Research gaps in neonatal HIV-related care

Directory of Open Access Journals (Sweden)

Mary-Ann Davies

2015-05-01

Full Text Available The South African prevention of mother to child transmission programme has made excellentprogress in reducing vertical HIV transmission, and paediatric antiretroviral therapyprogrammes have demonstrated good outcomes with increasing treatment initiation inyounger children and infants. However, both in South Africa and across sub-Saharan African,lack of boosted peri-partum prophylaxis for high-risk vertical transmission, loss to followup,and failure to initiate HIV-infected infants on antiretroviral therapy (ART before diseaseprogression are key remaining gaps in neonatal HIV-related care. In this issue of the Southern African Journal of HIV Medicine, experts provide valuable recommendations for addressingthese gaps. The present article highlights a number of areas where evidence is lacking toinform guidelines and programme development for optimal neonatal HIV-related care.

Evolution of HIV and AIDS Programmes in an African Institution of Higher Learning: The Case of the Copperbelt University in Zambia

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Sanjobo, Nawa; Lukwesa, Matilda; Kaziya, Charity; Tepa, Cornwell; Puta, Bernard

2016-01-01

Background: Universities present the foundation for socio-economic and political development. Without structures and processes to fight HIV, there is no prospect of enhancing treatment, prevention, care and support services. Copperbelt University HIV and AIDS response was initiated in 2003 with the aim of building capacity of students and employees in HIV and AIDS. Objectives: The main objective of this paper is to demonstrate how the CBU HIV response has evolved over time and provide a timeline of important milestones in the development process. Method: Peer educators and counsellors conduct sensitization campaigns through one on one discussion, workshops, and drama performances, distribution of Information, Education and Communication (IEC) materials. Results: HIV Programme has been set up with players from policy, programme and community levels. Strategic processes, collaborations, funding, medical insurance schemes, prevention, treatment, care and support services, training of peer educators and counsellors have been established. Conclusion: Copperbelt University HIV initiative has demonstrated potential to reduce new infections in the university, and is currently expanding her programme to encompass wellness and also spearhead the integration of HIV in the university curriculum. PMID:27347269

Evolution of HIV and AIDS Programmes in an African Institution of Higher Learning: The Case of the Copperbelt University in Zambia.

Science.gov (United States)

Sanjobo, Nawa; Lukwesa, Matilda; Kaziya, Charity; Tepa, Cornwell; Puta, Bernard

2016-01-01

Universities present the foundation for socio-economic and political development. Without structures and processes to fight HIV, there is no prospect of enhancing treatment, prevention, care and support services. Copperbelt University HIV and AIDS response was initiated in 2003 with the aim of building capacity of students and employees in HIV and AIDS. The main objective of this paper is to demonstrate how the CBU HIV response has evolved over time and provide a timeline of important milestones in the development process. Peer educators and counsellors conduct sensitization campaigns through one on one discussion, workshops, and drama performances, distribution of Information, Education and Communication (IEC) materials. HIV Programme has been set up with players from policy, programme and community levels. Strategic processes, collaborations, funding, medical insurance schemes, prevention, treatment, care and support services, training of peer educators and counsellors have been established. Copperbelt University HIV initiative has demonstrated potential to reduce new infections in the university, and is currently expanding her programme to encompass wellness and also spearhead the integration of HIV in the university curriculum.

The role of HIV/AIDS committees in effective workplace governance of HIV/AIDS in South African small and medium-sized enterprises (SMEs).

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Vaas, Jocelyn R

2008-04-01

The primary purpose of this study was to assess the role, status and scope of workplace HIV/AIDS committees as a means of effective workplace governance of the HIV/AIDS impact, and their role in extending social protective HIV/AIDS-related rights to employees. In-depth qualitative case studies were conducted in five South African small and medium-sized enterprises (SMEs) that were actively implementing HIV/AIDS policies and programmes. Companies commonly implemented HIV/AIDS policies and programmes through a workplace committee dedicated to HIV/AIDS or a generic committee dealing with issues other than HIV/ AIDS. Management, through the human resources department and the occupational health practitioner often drove initial policy formulation, and had virtually sole control of the HIV/AIDS budget. Employee members of committees were mostly volunteers, and were often production or blue collar employees, while there was a notable lack of participation by white-collar employees, line management and trade unions. While the powers of workplace committees were largely consultative, employee committee members often managed in an indirect manner to secure and extend social protective rights on HIV/AIDS to employees, and monitor their effective implementation in practice. In the interim, workplace committees represented one of the best means to facilitate more effective workplace HIV/AIDS governance. However, the increased demands on collective bargaining as a result of an anticipated rises in AIDS-related morbidity and mortality might prove to be beyond the scope of such voluntary committees in the longer term.

Attitudes, perceptions and behaviours towards HIV testing among African-American and East African immigrant women in Washington, DC: implications for targeted HIV testing promotion and communication strategies.

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De Jesus, Maria; Carrete, Claudia; Maine, Cathleen; Nalls, Patricia

2015-12-01

The objective of the study was to examine and compare the HIV testing attitudes, perceptions and behaviours between African-American and East African immigrant women in the Washington, DC metropolitan area. Adopting an inductive, qualitative methodological approach, we conducted a total of 40 in-depth, semistructured interviews between October 2012 and March 2013. Qualitative thematic analysis was used to analyse the data. Overall, African-American women held more favourable views towards HIV testing than East African immigrant women. Very few East African immigrant women sought HIV testing intentionally. The majority of East African participants were tested inadvertently, while others tested for immigration-related or employment-related purposes. There were many barriers that impede women from seeking an HIV test including negative assumptions (eg, "Getting an HIV test implies that I am HIV positive"), negative emotions (eg, "Fear of being diagnosed with HIV and what this will mean for me") and potential negative reactions from partner or others (eg, "Getting an HIV test can signal distrust, disrespect, or infidelity"). There were nuances in how each group articulated some of these barriers and East African women expressed unique concerns that originated from experiences in their home countries. The study shed light into the complexity of factors that constrain women from presenting themselves voluntarily for an HIV test and highlighted the nuances between African-American and East African perceptions. Implications of findings for effective targeted HIV screening promotion and communication strategies among these groups of women are discussed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Attitudes, perceptions, and behaviors toward HIV testing among African American and East African immigrant women in Washington, D.C.: Implications for targeted HIV testing promotion and communication strategies

Science.gov (United States)

De Jesus, Maria; Carrete, Claudia; Maine, Cathleen; Nalls, Patricia

2015-01-01

Objectives The objective of the study was to examine and compare the HIV testing attitudes, perceptions, and behaviors between African American and East African immigrant women in the Washington, D.C. Metropolitan area. Methods Adopting an inductive, qualitative methodological approach, we conducted a total of 40 in-depth, semi-structured interviews between October 2012 and March 2013. Qualitative thematic analysis was used to analyze the data. Results Overall, African American women held more favorable views toward HIV testing than East African immigrant women. Very few East African immigrant women sought HIV testing intentionally. The majority of East African participants were tested inadvertently, while others tested for immigration- or employment-related purposes. There were many barriers that impede women from seeking an HIV test including: negative assumptions (e.g., ‘Getting an HIV test implies that I am HIV positive’); negative emotions (e.g., ‘Fear of being diagnosed with HIV and what this will mean for me’); and potential negative reactions from partner or others (e.g., ‘Getting an HIV test can signal distrust, disrespect, or infidelity’). There were nuances in how each group articulated some of these barriers and East African women expressed unique concerns that originated from experiences in their home countries. Conclusions The study shed light into the complexity of factors that constrain women from presenting themselves voluntarily for an HIV test and highlighted the nuances between African American and East African perceptions. Implications of findings for effective targeted HIV screening promotion and communication strategies among these groups of women are discussed. PMID:25897146

Comparing HIV prevalence estimates from prevention of mother-to-child HIV transmission programme and the antenatal HIV surveillance in Addis Ababa

Directory of Open Access Journals (Sweden)

Mirkuzie Alemnesh H

2012-12-01

Full Text Available Abstract Background In the absence of reliable data, antenatal HIV surveillance has been used to monitor the HIV epidemic since the late 1980s. Currently, routine data from Prevention of Mother-to-child HIV transmission (PMTCT programmes are increasingly available. Evaluating whether the PMTCT programme reports provide comparable HIV prevalence estimates with the antenatal surveillance reports is important. In this study, we compared HIV prevalence estimates from routine PMTCT programme and antenatal surveillance in Addis Ababa with the aim to come up with evidence based recommendation. Methods Summary data were collected from PMTCT programmes and antenatal surveillance reports within the catchment of Addis Ababa. The PMTCT programme data were obtained from routine monthly reports from 2004 to 2009 and from published antenatal HIV surveillance reports from 2003 to 2009. Data were analysed using descriptive statistics. Results In Addis Ababa, PMTCT sites had increased from six in 2004 to 54 in 2009. The site expansion was accompanied by an increased number of women testing. There were marked increases in the rate of HIV testing following the introduction of routine opt-out HIV testing approach. Paralleling these increases, the HIV prevalence showed a steady decline from 10.0% in 2004 to 4.5% in 2009. There were five antenatal surveillance sites from 2003 to 2007 in Addis Ababa and they increased to seven by 2009. Four rounds of surveillance data from five sites showed a declining trend in HIV prevalence over the years. The overall antenatal surveillance data also showed that the HIV prevalence among antenatal attendees had declined from 12.4% in 2003 to 5.5% in 2009. The HIV prevalence estimates from PMTCT programme were 6.2% and 4.5% and from antenatal surveillance 6.1 and 5.5% in 2008 and 2009 respectively. Conclusions There were consistent HIV prevalence estimates from PMTCT programme and from antenatal surveillance reports. Both data sources

Human-resources strategies for managing HIV/AIDS: the case of the South African forestry industry.

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Gow, Jeff; Grant, Bligh

2010-09-01

Previous work has focused on HIV prevalence among forestry workers and the impact of HIV/AIDS on the sustainability of forest resources. Following a review of work examining the impacts of HIV/AIDS on the South African economy, this article presents original qualitative research examining the responses of company management to the HIV epidemic across a range of enterprises in the South African forestry industry, including large companies, contractors and cooperatives. At the level of the enterprise, management occupies a critical nexus, at which the intersecting requirements of complex government legislation, the wellbeing of workers and the demands of the business must be met. The research demonstrates that large forestry companies tend to provide only a small fraction of their workforces with HIV/AIDS education, prevention or treatment services, as they have essentially outsourced the requirement through the use of labour-supply contractors who, by and large, provide workers with scant HIV/AIDS-related programmes or benefits. Moreover, the extent to which the different types of forestry enterprises incorporate the management of HIV/AIDS in the workforce with the management of the business is highly variable, and in most instances falls short of legislative requirements that have been in place for over a decade. The implications of this for the forestry industry in South Africa are acute.

HIV/AIDS stigma and religiosity among African American women.

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Muturi, Nancy; An, Soontae

2010-06-01

African American women are disproportionately affected by HIV/AIDS compared with other ethnicities, accounting for two-thirds (67%) of all women diagnosed with HIV. Despite their increased risk of HIV infection, few studies have been conducted to understand culture-specific factors leading to their vulnerability. Given the central role of religious organizations in African American communities, this study explored whether and to what extent religiosity plays a role in stigma toward HIV/AIDS. Results of hierarchical regression showed that after controlling for key factors, religiosity was a significant factor predicting the level of religious stigma. Those with high religiosity displayed significantly higher stigma, associating HIV/AIDS with a curse or punishment from God. Verbatim responses to an open-ended question also revealed seemingly ingrained prejudice against HIV/AIDS from a religious perspective. The findings point to the important role of faith-based organizations (FBOs) in addressing HIV/AIDS issues within African American communities.

South African Antarctic earth science research programme

CSIR Research Space (South Africa)

SASCAR

1984-02-01

Full Text Available This document describes the past, current and planned future South African earth science research programme in the Antarctic, Southern Ocean and subantarctic regions. The scientific programme comprises five components into which present and future...

A one-size-fits-all HIV prevention and education approach?: Analyzing and interpreting divergent HIV risk perceptions between African American and East African immigrant women in Washington, DC

Science.gov (United States)

De Jesus, Maria; Taylor, Juanita; Maine, Cathleen; Nalls, Patricia

2015-01-01

Background To date, there are very few comparative US studies and none in DC that distinguish between US-born and foreign-born Black women to examine and compare their perceptions of HIV risk. This qualitative study, therefore, analyzes African American and East African women’s perceptions of HIV risk in the Washington DC Metropolitan area, which has the highest AIDS rate in the US. Methods Forty in-depth, semi-structured interviews and 10 cognitive interviews were conducted among a sample of 25 African American women and 25 East African born women between October 2012 and March 2013 to examine perceptions regarding HIV risk. The in-depth semi-structured interviews were preceded by the cognitive interviews and accompanying survey. Study protocol was reviewed and approved by the American University Institutional Review Board. Results Adopting Boerma and Weir’s Proximate Determinants conceptual framework to interpret the data, the results of the study demonstrate that African American and East African immigrant women have divergent perceptions of HIV risk. While African American women ascribe HIV risk to individual-level behaviors and choices such as unprotected sex, East African women attribute HIV risk to conditions of poverty and survival. Conclusions Study findings suggest that addressing HIV prevention and education among Black women in DC will require distinct and targeted strategies that are culturally and community-centered in order to resonate with these different audiences. PMID:26766523

HIV sero-conversion during late pregnancy – when to retest | Kalk ...

