowledge on HIV/AIDS.

RESULTS

Various individual- and community-level factors were associated with comprehensive knowledge of HIV/AIDS. From individual-level factors such as sex (male), educational status (educated), media exposure, and ever been tested for HIV, and from community-level factors such as place of residence (urban) and region (developed region) were predictors of comprehensive knowledge of HIV/AIDS.

CONCLUSION

Both individual- and community-level factors were identified as predictors of comprehensive knowledge of HIV/AIDS. The government should design strategies to address the HIV/AIDS knowledge gaps among women and other underprivileged population sub-groups.

Health interventions among mobile pastoralists: a systematic review to guide health service design

OBJECTIVE

Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap.

METHODS

We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records.

RESULTS

Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11).

CONCLUSION

Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.

Determinants of reproductive health services utilization among rural female adolescents in Asgede-Tsimbla district Northern Ethiopia: a community based cross-sectional study

BACKGROUND

Adolescents especially females in rural area are vulnerable to a wide range of reproductive health problems including sexually transmitted infections, unwanted pregnancies, and unsafe abortion. They have limited access to reproductive health services that focus on the special needs of female adolescents. This study was aimed to assess the determinants of reproductive health service utilization among rural female adolescents of Asgede-Tsimbla district.

METHODS

A community-based cross-sectional study was carried out from February to April 2018, in eight randomly selected sub-districts of Asgede-Tsimbla. A total of 844 female adolescents aged 15-19 were interviewed using a pre-tested structured questionnaire. Data were entered into Epi-info Version 3.5.3 and then exported to SPSS Version 21 for analysis. Bivariate and multivariate logistic regression analysis was carried out to assess the association. Statistical significance was declared by 95% confidence interval of the odds ratio.

RESULT

From 844 participants, 95.5% of female adolescents heard about reproductive services from different sources and 69.7% of them utilized the reproductive health services within the last 12 months. Factors like, age of 16-20 years (AOR = 1.85, 95%CI: 1.17-2.92), mother's educational status (being illiterate (AOR = .33, 95%CI:.14-.77)), discussion about reproductive health services with their family (AOR = 8.02, 9%CI:5.52-11.66), being Merchant (AOR = 2.7995%CI:1.11-6.96), unemployed (AOR = 2.90, 95%CI:1.19-7.06) or student (AOR:2.38, 95%CI:1.04-5.42) in occupation, high perceived severity (AOR = 4.05, 95%CI:2.68-6.11), high perceived barriers (AOR = .44, 95%CI:.30-64) were independent predictors of reproductive health services utilization among female adolescents the study area.

CONCLUSION

About 69.7% of the adolescent females were utilizing reproductive health services in the study area though it was very low as compared with the national plan. Introducing messages that increase the perceived threat and decreasing perceived barriers to utilize reproductive health services as well as increasing self-efficacy of adolescent females would help further increase reproductive health services utilization by adolescent females.

HIV/AIDS among pastoralists and refugees in north-east Africa: a neglected problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001-2014. Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.

Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, northeast Ethiopia

BACKGROUND

TB-HIV co-infection is one of the biggest public health challenges in sub-Saharan Africa. Although there is a wealth of information on TB-HIV co-infection among settled populations in Africa and elsewhere, to our knowledge, there are no published reports on TB-HIV co-infection from pastoral communities. In this study, we report the prevalence of TB, HIV and TB-HIV co-infection among pulmonary TB suspects in the Afar Regional State of Ethiopia.

DESIGN

In a cross-sectional study design, 325 pulmonary TB suspects were included from five health facilities. Three sputum samples (spot-morning-spot) were collected from each participant. Sputum samples were examined for the presence of acid fast bacilli using Ziehl-Neelsen staining method, and culture was done on the remaining sputum samples. Participants were interviewed and HIV tested.

RESULTS

Of the 325 pulmonary TB suspects, 44 (13.5%) were smear positive, and 105 (32.3%) were culture positive. Among smear-positive patients, five were culture negative and, therefore, a total of 110 (33.8%) suspects were bacteriologically confirmed pulmonary TB patients. Out of 287 pulmonary TB suspects who were tested for HIV infection, 82 (28.6%) were HIV positive. A significantly higher proportion of bacteriologically confirmed pulmonary TB patients [40 (40.4%)] were HIV co-infected compared with patients without bacteriological evidence for pulmonary TB [42 (22.3%)]. However, among ethnic Afar pastoralists, HIV infections in smear- and/or culture-negative pulmonary TB suspects [7 (7.6%)] and bacteriologically confirmed pulmonary TB patients [4 (11.8%)] were comparable. On multivariable logistic regression analysis, Afar ethnicity was independently associated with low HIV infection [OR=0.16 (95% CI: 0.07-0.37)], whereas literacy was independently associated with higher HIV infection [OR=2.21 (95% CI: 1.05-4.64)].