African Journals Online (AJOL)

The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV seroconversion during late pregnancy, demonstrating the limitations of the current programme.

Barriers to HIV testing for migrant black Africans in Western Europe.

Science.gov (United States)

Fakoya, I; Reynolds, R; Caswell, G; Shiripinda, I

2008-07-01

Migrant black Africans are disproportionately affected by HIV in Western Europe; we discuss the barriers to HIV testing for sub-Saharan migrants, with particular emphasis on the UK and the Netherlands. Cultural, social and structural barriers to testing, such as access to testing and care, fear of death and disease and fear of stigma and discrimination in the community, can be identified. Lack of political will, restrictive immigration policies and the absence of African representation in decision-making processes are also major factors preventing black Africans from testing. HIV testing strategies need to be grounded in outreach and community mobilisation, addressing fear of diagnosis, highlighting the success of treatment and tackling HIV-related stigma among black African migrant communities.

Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators.

Science.gov (United States)

Maleka, Elma Nelisiwe

2017-12-01

There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected

HIV among African American Gay and Bisexual Men

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... Syndicated Content Website Feedback HIV Among African American Gay and Bisexual Men Recommend on Facebook Tweet Share Compartir Black/African American a gay, bisexual, and other men who have sex with ...

Public health lessons from a pilot programme to reduce mother-to ...

African Journals Online (AJOL)

Public health lessons from a pilot programme to reduce mother-to-child transmission of HIV-1 in Khayelitsha. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... took blood for HIV enzyme-linked imrnunosorbent assay (EUSA) testing.

Strategies to prevent HIV transmission among heterosexual African-American women

Directory of Open Access Journals (Sweden)

Peters Ronald J

2005-03-01

Full Text Available Abstract Background African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. Methods Twenty five low income African American women, ages 18–29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. Results The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and

Parenting and child outcomes of HIV-infected African American mothers: a literature review.

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Muze, Ruth H

2013-01-01

Parenting young children while living with HIV is an important public health concern. This article reviews maternal HIV and the impact it has on the parenting experience of African American mothers. Because living with HIV has been considered a family illness, the Family Systems Model provided a framework for this article. The model demonstrated an important link between maternal HIV and its impact on the health and wellbeing of not only the mother and her children, but her parenting and family roles as well. Research has documented an association between maternal HIV and negative parent-child outcomes among African American mothers. I examined studies on parenting and child outcomes among African American mothers living with HIV. The review assists in conceptualizing parenting with HIV as an area of increasing importance in health services delivery to HIV-infected African American mothers who are caring for young children.

Availability of HIV/AIDS community intervention programmes and ...

African Journals Online (AJOL)

As a result, mining sites are at great risk of HIV transmission. While a ... Both quantitative and qualitative methods were used to collect data. ... The programmes carried out intervention activities which included HIV/AIDS education campaigns, ...

An implementation evaluation of a voluntary counselling and testing programme for the human immunodeficiency virus (HIV and acquired immunodeficiency syndrome (AIDS

Directory of Open Access Journals (Sweden)

Tarryn N. Anderson

2012-07-01

Research purpose: The purpose of this evaluation was to assess whether or not a Voluntary Counselling and Testing (VCT programme for HIV and AIDS, at a South African university, was implemented as intended. Motivation for the study: The evaluators were motivated to explore indications in the existing literature about these programmes that participants in VCT programmes are often not the intended target population who live a high risk lifestyle. Research design, approach and method: A descriptive design was used to evaluate service utlisation, service delivery and organisational support. Questionnaire data from 285 respondents who participated in the programme and programme records supplied by the programme staff were consulted to answer the evaluation questions. Main findings: The evaluation showed that the highest uptake for the programme occurred amongst female students. The low uptake amongst men was a concern. It was found that the programme was delivered as intended and that there were enough resources to implement it according to standards set. Practical/managerial implications: The systematic report on the programme process provided the programme managers with practical suggestions for programme improvement. Contribution/value-add: This was the first implementation evaluation of a VCT programme in a South African university context. As such it aimed to educate programme managers to think evaluatively about introducing new or continuing existing programmes.

Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators

Directory of Open Access Journals (Sweden)

Elma Nelisiwe Maleka

2017-01-01

Full Text Available There are number of Non-Governmental Organisations (NGOs in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS, however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA. Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour

Effects of an exercise programme with people living with HIV ...

African Journals Online (AJOL)

Effects of an exercise programme with people living with HIV: research in a disadvantaged setting. Clemens Ley, Lloyd Leach, María Rato Barrio, Susan Bassett. Abstract. This study aimed to analyse the physical health effects of a community based 10-week physical activity programme with people living with HIV.

A One-Size-Fits-All HIV Prevention and Education Approach?: Interpreting Divergent HIV Risk Perceptions Between African American and East African Immigrant Women in Washington, DC Using the Proximate-Determinants Conceptual Framework.

Science.gov (United States)

De Jesus, Maria; Taylor, Juanita; Maine, Cathleen; Nalls, Patricia

2016-02-01

To date, there are very few comparative US studies and none in DC that distinguish between US-born and foreign-born black women to examine and compare their perceptions of HIV risk. This qualitative study, therefore, analyzes African American and East African women's perceptions of HIV risk in the Washington DC Metropolitan area, which has the highest AIDS rate in the United States. Forty in-depth, semistructured interviews and 10 cognitive interviews were conducted among a sample of 25 African American women and 25 East African born women between October 2012 and March 2013 to examine perceptions regarding HIV risk. The in-depth semistructured interviews were preceded by the cognitive interviews and accompanying survey. Study protocol was reviewed and approved by the American University Institutional Review Board. Adopting Boerma and Weir's Proximate Determinants conceptual framework to interpret the data, the results of the study demonstrate that African American and East African immigrant women have divergent perceptions of HIV risk. Although African American women ascribe HIV risk to individual-level behaviors and choices such as unprotected sex, East African women attribute HIV risk to conditions of poverty and survival. Study findings suggest that addressing HIV prevention and education among black women in DC will require distinct and targeted strategies that are culturally and community-centered to resonate with these different audiences.

HIV sero-conversion during late pregnancy – when to retest

Directory of Open Access Journals (Sweden)

Emma Kalk

2013-06-01

Full Text Available The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV seroconversion during late pregnancy, demonstrating the limitations of the current programme. These could be mitigated by expanding the programme to include maternal testing at delivery and at immunisation clinic visits as we pursue the elimination of mother-to-child transmission.

African Primary Care Research: Performing a programme evaluation

OpenAIRE

Dudley, Lilian

2014-01-01

Abstract This article is part of a series on Primary Care Research in the African context and focuses on programme evaluation. Different types of programme evaluation are outlined: developmental, process, outcome and impact. Eight steps to follow in designing your programme evaluation are then described in some detail: engage stakeholders; establish what is known; describe the programme; define the evaluation and select a study design; define the indicators; plan and manage data collection an...

The utility of screening for parasitic infections in HIV-1-infected Africans with eosinophilia in London.

Science.gov (United States)

Sarner, Liat; Fakoya, Ade O; Tawana, Cheryl; Allen, Elizabeth; Copas, Andrew J; Chiodini, Peter L; Fenton, Kevin A

2007-09-01

The presence of asymptomatic eosinophilia in HIV patients has been demonstrated to have a wide variety of causes. Untreated parasitic infections in immunocompromised individuals can have potentially serious consequences. The utility of screening for parasitic infections in immigrant HIV-positive Africans with eosinophilia was investigated in a UK-based HIV clinic. HIV-positive African patients with eosinophilia were matched with HIV-positive African controls without eosinophilia. More than half of African HIV patients with eosinophilia had positive parasitic serology, and were significantly more likely to have positive serology compared with African HIV patients without eosinophilia. This study shows that asymptomatic eosinophilia in HIV-1-infected Africans is strongly suggestive of underlying parasitic infection. Individuals with eosinophilia should thus be screened for parasitic infections according to the infections prevalent in the countries they have lived in or visited for substantial periods of time.

Highlight: Building a strong future for African-led HIV prevention ...

International Development Research Centre (IDRC) Digital Library (Canada)

The search for an HIV vaccine is shifting from labs in North America and Europe, to include a greater number of African institutions. African researchers are leading the charge. Based in cities at the centre of the epidemic, they are familiar with the affected populations, and are best placed to conduct testing of HIV candidate ...

Long-Term Outcome of an HIV-Treatment Programme in Rural Africa: Viral Suppression despite Early Mortality

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Roos E. Barth

2011-01-01

Results. 63% of patients (466/735 have a fully suppressed HIV-RNA, a median of three years after treatment initiation. Early mortality was high: 14% died within 3 months after treatment start. 16% of patients experienced virological failure, but only 4% was switched to second-line ART. Male gender and a low performance score were associated with treatment failure; immunological failure was a poor predictor of virological failure. Conclusions. An “all or nothing” phenomenon was observed in this rural South African ART programme: high early attrition, but good virological control in those remaining in care. Continued efforts are needed to enrol patients earlier. Furthermore, the observed viro-immunological dissociation emphasises the need to make HIV-RNA testing more widely available.

Straight talk: HIV prevention for African-American heterosexual men: theoretical bases and intervention design.

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Frye, Victoria; Bonner, Sebastian; Williams, Kim; Henny, Kirk; Bond, Keosha; Lucy, Debbie; Cupid, Malik; Smith, Stephen; Koblin, Beryl A

2012-10-01

In the United States, racial disparities in HIV/AIDS are stark. Although African Americans comprise an estimated 14% of the U.S. population, they made up 52% of new HIV cases among adults and adolescents diagnosed in 2009. Heterosexual transmission is now the second leading cause of HIV in the United States. African Americans made up a full two-thirds of all heterosexually acquired HIV/AIDS cases between 2005 and 2008. Few demonstrated efficacious HIV prevention interventions designed specifically for adult, African-American heterosexual men exist. Here, we describe the process used to design a theory-based HIV prevention intervention to increase condom use, reduce concurrent partnering, and increase HIV testing among heterosexually active African-American men living in high HIV prevalence areas of New York City. The intervention integrated empowerment, social identity, and rational choices theories and focused on four major content areas: HIV/AIDS testing and education; condom skills training; key relational and behavioral turning points; and masculinity and fatherhood.

HIV/AIDS National Strategic Plans of Sub-Saharan African countries: an analysis for gender equality and sex-disaggregated HIV targets.

Science.gov (United States)

Sherwood, Jennifer; Sharp, Alana; Cooper, Bergen; Roose-Snyder, Beirne; Blumenthal, Susan

2017-12-01

National Strategic Plans (NSPs) for HIV/AIDS are country planning documents that set priorities for programmes and services, including a set of targets to quantify progress toward national and international goals. The inclusion of sex-disaggregated targets and targets to combat gender inequality is important given the high disease burden among young women and adolescent girls in Sub-Saharan Africa, yet no comprehensive gender-focused analysis of NSP targets has been performed. This analysis quantitatively evaluates national HIV targets, included in NSPs from eighteen Sub-Saharan African countries, for sex-disaggregation. Additionally, NSP targets aimed at reducing gender-based inequality in health outcomes are compiled and inductively coded to report common themes. On average, in the eighteen countries included in this analysis, 31% of NSP targets include sex-disaggregation (range 0-92%). Three countries disaggregated a majority (>50%) of their targets by sex. Sex-disaggregation in data reporting was more common for targets related to the early phases of the HIV care continuum: 83% of countries included any sex-disaggregated targets for HIV prevention, 56% for testing and linkage to care, 22% for improving antiretroviral treatment coverage, and 11% for retention in treatment. The most common target to reduce gender inequality was to prevent gender-based violence (present in 50% of countries). Other commonly incorporated target areas related to improving women's access to family planning, human and legal rights, and decision-making power. The inclusion of sex-disaggregated targets in national planning is vital to ensure that programmes make progress for all population groups. Improving the availability and quality of indicators to measure gender inequality, as well as evaluating programme outcomes by sex, is critical to tracking this progress. This analysis reveals an urgent need to set specific and separate targets for men and women in order to achieve an equitable

HIV/AIDS National Strategic Plans of Sub-Saharan African countries: an analysis for gender equality and sex-disaggregated HIV targets

Science.gov (United States)

Sherwood, Jennifer; Sharp, Alana; Cooper, Bergen; Roose-Snyder, Beirne; Blumenthal, Susan

2017-01-01

Abstract National Strategic Plans (NSPs) for HIV/AIDS are country planning documents that set priorities for programmes and services, including a set of targets to quantify progress toward national and international goals. The inclusion of sex-disaggregated targets and targets to combat gender inequality is important given the high disease burden among young women and adolescent girls in Sub-Saharan Africa, yet no comprehensive gender-focused analysis of NSP targets has been performed. This analysis quantitatively evaluates national HIV targets, included in NSPs from eighteen Sub-Saharan African countries, for sex-disaggregation. Additionally, NSP targets aimed at reducing gender-based inequality in health outcomes are compiled and inductively coded to report common themes. On average, in the eighteen countries included in this analysis, 31% of NSP targets include sex-disaggregation (range 0–92%). Three countries disaggregated a majority (>50%) of their targets by sex. Sex-disaggregation in data reporting was more common for targets related to the early phases of the HIV care continuum: 83% of countries included any sex-disaggregated targets for HIV prevention, 56% for testing and linkage to care, 22% for improving antiretroviral treatment coverage, and 11% for retention in treatment. The most common target to reduce gender inequality was to prevent gender-based violence (present in 50% of countries). Other commonly incorporated target areas related to improving women’s access to family planning, human and legal rights, and decision-making power. The inclusion of sex-disaggregated targets in national planning is vital to ensure that programmes make progress for all population groups. Improving the availability and quality of indicators to measure gender inequality, as well as evaluating programme outcomes by sex, is critical to tracking this progress. This analysis reveals an urgent need to set specific and separate targets for men and women in order to achieve

South African antarctic biological research programme

CSIR Research Space (South Africa)

SASCAR

1981-07-01

Full Text Available This document provides a description of the past, current and planned South African biological research activities in the sub-Antarctic and Antarctic regions. Future activities will fall under one of the five components of the research programme...

The intersection of antiretroviral therapy, peer support programmes, and economic empowerment with HIV stigma among HIV-positive women in West Nile Uganda.

Science.gov (United States)

Kellett, Nicole Coffey; Gnauck, Katherine

2016-12-01

HIV stigma remains a major problem of the AIDS epidemic in sub-Saharan Africa. Women fear impending social stigma including blame, isolation and abuse. HIV infection and HIV stigma interact cyclically, creating and reinforcing economic and social exclusion for individuals living with HIV. Evidence suggests that interventions for people living with HIV infection that include, in combination, antiretroviral therapy (ART), peer support and economic empowerment are likely to be more effective than if used alone. We report a qualitative study in West Nile Uganda that explored perceptions of HIV stigma among fifty-four HIV-positive women who had similar access to ART and HIV peer support programmes, but varying levels of participation (full-time, intermittent, none) in economic empowerment programmes. Our study found that access to ART, peer support groups, and economic empowerment programmes helped to curb perceptions of deep-seated HIV stigma for participants. More expressions of usefulness, hope and psychological well-being prevailed with participants who had increased participation in economic empowerment programmes. Our findings underscore the value of HIV outreach programmes which combine ART, peer support and economic empowerment to alleviate HIV stigma. Further research to quantify the interaction of these factors is warranted.

Differences in HIV natural history among African and non-African seroconverters in Europe and seroconverters in sub-Saharan Africa

DEFF Research Database (Denmark)

Pantazis, Nikos; Morrison, Charles; Amornkul, Pauli N

2012-01-01

It is unknown whether HIV treatment guidelines, based on resource-rich country cohorts, are applicable to African populations.......It is unknown whether HIV treatment guidelines, based on resource-rich country cohorts, are applicable to African populations....

Globalisation, transport and HIV | Andrews | Southern African ...

African Journals Online (AJOL)

No Abstract Southern African Journal of HIV Medicine Vol. 5 (4) 2004: 41-44. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

Making ward-based outreach teams an effective component of human immunodeficiency virus programmes in South Africa

Directory of Open Access Journals (Sweden)

Nireshni Naidoo

2018-04-01

Full Text Available The implementation of ward-based outreach teams (WBOTs, comprised of community health workers (CHWs, is one of the three interventions of the South African National Department of Health’s (NDoH Primary Health Care (PHC Re-engineering strategy for improving health outcomes. CHWs provide a necessary structure to contribute to successful implementation of the human immunodeficiency virus (HIV programme in four ways: (1 prevention of HIV infection by health education, (2 linkage to care by health education and referrals, (3 adherence support and (4 identification of individuals who are failing treatment. However, CHW programme and HIV programme-specific barriers exist that need to be resolved in order to achieve maximum impact. These include a lack of stakeholder and community support for WBOTs, challenging work and operational environments, a lack of in-depth knowledge and skills, and socio-cultural barriers such as HIV-related stigma. Considering its promising structure, documentation of the WBOT contribution to healthcare overall, and the HIV programme in particular, is urgently warranted to successfully and sustainably incorporate it into the South African healthcare system.

HIV/AIDS knowledge and attitudes among West African immigrant women in Western Australia.

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Drummond, Peter D; Mizan, Ayse; Wright, Bernadette

2008-09-01

Most women who live in sub-Saharan countries have heard of HIV/AIDS, but there is still widespread misunderstanding about how HIV is spread, the consequences of infection, and how to protect against infection. The aim of the present study was to investigate knowledge about HIV and attitudes towards condom use in West African refugees who had settled in Perth, Western Australia, within the past 5 years. Knowledge about transmission of HIV, myths about how HIV is spread, incorrect beliefs about protective factors, the effectiveness of condoms in protecting against sexually transmissible infections, and attitudes towards condom use were investigated by survey in 51 West African women, and in 100 Australian women for comparison. Where possible, each West African woman was matched for age and level of education with an Australian woman. Knowledge of HIV was poorest in the least educated West African women, but many of the more highly educated women also had misconceptions about how HIV is spread, how to protect against HIV, and the effectiveness of condoms in protecting against HIV. Moreover, most West African women held negative attitudes towards condom use. Within the Australian sample, HIV knowledge was greatest in women with tertiary qualifications, and was greater in younger than older women; in addition, attitudes towards condom use differed across the age span. The findings in the present study suggest that educational programs that focus on knowledge about HIV should be tailored to meet the needs and cultural sensitivities of newly emerging immigrant communities, and should target particular demographic groups within the Australian population.

Building African Capacity for HIV/AIDS Prevention Trials

International Development Research Centre (IDRC) Digital Library (Canada)

Canada-Africa Prevention Trials Network : Building African Capacity for HIV/AIDS Prevention Trials. The Canada-Africa Prevention Trials Network (CAPT Network) was formed through a capacity building grant from the Global Health Research Initiative (GHRI). The Network comprises eight African centres (four in Uganda, ...

Perceived Neighborhood Quality and HIV-related Stigma among African Diasporic Youth; Results from the African, Caribbean, and Black Youth (ACBY) Study.

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Kerr, Jelani; Northington, Toya; Sockdjou, Tamara; Maticka-Tyndale, Eleanor

2018-01-01

Socio-environmental factors such as neighborhood quality are increasingly recognized drivers of HIV disparities. Additionally, HIV- related stigma heightens HIV vulnerability among youth in the African Diaspora. However, little research examines the intersection of neighborhood quality and HIV- related stigma. This study uses survey data (N=495) from African, Caribbean, and Black youth in a midsized city in Ontario, Canada to address this research deficit. Analysis of variance and multivariate ordinary least squares regressions were conducted to determine differences in HIV- related stigma by neighborhood quality, experiences of discrimination, HIV- knowledge, and demographic factors. Residents in more socially disordered neighborhoods (p<.05), males (p<.0001), African- Muslim youth (p<.01), and individuals with lower HIV- knowledge (p<.0001) endorsed stigmatizing beliefs more often. Addressing neighborhood disadvantage may have implications for HIV- related stigma. More research should be conducted to understand the impact of socio- environmental disadvantage and HIV- related stigma.

Treating 'AIDS blindness': A critical pedagogical approach to HIV ...

African Journals Online (AJOL)

HIV and AIDS affect all South Africans, irrespective of gender, race, age and economic status. Teachers should therefore be able to meaningfully integrate HIV content into the school curriculum. However, pre-service teacher education programmes still do not pay adequate attention to HIV education, particularly in ...

Understanding HIV Transmission Risk Behavior Among HIV-Infected South Africans Receiving Antiretroviral Therapy: An Information—Motivation—Behavioral Skills Model Analysis

Science.gov (United States)

Kiene, Susan M.; Fisher, William A.; Shuper, Paul A.; Cornman, Deborah H.; Christie, Sarah; MacDonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Fisher, Jeffrey D.

2014-01-01

The current study applied the Information—Motivation—Behavioral Skills (IMB) model (J. D. Fisher & Fisher, 1992; W. A. Fisher & Fisher, 1993) to identify factors associated with HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa’s generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa. Results confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, while for women, the effects of HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV preventive behavior. These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa’s generalized HIV epidemic. PMID:23477576

Engaging African and Caribbean Immigrants in HIV Testing and Care in a Large US City: Lessons Learned from the African Diaspora Health Initiative.

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Kwakwa, Helena A; Wahome, Rahab; Goines, Djalika S; Jabateh, Voffee; Green, Arraina; Bessias, Sophia; Flanigan, Timothy P

2017-08-01

The lifting in 2010 of the HIV entry ban eliminated an access point for HIV testing of the foreign-born. The African Diaspora Health Initiative (ADHI) was developed to examine alternative pathways to testing for African and Caribbean persons. The ADHI consists of Clinics Without Walls (CWW) held in community settings. HIV testing is offered to participants along with hypertension and diabetes screening. A survey is administered to participants. Descriptive data were analyzed using SAS 9.2. Between 2011 and 2015, 4152 African and Caribbean individuals participated in 352 CWW. Participants were mostly (67.7 %) African. HIV rates were lowest in Caribbean women (0.4 %) and highest in Caribbean men (8.4 %). Efforts to engage African and Caribbean communities in HIV testing are important given the elimination of the HIV entry ban and continued immigration to the US from areas of higher prevalence. The ADHI offers a successful model of engagement.

African Journal of AIDS Research - Vol 10, No 3-Sup (2011)

African Journals Online (AJOL)

Gendered perceptions of HIV risk among young women and men in a ... Employment discrimination and HIV stigma: survey results from civil society ... treatment adherence in a South African mining workplace programme and implications for ...

Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: an information--motivation--behavioral skills model analysis.

Science.gov (United States)

Kiene, Susan M; Fisher, William A; Shuper, Paul A; Cornman, Deborah H; Christie, Sarah; Macdonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Fisher, Jeffrey D

2013-08-01

The current study applied the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992; Fisher & Fisher, 1993) to identify factors associated with human immunodeficiency virus (HIV) transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa's generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa. Findings confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, whereas for women, the effect of HIV prevention motivation works through HIV prevention behavioral skills to affect HIV preventive behavior. These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa's generalized HIV epidemic. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Stigma, lack of knowledge and prevalence maintain HIV risk among Black Africans in New Zealand.

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Henrickson, Mark; Dickson, Nigel; Mhlanga, Fungai; Ludlam, Adrian

2015-02-01

The AfricaNZ Health project aimed explore HIV risks in Black African communities in NZ with a view to informing HIV infection prevention and health promotion programs. AfricaNZ Health was completed in two phases. The first developed desk estimates of the resident Black African population in New Zealand, and Africans living with HIV. The second comprised two arms: an anonymous survey administered at African community events and a series of focus groups around the country. High levels of knowledge and positive attitudes about HIV were more often found in older than younger age groups. Condom use was higher in the younger group than in older age groups. Traditional attitudes still inform some beliefs about HIV. Stigma about HIV and anyone at risk for HIV remains very high among Africans. Western sexual identity constructs are not meaningful. A culturally informed strategy for risk and stigma reduction is urgently needed. The existing prevention and care infrastructure, informed by MSM experiences, must address increased risk to Black African new settlers, but this is not a reason to discriminate or further stigmatise an already vulnerable population. © 2014 Public Health Association of Australia.

Evaluating the Measurement Structure of the Abbreviated HIV Stigma Scale in a Sample of African Americans Living with HIV/AIDS

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Johnson, Eboneé T.; Yaghmaian, Rana A.; Best, Andrew; Chan, Fong; Burrell, Reginald, Jr.