CONCLUSIONS

Although the overall prevalence of TB-HIV co-infection in the current study is high, ethnic Afars had significantly lower HIV infection both in suspects as well as TB patients. The data suggest that the prevalence of HIV infection among Afar pastoralists is probably low. However, population-based prevalence studies are needed to substantiate our findings.

HIV related risk behaviours among taxi drivers and their assistants in Addis Ababa, Ethiopia: descriptive cross-sectional survey

Background

Risk taking behaviours in relation to HIV among the mobile population is a growing public health concern in many developing countries, including Ethiopia. The aim of this study was to describe risky sexual behaviours and associated factors among male taxi drivers and assistants in Addis Ababa.

Methods

A descriptive cross-sectional survey design with multistage cluster sampling procedure was employed to select 615 individuals for interview.

Results

Seventy six percent of the respondents were sexually active. Nearly 31% of the respondents reported casual sex and 7% of them did not use a condom with their most recent casual sex partner. More than half (58.5%) of the respondents had no condom use efficacy. Condom breakage and/or slippage during sex had been encountered by 44% of respondents with casual partners and sex during menstruation had ever occurred among 17% of respondents. Eleven percent had experienced sex with female sex workers. Thirty-three percent of the respondents were unfaithful to their spouse/steady partners. Multivariate analysis revealed that living with parents [AOR 95% CI; 2(1.14-3.60)], non-khat chewers [AOR 95% CI; 3.7(2.13-6.31)], never taken VCT [AOR 95% CI; 3.5(1.84-6.72)], middle-class monthly cash gain [AOR 95% CI; 0.5(0.25-0.98)] and more years of experience working on a taxi [AOR 95% CI; 0.17(0.60-0.47)] were statistically significant to influence lifetime abstinence. Non-khat chewers [AOR 95% CI; 0.53(0.37-0.78)], never taken VCT [AOR 95% CI; 0.54(0.36-0.88)] and higher monthly cash gain [AOR 95% CI; 2.9(1.14-7.19)] had a statistically significant association with condom use efficacy. Living with parents [AOR 95% CI; 2(1.31-3.72)], living with friends [AOR 95% CI; 6.4(3.13-12.89)] and non-khat chewers [AOR 95% CI; 2(1.34-3.53)] were risk factors found to be associated with faithfulness.

Conclusions

Risky sexual behaviours in this sub-population were considerable and associated factors were found to be multidimensional. Therefore, there is a need for robust intervention strategies such as tailored serial radio program targeting taxi drivers and their assistants.

Safer sex negotiation and its association with condom use among clients of female sex workers in Bangladesh

This study examines safer sex negotiation and its association with condom use among clients of female sex workers (FSWs) in Bangladesh. Data were collected from 484 FSWs living in Dhaka city following a convenient sampling procedure. Overall, 47% of the clients were suggested to use condom during last sexual intercourse and 21% did so. Both bivariate and multivariable binary logistic regression analyses yielded significantly increased risk of negotiation for safer sex with clients among FSWs with higher education. The power bargaining significantly (P < .001) increased the risk of condom use by 2.15 times (95% confidence interval = 1.28-3.59). The odds of condom use were significantly higher among the FSWs with higher education, unmarried, hotel-based, and among those with higher level of HIV/AIDS-related knowledge. The Bangladeshi FSWs have little control over their profession. HIV prevention programs should aim to encourage FSWs through information, education, and communication program to insist on condom use among clients.

Community perception, misconception, and discord regarding prevention and treatment of infection with human immunodeficiency virus in Addis Ababa, Ethiopia

Approximately one million persons infected with human immunodeficiency virus (HIV) live in Ethiopia. Socio-cultural factors influence prevention and treatment adherence. We applied a qualitative descriptive approach to evaluate community perception, knowledge, and the role of spiritual factors in regard to HIV. We conducted 14 focus groups with sampling of HIV+ and HIV- participants (n = 52) by using open-ended questions. We coded and analyzed data for major themes. There are misconceptions, including transmission via casual contact, and pervasive beliefs of holy water as a cure. Many HIV-participants believe treatment is ineffective or incompatible with holy water. Most HIV+ participants believe treatment and holy water can be taken together, but experienced either pressure to stop treatment or stigma when taking medications. Participants emphasized the role of spiritual leaders in directing and shaping community perspectives on HIV. Ongoing community education via local initiatives, nation-wide structural and environmental strategies, and efforts tailored toward Ethiopian society to reconcile treatment with faith are crucial.