2016-01-01

Purpose: The purpose of this study was to validate the 10-item version of the HIV Stigma Scale (HSS-10) in a sample of African Americans with HIV/AIDS. Method: One hundred and ten African Americans living with HIV/AIDS were recruited from 3 case management agencies in Baton Rouge, Louisiana. Measurement structure of the HSS-10 was evaluated using…

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review.

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Ngidi, Wilbroda H; Naidoo, Joanne R; Ncama, Busisiwe P; Luvuno, Zamasomi P B; Mashamba-Thompson, Tivani P

2017-05-29

Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included 'Sub-Saharan African countries', 'implementation strategies', 'interventions to bridge implementation gap', 'prevention of mother-to-child transmission of HIV' and 'closing implementation gap'. Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use - mHealth, family-centred approaches, male involvement, culturally appropriate interventions). There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.

A multilevel understanding of HIV/AIDS disease burden among African American women.

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Brawner, Bridgette M

2014-01-01

Disproportionate HIV/AIDS rates among African American women have been examined extensively, primarily from an individual-centered focus. Beyond individual behaviors, factors such as the hyperincarceration of African American men and geographically concentrated disadvantage may better explain inequitable disease burden. In this article I propose a conceptual model of individual, social, and structural factors that influence HIV transmission among African American women. The model can be used to develop comprehensive assessments and guide prevention programs in African American communities. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

The Global Fund's resource allocation decisions for HIV programmes

DEFF Research Database (Denmark)

Avdeeva, Olga; Lazarus, Jeff; Aziz, Mohamed Abdel

2011-01-01

Between 2002 and 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria's investment in HIV increased substantially to reach US$12 billion. We assessed how the Global Fund's investments in HIV programmes were targeted to key populations in relation to disease burden and national income....

South African Antarctic research programme 1978-1982

CSIR Research Space (South Africa)

SASCAR

1978-12-01

Full Text Available This document provides a comprehensive review of the planned South African scientific activities in Antarctica and on the sub-Antarctic islands in the five year period starting in 1978. The scientific programmes are classified under five headings...

Critical consciousness, racial and gender discrimination, and HIV disease markers in African American women with HIV.

Science.gov (United States)

Kelso, Gwendolyn A; Cohen, Mardge H; Weber, Kathleen M; Dale, Sannisha K; Cruise, Ruth C; Brody, Leslie R

2014-07-01

Critical consciousness, the awareness of social oppression, is important to investigate as a buffer against HIV disease progression in HIV-infected African American women in the context of experiences with discrimination. Critical consciousness comprises several dimensions, including social group identification, discontent with distribution of social power, rejection of social system legitimacy, and a collective action orientation. The current study investigated self-reported critical consciousness as a moderator of perceived gender and racial discrimination on HIV viral load and CD4+ cell count in 67 African American HIV-infected women. Higher critical consciousness was found to be related to higher likelihood of having CD4+ counts over 350 and lower likelihood of detectable viral load when perceived racial discrimination was high, as revealed by multiple logistic regressions that controlled for highly active antiretroviral therapy (HAART) adherence. Multiple linear regressions showed that at higher levels of perceived gender and racial discrimination, women endorsing high critical consciousness had a larger positive difference between nadir CD4+ (lowest pre-HAART) and current CD4+ count than women endorsing low critical consciousness. These findings suggest that raising awareness of social oppression to promote joining with others to enact social change may be an important intervention strategy to improve HIV outcomes in African American HIV-infected women who report experiencing high levels of gender and racial discrimination.

Oral manifestations among people living with HIV/AIDS in Tanzania

DEFF Research Database (Denmark)

Fabian, F M; Kahabuka, F K; Petersen, P E

2009-01-01

BACKGROUND: This study aimed to determine the prevalence of various oral and peri-oral manifestations in people living with HIV/AIDS in Tanzania. METHODS: A cross sectional study. A total of 187 persons with HIV infection were recruited from non-governmental organisations serving people living...... associated with low body mass index (BMI). CONCLUSION: This community survey carried out in an African sub-Saharan country showed that oral lesions are frequent among people living with HIV/AIDS. As emphasised by the World Health Organization Global Oral Health Programme, national HIV/AIDS programmes should...

A Systematic Review of HIV Serostatus Disclosure Among African Immigrants in Europe.

Science.gov (United States)

Whembolua, Guy-Lucien; Conserve, Donaldson F; Thomas, Kirstyn; Handler, Lara

2017-08-01

As the human immunodeficiency virus continues to devastate large parts of Africa, particularly the Sub-Saharan region, the number of immigrants migrating from these areas to European nations continues to grow. African men and women leave their countries for Europe because of armed conflicts, unemployment, or poverty. Thus, these migration patterns combined with newly contracted infections have resulted in a large and growing number of HIV-positive diagnoses among African immigrants living in Europe. Using the disclosure process model, this systematic review examines the reasons for HIV status disclosure and nondisclosure among African immigrants residing in Europe. PubMed, PsycINFO, Embase, Global Health, and Web of Science were searched. Bibliographies of retrieved studies were also reviewed for other relevant citations. Studies were eligible if they: (1) focused on HIV-positive immigrants from SSA residing in Europe; and (2) described or measured HIV status disclosure. Out of 166 articles found, a total of 17 articles and 1 brief report met the inclusion criteria. Factors such as stigma and social implications of disclosure contribute to avoidance goals leading to nondisclosure while approach goals or disclosure reasons were found to include health status and behaviors such as seeking support, and helping others. The findings highlight the importance of understanding the avoidance and approach goals involved in HIV status disclosure among African immigrants in Europe. Interventions and future research directed at increasing HIV disclosure among African immigrants in Europe should move beyond individual-level to consider multilevel factors including country-specific social behaviors.

Correlates of HIV Risk Reduction Self-Efficacy among Youth in South Africa

Directory of Open Access Journals (Sweden)

Julia Louw

2012-01-01

Full Text Available Even though a decline in HIV prevalence has been reported among South African youth 15–24 from 10.3% in 2005 to 8.6% in 2008, the prevalence remains disproportionately high for females overall in comparison to males. This study examines factors associated by HIV risk reduction self-efficacy of South African youth as part of an evaluation of the impact of loveLife, a youth focused HIV prevention programme. A cross-sectional population-based household survey was conducted with persons of ages 18 to 24 years in four selected provinces in South Africa. Among female respondents (, factors associated with high self-efficacy in the adjusted model were having a low HIV risk perception, HIV/AIDS stigma, ever using drugs, and having life goals. Male respondents ( with high self-efficacy were more likely to have been tested for HIV, have concurrent sexual partners, have had a transactional sex partner in lifetime, a low HIV risk perception, difficulty in having condoms, agreed with coercive sex, high relationship control, and had loveLife face-to-face programme participation. The factors identified with high self-efficacy and HIV-sexual risk behaviour may be considered to strengthen youth HIV prevention programmes in South Africa.

Risk and protection for HIV/AIDS in African-American, Hispanic, and White adolescents.

Science.gov (United States)

Bartlett, Robin; Buck, Raymond; Shattell, Mona M

2008-07-01

African-Americans and Hispanics are disproportionately affected by HIV/AIDS in the United States. HIV infection is often acquired during adolescence, a time when risky sexual behaviors are at their peak. This study explored relationships among selected risk factors, protective factors, and risky sexual behaviors among African-American, Hispanic, and White adolescents, from a sample of adolescents from the National Longitudinal Study of Adolescent Health. African-Americans and Hispanics were more likely to have sexual intercourse without the use of birth control than were Whites. African-Americans were more likely to have sexual behavior with multiple sexual partners than either Hispanics or Whites were, and African-Americans had higher self-esteem than did Hispanics and Whites. In order to develop culturally sensitive, effective interventions to prevent HIV/AIDS in adolescents, racial differences in risk and protective factors must be examined.

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study.

Science.gov (United States)

Seguin, Maureen; Dodds, Catherine; Mugweni, Esther; McDaid, Lisa; Flowers, Paul; Wayal, Sonali; Zomer, Ella; Weatherburn, Peter; Fakoya, Ibidun; Hartney, Thomas; McDonagh, Lorraine; Hunter, Rachael; Young, Ingrid; Khan, Shabana; Freemantle, Nick; Chwaula, Jabulani; Sachikonye, Memory; Anderson, Jane; Singh, Surinder; Nastouli, Eleni; Rait, Greta; Burns, Fiona

2018-04-01

difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.

Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study.

Directory of Open Access Journals (Sweden)

Quang Duy Pham

Full Text Available Vietnam has been largely reliant on international support in its HIV response. Over 2006-2010, a total of US$480 million was invested in its HIV programmes, more than 70% of which came from international sources. This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness.We conducted a data synthesis of HIV programming, spending, epidemiological, and clinical outcomes. Counterfactual scenarios were defined based on assumed programme coverage and behaviours had the programmes not been implemented. An epidemiological model, calibrated to reflect the actual epidemiological trends, was used to estimate plausible ranges of programme impacts. The model was then used to estimate the costs per averted infection, death, and disability adjusted life-year (DALY.Based on observed prevalence reductions amongst most population groups, and plausible counterfactuals, modelling suggested that antiretroviral therapy (ART and prevention programmes over 2006-2010 have averted an estimated 50,600 [95% uncertainty bound: 36,300-68,900] new infections and 42,600 [36,100-54,100] deaths, resulting in 401,600 [312,200-496,300] fewer DALYs across all population groups. HIV programmes in Vietnam have cost an estimated US$1,972 [1,447-2,747], US$2,344 [1,843-2,765], and US$248 [201-319] for each averted infection, death, and DALY, respectively.Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective. ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden.

Estimating the Cost-Effectiveness of HIV Prevention Programmes in Vietnam, 2006-2010: A Modelling Study

Science.gov (United States)

Pham, Quang Duy; Wilson, David P.; Kerr, Cliff C.; Shattock, Andrew J.; Do, Hoa Mai; Duong, Anh Thuy; Nguyen, Long Thanh; Zhang, Lei

2015-01-01

Introduction Vietnam has been largely reliant on international support in its HIV response. Over 2006-2010, a total of US$480 million was invested in its HIV programmes, more than 70% of which came from international sources. This study investigates the potential epidemiological impacts of these programmes and their cost-effectiveness. Methods We conducted a data synthesis of HIV programming, spending, epidemiological, and clinical outcomes. Counterfactual scenarios were defined based on assumed programme coverage and behaviours had the programmes not been implemented. An epidemiological model, calibrated to reflect the actual epidemiological trends, was used to estimate plausible ranges of programme impacts. The model was then used to estimate the costs per averted infection, death, and disability adjusted life-year (DALY). Results Based on observed prevalence reductions amongst most population groups, and plausible counterfactuals, modelling suggested that antiretroviral therapy (ART) and prevention programmes over 2006-2010 have averted an estimated 50,600 [95% uncertainty bound: 36,300–68,900] new infections and 42,600 [36,100–54,100] deaths, resulting in 401,600 [312,200–496,300] fewer DALYs across all population groups. HIV programmes in Vietnam have cost an estimated US$1,972 [1,447–2,747], US$2,344 [1,843–2,765], and US$248 [201–319] for each averted infection, death, and DALY, respectively. Conclusions Our evaluation suggests that HIV programmes in Vietnam have most likely had benefits that are cost-effective. ART and direct HIV prevention were the most cost-effective interventions in reducing HIV disease burden. PMID:26196290

Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case.

Science.gov (United States)

Meyer-Rath, Gesine; van Rensburg, Craig; Larson, Bruce; Jamieson, Lise; Rosen, Sydney

2017-01-01

The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment Case produced an alternative cost-effectiveness threshold for HIV prevention and treatment interventions based on estimates of life years saved and the country's committed HIV budget. We analysed the optimal mix of HIV interventions over a baseline of the current HIV programme under the committed HIV budget for 2016-2018. We calculated the incremental cost-effectiveness ratio (ICER) as cost per life-year saved (LYS) of 16 HIV prevention and treatment interventions over 20 years (2016-2035). We iteratively evaluated the most cost effective option (defined by an intervention and its coverage) over a rolling baseline to which the more cost effective options had already been added, thereby allowing for diminishing marginal returns to interventions. We constrained the list of interventions to those whose combined cost was affordable under the current HIV budget. Costs are presented from the government perspective, unadjusted for inflation and undiscounted, in 2016 USD. The current HIV budget of about $1.6 billion per year was sufficient to pay for the expansion of condom availability, medical male circumcision, universal treatment, and infant testing at 6 weeks to maximum coverage levels, while also implementing a social and behavior change mass media campaign with a message geared at increasing testing uptake and reducing the number of sexual partners. The combined ICER of this package of services was $547/ LYS. The ICER of the next intervention that was above the affordability threshold was $872/LYS. The results of the South African HIV Investment Case point to an HIV cost-effectiveness threshold based on affordability under the current budget of $547-872 per life year saved, a small fraction of the country's GDP per capita of

Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case.