'They were about to take out their guns on us': accessing rural Afar communities in Ethiopia with HIV-related interventions

Although pastoralists are a significant proportion of the rural population in many African countries, they are often underserved with regard to health-related interventions. This paper presents data on an effort to provide information about HIV prevention and treatment to Afar people living in remote, northeastern Ethiopia. Using an evidence-based approach, we worked together with the National Network of Positive Women Ethiopians to build relations with Afar communities to design and test an intervention to improve HIV awareness. In this study we observed how multi-directional, local level perceptions--of Afar regarding HIV and existing health-related interventions, of staff from organisations regarding Afar and of the researchers conducting this study regarding Afar--shape the ways in which health-related interventions are offered to Afar and how these are understood by them. While the Afar people express a desire for culturally appropriate HIV-related interventions, few such initiatives have reached them to date. Organisations working in the area often believed that Afar people did not want to accept HIV and were therefore not responsive to their interventions. We argue that the specific history of the Afar people and how this affects their understanding of HIV needs to be better understood and integrated into HIV interventions.

Assessment of comprehensive HIV/AIDS knowledge level among in-school adolescents in eastern Ethiopia

INTRODUCTION

In Ethiopia, more adolescents are in school today than ever before; however, there are no studies that have assessed their comprehensive knowledge of HIV/AIDS. Thus, this study tried to assess the level of this knowledge and the factors associated with it among in-school adolescents in eastern Ethiopia.

METHODS

A cross-sectional school-based study was conducted using a facilitator-guided self-administered questionnaire. The respondents were students attending regular school in 14 high schools located in 14 different districts in eastern Ethiopia. The proportion of in-school adolescents with comprehensive HIV/AIDS knowledge was computed and compared by sex. The factors that were associated with the comprehensive HIV/AIDS knowledge were assessed using bivariate and multivariable logistic regression.

RESULTS

Only about one in four, 677 (24.5%), in-school adolescents have comprehensive HIV/AIDS knowledge. The knowledge was better among in-school adolescents from families with a relatively middle or high wealth index (adjusted OR [95% CI]=1.39 [1.03-1.87] and 1.75 [1.24-2.48], respectively), who got HIV/AIDS information mainly from friends or mass media (adjusted OR [95% CI]=1.63 [1.17-2.27] and 1.55 [1.14-2.11], respectively) and who received education on HIV/AIDS and sexual matters at school (adjusted OR [95% CI]=1.59 [1.22-2.08]). The females were less likely to have comprehensive HIV/AIDS knowledge compared to males (adjusted OR and [95% CI]=0.60 [0.49-0.75]).

CONCLUSIONS

In general, only about a quarter of in-school adolescents had comprehensive HIV/AIDS knowledge. Although the female adolescents are highly vulnerable to HIV infection and its effects, they were by far less likely to have comprehensive HIV/AIDS knowledge. HIV/AIDS information, education and communication activities need to be intensified in high schools.

Persons at high risk for HIV infection in Kisumu, Kenya: identifying recruitment strategies for enrolment in HIV-prevention studies

A combination of in-depth interviews ( n = 38) and surveys ( n = 203) were used to (1) identify strategies to recruit persons at high risk for HIV infection; (2) determine whether one strategy was more successful than others; and (3) describe motivators and barriers to participation in HIV-prevention studies. From in-depth interviews, four main recruitment strategies were identified: (1) use of a person with specific knowledge of a target population (link person mobilization); (2) use of co-workers or contemporaries (peer mobilization); (3) use of group or association leaders (leader mobilization); and (4) contacting persons by study staff directly (staff contact mobilization). The odds of inconsistently using condoms during sex were greater among those recruited using the peer mobilization (adjusted odds ratio [AOR] = 3.59; 95% confidence interval [CI] = 1.35–9.54) and the leader mobilization strategies (AOR = 2.76; 95% CI = 1.04–7.38) compared with the link person mobilization strategy. The main motivators for taking part in an HIV research study were receiving HIV-prevention education, HIV information or counselling, and receiving compensation for study participation. The main barriers were fear of lack of confidentiality and HIV testing concerns. Using evaluated strategies to recruit persons at high risk for HIV infection and addressing barriers to participation will improve the conduct and outcome of HIV-prevention studies.

Level of stigma among female sex workers: comparison of two surveys of HIV behavioral data, Ethiopia

BACKGROUND

HIV and AIDS stigma and discrimination is widespread in Africa. We did a secondary data analysis of HIV and AIDS behavioral surveillance surveys (BSS) on female sex workers residing in three major cities in Ethiopia.

OBJECTIVES

To compare level of sigma among sex workers through the analysis of two data sources of BSS conducted in 2002 and 2005 in Ethiopia.

METHODS

The BSS used standardized methodology to study the level of stigma among female sex workers. Female sex workers were sampled using two-stage probability sampling methods in each of the three cities. Data from a total of 2,888 female sex workers was analyzed and interpreted. We used Chi square to compare the socio-demographic variables of the two surveys and logistic regression to compare level of stigma between the two surveys.

RESULTS

There is a significant difference in the level of stigma between the two surveys. This applies to most of the questions that were included in the surveys.

CONCLUSION

The proportion of female sex workers with a stigmatizing attitude is considerably high, posing threats to the HIV prevention program. Strengthening interventions on all aspects of stigma is recommended.