Directory of Open Access Journals (Sweden)

Gesine Meyer-Rath

Full Text Available The use of cost-effectiveness thresholds based on a country's income per capita has been criticized for not being relevant to decision making, in particular in middle-income countries such as South Africa. The recent South African HIV Investment Case produced an alternative cost-effectiveness threshold for HIV prevention and treatment interventions based on estimates of life years saved and the country's committed HIV budget.We analysed the optimal mix of HIV interventions over a baseline of the current HIV programme under the committed HIV budget for 2016-2018. We calculated the incremental cost-effectiveness ratio (ICER as cost per life-year saved (LYS of 16 HIV prevention and treatment interventions over 20 years (2016-2035. We iteratively evaluated the most cost effective option (defined by an intervention and its coverage over a rolling baseline to which the more cost effective options had already been added, thereby allowing for diminishing marginal returns to interventions. We constrained the list of interventions to those whose combined cost was affordable under the current HIV budget. Costs are presented from the government perspective, unadjusted for inflation and undiscounted, in 2016 USD.The current HIV budget of about $1.6 billion per year was sufficient to pay for the expansion of condom availability, medical male circumcision, universal treatment, and infant testing at 6 weeks to maximum coverage levels, while also implementing a social and behavior change mass media campaign with a message geared at increasing testing uptake and reducing the number of sexual partners. The combined ICER of this package of services was $547/ LYS. The ICER of the next intervention that was above the affordability threshold was $872/LYS.The results of the South African HIV Investment Case point to an HIV cost-effectiveness threshold based on affordability under the current budget of $547-872 per life year saved, a small fraction of the country's GDP

HIV/AIDS policies, practices and conditions in South African prisons ...

African Journals Online (AJOL)

The level of HIV infection in South African prisoners is unknown. However, given that 4.2 million citizens or 20% of the adult population are infected by HIV then the problem of infection within the prison system would seem to be a large and a significant management issue. Policies to treat HIV+ prisoners and prevent HIV ...

Promoting African American women and sexual assertiveness in reducing HIV/AIDS: an analytical review of the research literature.

Science.gov (United States)

Kennedy, Bernice Roberts; Jenkins, Chalice C

2011-01-01

African American women, including adolescents and adults, are disproportionately affected by the transmission of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). HIV/AID is a health disparity issue for African American females in comparison to other ethnic groups. According to data acquired from 33 states in 2005, 64% of women who have HIV/ AIDS are African American women. It is estimated that during 2001-2004, 61% of African Americans under the age of 25 had been living with HIV/AIDS. This article is an analytical review of the literature emphasizing sexual assertiveness of African American women and the gap that exists in research literature on this population. The multifaceted model of HIV risk posits that an interpersonal predictor of risky sexual behavior is sexual assertiveness. The critical themes extracted from a review of the literature reveal the following: (a) sexual assertiveness is related to HIV risk in women, (b) sexual assertiveness and sexual communication are related, and (c) women with low sexual assertiveness are at increased risk of HIV As a result of this comprehensive literature, future research studies need to use models in validating sexual assertiveness interventions in reducing the risk of HIV/AIDS in African American women. HIV/AIDs prevention interventions or future studies need to target reducing the risk factors of HIV/AIDS of African Americans focusing on gender and culture-specific strategies.

Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa

Directory of Open Access Journals (Sweden)

Essack Zaynab

2010-03-01

Full Text Available Abstract Background Africa continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges. Methods In order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009. Results Key cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing. Conclusion The consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields.

Convergent ethical issues in HIV/AIDS, tuberculosis and malaria vaccine trials in Africa: Report from the WHO/UNAIDS African AIDS Vaccine Programme's Ethics, Law and Human Rights Collaborating Centre consultation, 10-11 February 2009, Durban, South Africa.

Science.gov (United States)

Mamotte, Nicole; Wassenaar, Douglas; Koen, Jennifer; Essack, Zaynab

2010-03-09

Africa continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges. In order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009. Key cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing. The consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields.

African American Clergy Perspectives About the HIV Care Continuum: Results From a Qualitative Study in Jackson, Mississippi.

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Nunn, Amy; Parker, Sharon; McCoy, Katryna; Monger, Mauda; Bender, Melverta; Poceta, Joanna; Harvey, Julia; Thomas, Gladys; Johnson, Kendra; Ransome, Yusuf; Sutten Coats, Cassandra; Chan, Phil; Mena, Leandro

2018-01-01

Mississippi has some of the most pronounced racial disparities in HIV infection in the country; African Americans comprised 37% of the Mississippi population but represented 80% of new HIV cases in 2015. Improving outcomes along the HIV care continuum, including linking and retaining more individuals and enhancing adherence to medication, may reduce the disparities faced by African Americans in Mississippi. Little is understood about clergy's views about the HIV care continuum. We assessed knowledge of African American pastors and ministers in Jackson, Mississippi about HIV and the HIV care continuum. We also assessed their willingness to promote HIV screening and biomedical prevention technologies as well as efforts to enhance linkage and retention in care with their congregations. Four focus groups were conducted with 19 African American clergy. Clergy noted pervasive stigma associated with HIV and believed they had a moral imperative to promote HIV awareness and testing; they provided recommendations on how to normalize conversations related to HIV testing and treatment. Overall, clergy were willing to promote and help assist with linking and retaining HIV positive individuals in care but knew little about how HIV treatment can enhance prevention or new biomedical technologies such as pre-exposure prophylaxis (PrEP). Clergy underscored the importance of building coalitions to promote a collective local response to the epidemic. The results of this study highlight important public health opportunities to engage African American clergy in the HIV care continuum in order to reduce racial disparities in HIV infection.

The impact of alcohol on HIV prevention and treatment for South Africans in primary healthcare

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Michelle Schneider

2014-02-01

Full Text Available Background: Antiretroviral treatment (ART has substantially reduced morbidity and mortality for HIV patients. In South Africa, with the largest ART programme globally, attention is needed not only on the further expansion of ART coverage, but also on factors which undermine its effectiveness, such as alcohol use.Objective: Given the decentralised approach of nurse-initiated and -sustained ART in the South African primary health sector, it is important to document key aspects of alcohol use to be conveyed to HIV-positive individuals and those at risk for HIV.Method: This study comprised a narrative review of relevant literature.Results: Alcohol acts through both behavioural and physiological pathways to impact on the acquisition, further transmission and then progression of HIV disease. Besides links to risky sex, alcohol undermines the immune system, raising susceptibility to contracting and then countering HIV and other infections. There are important drug interactions between alcohol and ART, or therapies for opportunistic infections and other co-morbidities. Moreover, alcohol undermines adherence to the medication which is essential for effective ART.Conclusion: Primary healthcare clinic attendees need evidence-based information on the detrimental effects of alcohol consumption on HIV infection, which ensue throughout the clinical course of HIV. This spans the role of alcohol consumption as a risk factor for HIV infection, HIV replication in infected individuals, a person’s response to HIV infection and HIV treatment. Primary healthcare workers, especially nurses and HIV counsellors, require training in order to screen for and provide appropriate interventions for HIV-positive patients, those on treatment and treatment-naïve patients, who will benefit from reduced alcohol consumption or the cessation thereof.

Evaluation of an HIV-risk reduction programme for first-year ...

African Journals Online (AJOL)

Results indicated that HIV-related knowledge; condom knowledge and risk perception were enhanced by the HIV- related risk reduction programme. However, there is a need for improvement, especially with regard to attitudes towards condoms since some students still had negative attitudes even after the intervention ...

Cutting the cost of South African antiretroviral therapy using newer, safer drugs

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W F Venter

2017-01-01

Full Text Available Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.

Brief research report: sociodemographic factors associated with HIV status among African American women in Washington, DC

Directory of Open Access Journals (Sweden)

Perkins EL

2013-09-01

Full Text Available Emory L Perkins,1 Dexter R Voisin,2 Kesslyn A Brade Stennis1 1Department of Social Work, Bowie State University, Bowie, MD, USA; 2School of Social Service Administration, University of Chicago, Chicago, IL, USA Introduction: African American women living in Washington, DC have one of the highest Human immunodeficiency virus (HIV incidence rates in the US. However, this population has been understudied, especially as it relates to factors associated with HIV status. Methods: This cross-sectional study examined sociodemographic factors that were associated with having a negative or positive HIV status among a sample of 115 African American women between the ages of 24 and 44 years. We assessed such factors as age, education, sexual orientation, household income, sources of income, number of children, length of residency tenure in Washington, DC, and level of HIV-prevention knowledge. Results: Among the overall sample, 53 women self-identified as HIV-positive and 62 as HIV-negative. Compared to their HIV-negative counterparts, women who reported being HIV-positive were less educated, had lower household income, and had longer residency tenure in Washington, DC. There were no differences in HIV knowledge between HIV-positive and -negative study participants. Conclusion: These findings may provide important directions for targeting specific subpopulations of African Americans for HIV-prevention/intervention programs. Keywords: HIV status, African American women, sociodemographic factors

Retention and mortality on antiretroviral therapy in sub-Saharan Africa: collaborative analyses of HIV treatment programmes.

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Haas, Andreas D; Zaniewski, Elizabeth; Anderegg, Nanina; Ford, Nathan; Fox, Matthew P; Vinikoor, Michael; Dabis, François; Nash, Denis; Sinayobye, Jean d'Amour; Niyongabo, Thêodore; Tanon, Aristophane; Poda, Armel; Adedimeji, Adebola A; Edmonds, Andrew; Davies, Mary-Ann; Egger, Matthias

2018-02-01

By 2020, 90% of all people diagnosed with HIV should receive long-term combination antiretroviral therapy (ART). In sub-Saharan Africa, this target is threatened by loss to follow-up in ART programmes. The proportion of people retained on ART long-term cannot be easily determined, because individuals classified as lost to follow-up, may have self-transferred to another HIV treatment programme, or may have died. We describe retention on ART in sub-Saharan Africa, first based on observed data as recorded in the clinic databases, and second adjusted for undocumented deaths and self-transfers. We analysed data from HIV-infected adults and children initiating ART between 2009 and 2014 at a sub-Saharan African HIV treatment programme participating in the International epidemiology Databases to Evaluate AIDS (IeDEA). We used the Kaplan-Meier method to calculate the cumulative incidence of retention on ART and the Aalen-Johansen method to calculate the cumulative incidences of death, loss to follow-up, and stopping ART. We used inverse probability weighting to adjust clinic data for undocumented mortality and self-transfer, based on estimates from a recent systematic review and meta-analysis. We included 505,634 patients: 12,848 (2.5%) from Central Africa, 109,233 (21.6%) from East Africa, 347,343 (68.7%) from Southern Africa and 36,210 (7.2%) from West Africa. In crude analyses of observed clinic data, 52.1% of patients were retained on ART, 41.8% were lost to follow-up and 6.0% had died 5 years after ART initiation. After accounting for undocumented deaths and self-transfers, we estimated that 66.6% of patients were retained on ART, 18.8% had stopped ART and 14.7% had died at 5 years. Improving long-term retention on ART will be crucial to attaining the 90% on ART target. Naïve analyses of HIV cohort studies, which do not account for undocumented mortality and self-transfer of patients, may severely underestimate both mortality and retention on ART. © 2018 The

The Significance of Sexuality and Intimacy in the Lives of Older African Americans With HIV/AIDS

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Nevedal, Andrea; Sankar, Andrea

2016-01-01

Purpose of the Study: Aging and HIV/AIDS research focuses primarily on standardized clinical, social, and behavioral measures, leaving unanswered questions about how this chronic and stigmatizing condition affects life course expectations and the meaning of aging with the disease. Utilizing Gaylene Becker’s (1997) life course disruption theory, we explored older African Americans’ experiences of living with HIV/AIDS. Design and Methods: A purposive sample (N = 43) of seropositive African Americans aged 50 and older was selected from a parent study. Thirteen participants completed one semi-structured in-depth interview on life course expectations and experiences of living with HIV/AIDS. Interview transcripts were analyzed using standard qualitative coding and thematic analysis. Results: Responding to broad, open-ended questions about the impact of HIV on life course expectations, participants emphasized how HIV limited their ability to experience sexuality and intimacy. Two major themes emerged, damaged sexuality and constrained intimacy. Implications: Older African Americans’ discussions of living with HIV focused on the importance of and the challenges to sexuality and intimacy. Researchers and clinicians should be attentive to significant and ongoing HIV-related challenges to sexuality and intimacy facing older African Americans living with HIV/AIDS. PMID:26035889

Determinants of Self-Perceived HIV Risk in Young South Africans ...

African Journals Online (AJOL)

Determinants of Self-Perceived HIV Risk in Young South Africans Engaged in Concurrent Sexual Relationships. C Kenyon, S Zondo, M Badri. Abstract. Concurrent sexual partnerships are increasingly believed to be a key factor explaining the size of the HIV pandemic in Southern and Eastern Africa. Little, however, is ...

Sociocultural dimensions of HIV/AIDS among Middle Eastern immigrants in the US: bridging culture with HIV/AIDS programmes.

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Ehsanzadeh-Cheemeh, Parvaneh; Sadeque, Abul; Grimes, Richard M; Essien, E James

2009-09-01

The population of Middle Eastern immigrants in the US has been increasing dramatically over the past 30 years, growing from 200,000 in 1970 to 1.5 million in 2000. These immigrants and their descendants constitute an important new population of interest for public health and other social programmes. With this addition to the cultural diversity of American society, it is important for healthcare programmes to be responsive to the unique cultural needs of those of Middle Eastern origin and to include them in healthcare curricula. This need is particularly imperative for human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) intervention programmes, where the reduction of risky behaviours is essential to controlling the epidemic. When Middle Easterners emigrate to the US they must adjust to the American culture, which leads to preservation of some aspects of their culture and adjustment of behaviors to match American customs. This article aims to present sociocultural factors of HIV risk behaviours that are specific to Middle Eastern culture. The article also provides recommendations for HIV/AIDS-culturally appropriate intervention programmes.

Gender norms in South Africa: Implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution

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Mantell, Joanne E.; Needham, Sarah L.; Smit, Jennifer Ann; Hoffman, Susie; Cebekhulu, Queen; Adams-Skinner, Jessica; Exner, Theresa M.; Mabude, Zonke; Beksinska, Mags; Stein, Zena A.; Milford, Cecilia

2009-01-01

In post-Apartheid South Africa, women are constitutionally guaranteed protections and freedoms that were previously unknown to them. These freedoms may have positive implications for women’s ability to negotiate sexual protection with partners and hence prevent unintended pregnancy and decrease their risk of HIV. Among tertiary institution students who are a relatively ‘privileged’ group, there is little information on gender norms that might shape responses to HIV prevention programmes. To elicit gender norms regarding women’s and men’s roles, condom and contraceptive use, sexual communication, and sexual pleasure, we conducted 10 semi-structured focus group discussions with African and Indian female tertiary institution students so as to understand how norms might be used to buttress HIV and pregnancy prevention. Participants reported dramatic changes in the structure of gender norms and relations with the formal recognition of women’s rights in the post-Apartheid context. These generational shifts in norms are supported by other research in South Africa. At the same time, women recognized the co-existence of traditional constructions of gender that operate to constrain women’s freedom. The perceived changes that have taken place provide an entry point for intervention, particularly for reinforcing emerging gender norms that promote women’s protection against unintended pregnancy and HIV/STIs. PMID:19247859

Gender norms in South Africa: implications for HIV and pregnancy prevention among African and Indian women students at a South African tertiary institution.

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Mantell, Joanne E; Needham, Sarah L; Smit, Jennifer Ann; Hoffman, Susie; Cebekhulu, Queen; Adams-Skinner, Jessica; Exner, Theresa M; Mabude, Zonke; Beksinska, Mags; Stein, Zena A; Milford, Cecilia

2009-02-01

In post-Apartheid South Africa, women are constitutionally guaranteed protections and freedoms that were previously unknown to them. These freedoms may have positive implications for women's ability to negotiate sexual protection with partners and hence prevent unintended pregnancy and decrease their risk of HIV. Among tertiary institution students, who are a relatively 'privileged' group, there is little information on gender norms that might shape responses to HIV-prevention programmes. To elicit gender norms regarding women's and men's roles, condom and contraceptive use, sexual communication and sexual pleasure, we conducted 10 semi-structured focus group discussions with African and Indian female tertiary institution students in order to understand how norms might be used to buttress HIV- and pregnancy-prevention. Participants reported dramatic changes in the structure of gender norms and relations with the formal recognition of women's rights in the post-Apartheid context. These generational shifts in norms are supported by other research in South Africa. At the same time, women recognized the co-existence of traditional constructions of gender that operate to constrain women's freedom. The perceived changes that have taken place provide an entry point for intervention, particularly for reinforcing emerging gender norms that promote women's protection against unintended pregnancy and HIV/STIs.

The role of small satellites in the development of the South African space programme

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Martinez, Peter

In the 1990s a team of scientists and engineers at Stellenbosch University built the first South African satellite to fly in space, the 64-kg Sunsat. This university-based satellite programme took advantage of the skills and facilities developed in the previous South African space programme of the 1980s and early 1990s, which had developed a much larger satellite (Greensat), but was cancelled in the mid-1990s prior to launch. Sunsat incorporated a number of novel capabilities for a microsatellite platform, and interest was shown in these technologies by other groups developing similar satellites. As the University was not the ideal environment to develop the commercial potential of these microsatellite technologies, a company called Sunspace was later established, thus creating industrial capacity in South Africa in a niche area of space technology. This new industrial capability, together with the infrastructure from the previous space programme, have created a foundation upon which to build the new South African space programme. This paper discusses the historical, current and possible future roles of small satellites in the development of the South African space programme.

College Graduation Reduces Vulnerability to STIs / HIV among African-American Young Adult Women

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Painter, Julia E.; Wingood, Gina M.; DiClemente, Ralph J.; DePadilla, Lara M.; Simpson-Robinson, LaShun

2012-01-01

African-American women are disproportionately affected by STIs including HIV. The Theory of Gender and Power (TGP) posits that economic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (N=848) aged 18–29 recruited from three Kaiser Permanente Centers in Atlanta, GA. Data collection included 1) a survey of demographic, psychosocial, and behavioral measures and 2) self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared to participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the Sexual Division of Power and the Structure of Cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural level interventions, emphasizing both high-school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women. PMID:22555218

African American church-based HIV testing and linkage to care: assets, challenges and needs.

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Stewart, Jennifer M; Thompson, Keitra; Rogers, Christopher

2016-01-01

The US National HIV AIDS strategy promotes the use of faith communities to lessen the burden of HIV in African American communities. One specific strategy presented is the use of these non-traditional venues for HIV testing and co-location of services. African American churches can be at the forefront of this endeavour through the provision of HIV testing and linkage to care. However, there are few interventions to promote the churches' involvement in both HIV testing and linkage to care. We conducted 4 focus groups (n = 39 participants), 4 interviews and 116 surveys in a mixed-methods study to examine the feasibility of a church-based HIV testing and linkage to care intervention in Philadelphia, PA, USA. Our objectives were to examine: (1) available assets, (2) challenges and barriers and (3) needs associated with church-based HIV testing and linkage to care. Analyses revealed several factors of importance, including the role of the church as an access point for testing in low-income neighbourhoods, challenges in openly discussing the relationship between sexuality and HIV, and buy-in among church leadership. These findings can support intervention development and necessitate situating African American church-based HIV testing and linkage to care interventions within a multi-level framework.

The quality of life of HIV-infected South African university students: Experiences with the WHOQOL-HIV-Bref.

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Cronje, Johan Herman; Williams, Margaret; Steenkamp, Liana; Venter, Danie; Elkonin, Diane

2017-05-01

HIV and AIDS has serious repercussions on psychological, social and physical well-being, and the assessment of Quality of Life (QoL) of people living with HIV and AIDS is essential to gauge how these challenges are met. The WHOQoL-HIV Bref forms part of a suite of instruments developed by the World Health Organisation. The purpose of this paper is to describe the quality of life of a sample of HIV-infected students at a South African university, as well as explain the internal consistency between questions within each of the QoL domains. A descriptive, cross-sectional study design using a quantitative approach was applied. A non-probability, purposive sampling approach was utilized and students enrolled in the antiretroviral therapy or wellness programme were invited to voluntarily participate in this study. The WHOQOL-HIV Bref was self-administered after explanation of the questions by a registered, trained health care professional. A total of 63 students returned completed questionnaires that were included in the analysis. Acceptable to good reliability scores were established for the following domains: Level of Independence; Social Relations; Environment and Spiritual or Personal Beliefs. Assessing QoL in the sample, the lowest score was for "Spirituality" and the highest "Social Relations". The "Physical" and "Psychological" domain scores for females were significantly lower than the score for males. There was no significant difference between any of the domain scores among participants with CD4 cell counts above or below 350 cells/mm 3 . In general the performance of this sample is encouraging and it is recommended that the measure be utilized for QoL screening, and further research. The WHOQOL-HIV Bref for students does not contain an academic wellness component which should be added considering the significant effects of HIV on neuropsychological functioning. Also further investigation into the reasons for poor scores obtained in physical and psychological

Minimum Benefits for HIV/AIDS in South African Medical Schemes ...

African Journals Online (AJOL)

... to the Minister of Health in respect of the extent of prescribed minimum benefits for HIV/AIDS. Medical schemes are required to provide the PMBs to their members without limits or co-payments. Keywords: Medical schemes; HIV; AIDS; benefits; prescribed minimum benefits. South African Actuarial Journal: 2003 3: 77-112 ...

HIV/AIDS knowledge among adolescent sign-language users in ...

African Journals Online (AJOL)

, particularly sign language users, in HIV-prevention programmes. Keywords: communication, disability, disability studies, hearing impairment, qualitative research, scoping study. African Journal of AIDS Research 2010, 9(3): 307–313 ...

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection.

Directory of Open Access Journals (Sweden)

Amy Nunn

Full Text Available In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection.

Science.gov (United States)

Nunn, Amy; Cornwall, Alexandra; Chute, Nora; Sanders, Julia; Thomas, Gladys; James, George; Lally, Michelle; Trooskin, Stacey; Flanigan, Timothy

2012-01-01

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in

Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection

Science.gov (United States)

Nunn, Amy; Cornwall, Alexandra; Chute, Nora; Sanders, Julia; Thomas, Gladys; James, George; Lally, Michelle; Trooskin, Stacey; Flanigan, Timothy

2012-01-01

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia’s most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia’s racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations’ existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services

The Significance of Sexuality and Intimacy in the Lives of Older African Americans With HIV/AIDS.

Science.gov (United States)

Nevedal, Andrea; Sankar, Andrea

2016-08-01

Aging and HIV/AIDS research focuses primarily on standardized clinical, social, and behavioral measures, leaving unanswered questions about how this chronic and stigmatizing condition affects life course expectations and the meaning of aging with the disease. Utilizing Gaylene Becker's (1997) life course disruption theory, we explored older African Americans' experiences of living with HIV/AIDS. A purposive sample (N = 43) of seropositive African Americans aged 50 and older was selected from a parent study. Thirteen participants completed one semi-structured in-depth interview on life course expectations and experiences of living with HIV/AIDS. Interview transcripts were analyzed using standard qualitative coding and thematic analysis. Responding to broad, open-ended questions about the impact of HIV on life course expectations, participants emphasized how HIV limited their ability to experience sexuality and intimacy. Two major themes emerged, damaged sexuality and constrained intimacy. Older African Americans' discussions of living with HIV focused on the importance of and the challenges to sexuality and intimacy. Researchers and clinicians should be attentive to significant and ongoing HIV-related challenges to sexuality and intimacy facing older African Americans living with HIV/AIDS. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Implementation of evidence-based HIV interventions for young adult African American women in church settings.

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Stewart, Jennifer M

2014-01-01

To assess the barriers and facilitators to using African American churches as sites for implementation of evidence-based HIV interventions among young African American women. Mixed methods cross-sectional design. African American churches in Philadelphia, PA. 142 African American pastors, church leaders, and young adult women ages 18 to 25. Mixed methods convergent parallel design. The majority of young adult women reported engaging in high-risk HIV-related behaviors. Although church leaders reported willingness to implement HIV risk-reduction interventions, they were unsure of how to initiate this process. Key facilitators to the implementation of evidence-based interventions included the perception of the leadership and church members that HIV interventions were needed and that the church was a promising venue for them. A primary barrier to implementation in this setting is the perception that discussions of sexuality should be private. Implementation of evidence-based HIV interventions for young adult African American women in church settings is feasible and needed. Building a level of comfort in discussing matters of sexuality and adapting existing evidence-based interventions to meet the needs of young women in church settings is a viable approach for successful implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Metabolic Syndrome After HIV Acquisition in South African Women.

Science.gov (United States)

Sobieszczyk, Magdalena E; Werner, Lise; Mlisana, Koleka; Naicker, Nivashnee; Feinstein, Addi; Gray, Clive M; Masson, Lindi; Passmore, Jo-Ann S; Williamson, Carolyn; Abdool Karim, Quarraisha; Abdool Karim, Salim S; Garrett, Nigel J

2016-12-01

Noncommunicable diseases are common among chronically infected patients with HIV in the developed world, but little is known about these conditions in African cohorts. We assessed the epidemiology of metabolic syndrome among young South African women during the first 3 years after HIV acquisition. A total of 160 women were followed prospectively in the CAPRISA 002 Acute Infection study. Metabolic syndrome was defined as a constellation of hyperlipidemia, hypertension, hyperglycemia/diabetes, and abdominal obesity. Time trends were assessed using generalized estimation equation models. Median age was 24 years and body mass index 27 kg/m. Prevalence of metabolic syndrome at infection was 8.7% increasing to 19.2% over 36 months (P = 0.001). The proportion of women with body mass index >30 kg/m increased from 34.4% to 47.7% (P = 0.004), those with abnormal waist circumference and elevated blood pressure increased from 33.5% to 44.3% (P = 0.060) and 23.8% to 43.9% (P metabolic syndrome was 9.13/100 person-years (95% CI: 6.02 to 13.28). Predictors of metabolic syndrome were age (per year increase odds ratio (OR) = 1.12; 95% CI: 1.07 to 1.16), time postinfection (per year OR = 1.47; 95% CI: 1.12 to 1.92), family history of diabetes (OR = 3.13; 95% CI: 1.71 to 5.72), and the human leukocyte antigen (HLA)-B*81:01 allele (OR = 2.95; 95% CI: 1.21 to 7.17), whereas any HLA-B*57 or B*58:01 alleles were protective (OR = 0.34; 95% CI: 0.15 to 0.77). HIV-1 RNA (OR = 0.89; 95% CI: 0.62 to 1.27) and CD4 count (OR = 1.03; 95% CI: 0.95 to 1.11) did not predict metabolic syndrome. The high burden of metabolic conditions in young South African HIV-infected women highlights the need to integrate noncommunicable disease and HIV care programs. Interventions to prevent cardiovascular disease must start at HIV diagnosis, rather than later during the disease course.

Taking It One Day at a Time: African American Women Aging with HIV and Co-Morbidities

OpenAIRE

Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi

2014-01-01

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52–65. Topics...

Developing consumer involvement in rural HIV primary care programmes.

Science.gov (United States)

Mamary, Edward M; Toevs, Kim; Burnworth, Karla B; Becker, Lin

2004-06-01

As part of a broader medical and psychosocial needs assessment in a rural region of northern California, USA, five focus groups were conducted to explore innovative approaches to creating a system of consumer involvement in the delivery of HIV primary care services in the region. A total of five focus groups (n = 30) were conducted with clients from three of five counties in the region with the highest number of HIV patients receiving primary care. Participants were recruited by their HIV case managers. They were adults living with HIV, who were receiving health care, and who resided in a rural mountain region of northern California. Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment. Recommendations for consumer involvement included a multi-method approach consisting of traditional written surveys, a formal advisory group, and monthly consumer led social support/informal input groups. Specific challenges discussed included winter weather conditions, transportation barriers, physical limitations, confidentiality concerns, and needs for social support and education. A multiple-method approach would ensure more comprehensive consumer involvement in the programme planning process. It is also evident that methods for incorporating consumer involvement must be adapted to the specific context and circumstances of a given programme.

Breaking the silence: South African HIV policies and the needs of men who have sex with men.

Science.gov (United States)

Rispel, Laetitia C; Metcalf, Carol A

2009-05-01

Although the HIV epidemic among men who have sex with men (MSM) in South Africa preceded the onset of the generalised HIV epidemic by several years, current policies and programmes focus on heterosexual transmission and mother-to-child transmission. We used an adaptation of the UNAIDS Country Harmonised Alignment Tool (CHAT) to assess whether existing HIV policies and programmes in South Africa address the needs of MSM. This covered mapping of key risk factors and epidemiology of HIV among MSM; participation of MSM in the HIV response; and an enabling environment for service provision, funding and human resources. We found that current policies and programmes are unresponsive to the needs of MSM and that epidemiologic information is lacking, in spite of policy on MSM in the National Strategic Plan. We recommend that government initiate sentinel surveillance to determine HIV prevalence among MSM, social science research on the contexts of HIV transmission among MSM, and appropriate HIV prevention and care strategies. MSM should be closely involved in the design of policies and programmes. Supportive programme development should include dedicated financial and human resources, appropriate guidelines, and improved access to and coverage of HIV prevention, treatment and care services for MSM.

Barriers to HIV testing for migrant black Africans in Western Europe

NARCIS (Netherlands)

Fakoya, A.; Reynolds, R.; Caswell, G.; Shiripinda, I.

2008-01-01

Migrant black Africans are disproportionately affected by HIV in Western Europe; we discuss the barriers to HIV testing for sub-Saharan migrants, with particular emphasis on the UK and the Netherlands. Cultural, social and structural barriers to testing, such as access to testing and care, fear of

HIV Treatment in African American Women-Care That Makes a Difference.

Science.gov (United States)

Okoro, Olihe; Odedina, Folakemi

2017-06-01

African American women bear a disproportionate burden of HIV disease. Socioeconomic and psycho-social factors while adding to the vulnerability of this population also contribute to non-adherence and consequently poor outcomes. The provider-patient relationship has the potential to enhance HIV medication adherence in this population. Using in-depth interviews, patient and provider perspectives are explored to identify specific elements of the provider-patient interaction that enhance patient satisfaction with care and consequently improve HIV medication adherence. Themes associated with provider attitudes and actions perceived as positively impacting care in this patient group include (1) physical touch, (2) treating (the patient) "as a person", (3) actively listening to the patient, (4) showing empathy, (5) being non-judgmental, and (6) being readily accessible. These findings suggest that the demonstration of care and commitment from the provider as perceived by the patient is important to African American women living with HIV and may significantly influence adherence behavior and enhance treatment outcomes in this population.

Combination HIV prevention for female sex workers: what is the evidence?

Science.gov (United States)

Bekker, Linda-Gail; Johnson, Leigh; Cowan, Frances; Overs, Cheryl; Besada, Donela; Hillier, Sharon; Cates, Willard

2015-01-03

Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bactericidal Immunity to Salmonella in Africans and Mechanisms Causing Its Failure in HIV Infection.

Directory of Open Access Journals (Sweden)

Yun Shan Goh

2016-04-01

Full Text Available Nontyphoidal strains of Salmonella are a leading cause of death among HIV-infected Africans. Antibody-induced complement-mediated killing protects healthy Africans against Salmonella, but increased levels of anti-lipopolysaccharide (LPS antibodies in some HIV-infected African adults block this killing. The objective was to understand how these high levels of anti-LPS antibodies interfere with the killing of Salmonella.Sera and affinity-purified antibodies from African HIV-infected adults that failed to kill invasive S. Typhimurium D23580 were compared to sera from HIV-uninfected and HIV-infected subjects with bactericidal activity. The failure of sera from certain HIV-infected subjects to kill Salmonella was found to be due to an inherent inhibitory effect of anti-LPS antibodies. This inhibition was concentration-dependent and strongly associated with IgA and IgG2 anti-LPS antibodies (p<0.0001 for both. IgG anti-LPS antibodies, from sera of HIV-infected individuals that inhibit killing at high concentration, induced killing when diluted. Conversely, IgG, from sera of HIV-uninfected adults that induce killing, inhibited killing when concentrated. IgM anti-LPS antibodies from all subjects also induced Salmonella killing. Finally, the inhibitory effect of high concentrations of anti-LPS antibodies is seen with IgM as well as IgG and IgA. No correlation was found between affinity or avidity, or complement deposition or consumption, and inhibition of killing.IgG and IgM classes of anti-S. Typhimurium LPS antibodies from HIV-infected and HIV-uninfected individuals are bactericidal, while at very high concentrations, anti-LPS antibodies of all classes inhibit in vitro killing of Salmonella. This could be due to a variety of mechanisms relating to the poor ability of IgA and IgG2 to activate complement, and deposition of complement at sites where it cannot insert in the bacterial membrane. Vaccine trials are required to understand the significance of

Source credibility and evidence format: examining the effectiveness of HIV/AIDS messages for young African Americans.

Science.gov (United States)

Major, Lesa Hatley; Coleman, Renita

2012-01-01

Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source--physician or minister--that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.

Association of Internalized and Social Network Level HIV Stigma With High-Risk Condomless Sex Among HIV-Positive African American Men

OpenAIRE

Wagner, Glenn J.; Bogart, Laura M.; Klein, David J.; Green, Harold D.; Mutchler, Matt G.; McDavitt, Bryce; Hilliard, Charles

2015-01-01

We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assess...

Identity, Physical Space, and Stigma Among African American Men Living with HIV in Chicago and Seattle.

Science.gov (United States)

Singleton, Judith L; Raunig, Manuela; Brunsteter, Halley; Desmond, Michelle; Rao, Deepa

2015-12-01

African American men have the highest rates of HIV in the USA, and research has shown that stigma, mistrust of health care, and other psychosocial factors interfere with optimal engagement in care with this population. In order to further understand reducing stigma and other psychosocial issues among African American men, we conducted qualitative interviews and focus groups with African American men in two metropolitan areas in the USA: Chicago and Seattle. We examined transcripts for relationships across variables of stigma, anonymity, self-identity, and space within the context of HIV. Our analysis pointed to similarities between experiences of stigma across the two cities and illustrated the relationships between space, isolation, and preferred anonymity related to living with HIV. The men in our study often preferred that their HIV-linked identities remain invisible and anonymous, associated with perceived and created isolation from physical community spaces. This article suggests that our health care and housing institutions may influence preferences for anonymity. We make recommendations in key areas to create safer spaces for African American men living with HIV and reduce feelings of stigma and isolation.

Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama.

Science.gov (United States)

Williams, Michelle; Moneyham, Linda; Kempf, Mirjam-Colette; Chamot, Eric; Scarinci, Isabel

2015-01-01

African American women have disproportionately high prevalence rates of HIV and cervical cancer. HIV-infected women are significantly less likely to obtain recommended cervical cancer screenings than HIV-uninfected women. The purpose of this study was to examine sociocultural and structural factors associated with cervical cancer screening among HIV-infected African American in Alabama. The PEN-3 Model and the Health Belief Model were used as theoretical frameworks. In-depth interviews were conducted with twenty HIV-infected African American women to identify perceptions, enablers, and nurturers, perceived susceptibility, perceived severity, and perceived benefits related to cervical cancer and screening. The most common positive perceptions, enablers, and nurturers that contributed to cervical cancer screening included internal motivation and awareness of the importance of HIV-infected women getting Pap tests due to their weakened immune system. Negative perceptions, enablers, and nurturers included lack of knowledge about cervical cancer and screening, and lack of perceived susceptibility to cervical cancer. The results of this study can be used to guide the development of culturally relevant cervical cancer and screening education interventions aimed at increasing cervical cancer screening adherence among HIV-infected African American women.

Globalisation, transport and HIV | Andrews | Southern African ...

African Journals Online (AJOL)

Southern African Journal of HIV Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 4 (2004) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected ...

The application of Intervention Mapping in developing and implementing school-based sexuality and HIV/AIDS education in a developing country context: the case of Tanzania

NARCIS (Netherlands)

Mkumbo, K.; Schaalma, H.P.; Kaaya, S.; Leerlooijer, J.N.; Mbwambo, J.; Kilonzo, G.

2009-01-01

Aims: Effective sexuality and HIV/AIDS education programmes are needed to protect young people against HIV/AIDS and teenage pregnancy in Tanzania and other Sub-Saharan African countries. Using a theory- and evidence-based approach and adapting the programmes to local contexts, increases the

"Gender-specific HIV policies and programmes at South African ...

African Journals Online (AJOL)

HP27975994114

2004-06-07

Jun 7, 2004 ... will discuss employers' duties in the fight against HIV/AIDS with ..... The breach of the duty of care can also take the form of an omission.26 Brassey states: ... responsibility to the employer for the consequences of a negligent ...

How to integrate water, sanitation, and hygiene into HIV programmes

National Research Council Canada - National Science Library

Bery, Renuka; Rosenbaum, Julia

2010-01-01

"Water, sanitation and hygiene (WASH) practices are essential for maintaining health, yet most countries and donors have not included WASH in national policies and programmes for human immunodeficiency virus (HIV...

Receptivity of African American Adolescents to an HIV-Prevention Curriculum Enhanced by Text Messaging

Science.gov (United States)

Cornelius, Judith B.; St Lawrence, Janet S.

2013-01-01

PURPOSE This study assessed African American adolescents’ receptivity to an HIV-prevention curriculum enhanced by text messaging. DESIGN AND METHODS Two focus groups were conducted with 14 African American adolescents regarding how an HIV-prevention curriculum could be enhanced for text messaging delivery. RESULTS The adolescents were receptive to the idea of text messaging HIV-prevention information but wanted to receive a maximum of three messages per day during the hours of 4:00–6:00 p.m. PRACTICE IMPLICATIONS By taking the findings of this study, nurses, other healthcare providers, and community-based organizations can adapt evidence-based interventions for text messaging delivery to individuals at high risk for HIV infection. PMID:19356206

Determination of HIV Status in African Adults With Discordant HIV Rapid Tests.

Science.gov (United States)

Fogel, Jessica M; Piwowar-Manning, Estelle; Donohue, Kelsey; Cummings, Vanessa; Marzinke, Mark A; Clarke, William; Breaud, Autumn; Fiamma, Agnès; Donnell, Deborah; Kulich, Michal; Mbwambo, Jessie K K; Richter, Linda; Gray, Glenda; Sweat, Michael; Coates, Thomas J; Eshleman, Susan H

2015-08-01

In resource-limited settings, HIV infection is often diagnosed using 2 rapid tests. If the results are discordant, a third tie-breaker test is often used to determine HIV status. This study characterized samples with discordant rapid tests and compared different testing strategies for determining HIV status in these cases. Samples were previously collected from 173 African adults in a population-based survey who had discordant rapid test results. Samples were classified as HIV positive or HIV negative using a rigorous testing algorithm that included two fourth-generation tests, a discriminatory test, and 2 HIV RNA tests. Tie-breaker tests were evaluated, including rapid tests (1 performed in-country), a third-generation enzyme immunoassay, and two fourth-generation tests. Selected samples were further characterized using additional assays. Twenty-nine samples (16.8%) were classified as HIV positive and 24 of those samples (82.8%) had undetectable HIV RNA. Antiretroviral drugs were detected in 1 sample. Sensitivity was 8.3%-43% for the rapid tests; 24.1% for the third-generation enzyme immunoassay; 95.8% and 96.6% for the fourth-generation tests. Specificity was lower for the fourth-generation tests than the other tests. Accuracy ranged from 79.5% to 91.3%. In this population-based survey, most HIV-infected adults with discordant rapid tests were virally suppressed without antiretroviral drugs. Use of individual assays as tie-breaker tests was not a reliable method for determining HIV status in these individuals. More extensive testing algorithms that use a fourth-generation screening test with a discriminatory test and HIV RNA test are preferable for determining HIV status in these cases.

HIV infection in the South African construction industry.

Science.gov (United States)

Bowen, Paul; Govender, Rajen; Edwards, Peter; Lake, Antony

2018-06-01

South Africa has one of the highest HIV prevalences in the world, and compared with other sectors of the national economy, the construction industry is disproportionately adversely affected. Using data collected nationally from more than 57,000 construction workers, HIV infection among South African construction workers was estimated, together with an assessment of the association between worker HIV serostatus and worker characteristics of gender, age, nature of employment, occupation, and HIV testing history. The HIV infection of construction workers was estimated to be lower than that found in a smaller 2008 sample. All worker characteristics are significantly associated with HIV serostatus. In terms of most at-risk categories: females are more at risk of HIV infection than males; workers in the 30-49 year old age group are more at risk than other age groups; workers employed on a less permanent basis are more at risk; as are workers not having recently tested for HIV. Among occupations in the construction industry, general workers, artisans, and operator/drivers are those most at risk. Besides yielding more up-to-date estimated infection statistics, this research also identifies vulnerable sub-groups as valuable pointers for more targeted workplace interventions by construction firms.

Patterns of disclosure and antiretroviral treatment adherence in a South African mining workplace programme and implications for HIV prevention.

Science.gov (United States)

Bhagwanjee, Anil; Govender, Kaymarlin; Akintola, Olagoke; Petersen, Inge; George, Gavin; Johnstone, Leigh; Naidoo, Kerisha

2011-01-01

Social and psychological barriers to the disclosure of one's seropositive HIV status to significant others and poor adherence to taking medications pose significant challenges to the scaling-up of access to antiretroviral treatment (ART) in the workplace. Such barriers are predictive of sub-optimal treatment outcomes and bedevil HIV-prevention interventions at a societal level. Against this background, this article explores the lived experiences of 19 HIV-positive male participants, between the ages of 33 and 57 years, who were enrolled in an ART programme managed at an occupational health clinic at a mining company in South Africa. The majority of these mineworkers had been aware of their HIV status for between 5 and 7 years. The study explored psychological and relational factors, as aspects of these participants lived experiences, which had a bearing on their adherence to their ART regimen and the disclosure choices that they made regarding their HIV status. In our sample, those participants who were adherent demonstrated higher levels of control and acceptance of their HIV infection and were more confident in their ability to manage their treatment, while the group who were non-adherent presented with lower levels of adherence motivation and self-efficacy, difficulties in maintaining a healthy lifestyle and significant challenges in maintaining control over their lives. While most of the men favoured disclosing their HIV status to their partners for the sake of treatment support, they were less sure about disclosing to family members and non-family members, respectively, because of their need to protect these persons and due to their fear of being stigmatised. It was evident that treatment adherence choices and behaviours were impacted by psychological and relational factors, including disclosure decisions. We conclude with a bivariate model for understanding the adherence behaviours that influenced different patterns of ART adherence among the sample, and

Antiretroviral therapy programme on control of HIV transmission in ...

African Journals Online (AJOL)

Antiretroviral therapy programme on control of HIV transmission in Morogoro municipality, Tanzania: A challenge for development. ... The government and partners should improve access to ART services to enable many PLHIV to access the services. Key words: Antiretroviral Therapy, Highly Active Antiretroviral Treatment, ...

The South African nuclear programme in a strategic perspective

International Nuclear Information System (INIS)

Zelinka, Martin; Sůsa, Tomáš

2017-01-01

The main idea behind the article is that the strategic aspects of the South African nuclear proliferation programme might be seen from a different point of view. The goal is to gain a perspective by looking into South African history, politics and international status, using these factors as the context for the nuclear programme. First, the authors define the necessary theoretical background, emphasizing the various motivations behind nuclear proliferation. The main focus of the article is on South Africa's motivation – where it came from and which factors influenced it. Among the examined aspects are: historical development and emergence of the regime, internal and external opposition (enemies), international status and the nature of the local political system. The various options South Africa had for actual usage of its nuclear weapons are also considered, The questions as to the motivation, results of nuclear proliferation (whether or not it was successful) and practical use of weapons developed are answered in the conclusion. (orig.)

The epidemiology of sexually transmitted co-infections in HIV-positive and HIV-negative African-Caribbean women in Toronto.

Science.gov (United States)

Remis, Robert S; Liu, Juan; Loutfy, Mona; Tharao, Wangari; Rebbapragada, Anuradha; Perusini, Stephen J; Chieza, Lisungu; Saunders, Megan; Green-Walker, LoriAnn; Kaul, Rupert

2013-11-17

HIV disproportionately affects African-Caribbean women in Canada but the frequency and distribution of sexually transmitted infections in this community have not been previously studied. We recruited women based on HIV status through a Toronto community health centre. Participants completed a socio-behavioural questionnaire using Audio Computer Assisted Self-Interview (ACASI) and provided blood for syphilis, HIV, hepatitis B and C, herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2), and human cytomegalovirus (CMV) serology, urine for chlamydia and gonorrhea molecular testing and vaginal secretions for bacterial vaginosis (BV) and human papillomavirus (HPV). Differences in prevalence were assessed for statistical significance using chi-square. We recruited 126 HIV-positive and 291 HIV-negative women, with a median age of 40 and 31 years, respectively (p history of HBV vaccination (66.1% vs. 44.0%, p = 0.0001). Classical STIs were rare in both groups; BV prevalence was low and did not vary by HIV status. HSV-2 infection was markedly more frequent in HIV-positive (86.3%) than HIV-negative (46.6%) women (p < 0.0001). Vaginal HPV infection was also more common in HIV-positive than in HIV-negative women (50.8% vs. 22.6%, p < 0.0001) as was infection with high-risk oncogenic HPV types (48.4% vs. 17.3%, p < 0.0001). Classical STIs were infrequent in this clinic-based population of African-Caribbean women in Toronto. However, HSV-2 prevalence was higher than that reported in previous studies in the general Canadian population and was strongly associated with HIV infection, as was infection with hepatitis B and HPV.

Text-Messaging-Enhanced HIV Intervention for African American Adolescents: A Feasibility Study

Science.gov (United States)

Cornelius, Judith B.; Dmochowski, Jacek; Boyer, Cherrie; St Lawrence, Janet; Lightfoot, Marguerita; Moore, Michael

2013-01-01

We examined the feasibility and acceptability of an HIV prevention intervention for African American adolescents delivered via mobile cell phones and looked at intervention-related changes in beliefs and sexual behaviors. We used a longitudinal one-group comparison design with data collected at three points. Forty adolescents, 13–18 years old, participated in the Becoming a Responsible Teen intervention followed by the delivery of daily multimedia messages for 3 months. The mobile-cell-phone enhanced intervention was feasible and acceptable to the participants. Greater HIV knowledge, improved attitudes toward condoms, and increased perceived HIV risk scores were observed with older adolescents (16–18 years old). Behavior trends showed a decrease in the number of times participants reported engaging in unprotected sexual intercourse over the previous 2 months. Mobile-cell-phone multimedia-text-messaging boosters tested in this study provided preliminary evidence of efficacy of the enhanced HIV prevention intervention for African American youth. PMID:23122907

'Just talking about it opens your heart': meaning-making among Black African migrants and refugees living with HIV.

Science.gov (United States)

Henrickson, Mark; Brown, Derek Brian; Fouché, Christa; Poindexter, Cynthia C; Scott, Kay

2013-01-01

Meaning-making has emerged as a core construct in addressing trauma, loss or crisis. This paper considers how diasporic Black Africans living with HIV, who come from interdependent collectivist cultures where the norm is one of implicit support, extend their meaning-making strategies when faced with a diagnosis of HIV. In this qualitative study, 13 Black African migrants and refugees living with HIV in New Zealand were interviewed and the transcripts analysed. After their diagnosis, participants began a journey of reconceptualising situational and global meaning. They extended their meaning-making strategies to include a community of like others to gain explicit support. Caregivers in host countries must understand the meaning-making processes of HIV-positive Black African migrants in order to provide competent services that lead to good social and health outcomes. All healthcare and social services workers should regularly assess Black African migrants and refugees living with HIV for positive social connectedness as well as medication adherence and more specific health concerns.

A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada.

Directory of Open Access Journals (Sweden)

Carmen H Logie

Full Text Available African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health. We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39 of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154 = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance

[Integrated screening for HIV, syphilis, and toxoplasmosis among pregnant women in the Central African Republic].

Science.gov (United States)

Gamba, E P; Nambei, W S; Kamandji, L

2013-01-01

The aim of this study was to determine the prevalence of syphilis and toxoplasmosis infection in pregnant women in the Central African Republic who were and were not HIV-infected, in the framework of HIV surveillance. This case-control study included 270 HIV(+) and 217 HIV(-) pregnant women among 4 750 women who attended prenatal-care clinics throughout the Central African Republic from November 2011 through January 2012. Blood specimens were collected and serological evidence of HIV1/2 was analyzed by ELISA1 and ELISA2. The Toxoplasma gondii antibody was detected with the Toxo-Hai Fumouze(®) diagnostic kit. A VDRL test was performed to screen for syphilis in all study participants. Of the 434 samples tested, 33 (7.60%) were positive for syphilis: 21 (9.7%) among HIV(+) and 12 (5.5%) among HIV(-) women (p = 0.1031); 221 (50.90%) were positive for toxoplasmosis: 117 (53.9%) among HIV(+) and 104 (47.9%) among HIV(-) women (p = 0, 2119). Coinfection with HIV, syphilis, and toxoplasmosis was found in 6.00%. No association was found between coinfection and age, parity, and residence area. The rate of syphilis infection was very high in pregnant women living in rural areas (ORcrude = 4.37; 95% CI = 2,11, 9.05). This study showed a high prevalence of toxoplasmosis and syphilis in pregnant women in the Central African Republic, regardless of their HIV infection status. Sexually transmitted infections (STIs) are common in pregnant women living in rural areas. It may be appropriate to include routine serological screening tests to determine of toxoplasmosis, syphilis and HIV in pregnant women in this country.

Spirituality, psychological well-being, and HIV symptoms for African Americans living with HIV disease.

Science.gov (United States)

Coleman, C L; Holzemer, W L

1999-01-01

The purpose of this descriptive cross-sectional study was to explore the contribution of spiritual well-being and human immunodeficiency virus (HIV) symptoms to psychological well-being measured by depression, hope, and state-trait anxiety in a sample of 117 African-American men and women with a mean age of 38 years living with HIV disease. Of the respondents, 26% had acquired immunodeficiency syndrome (AIDS), and 74% were HIV seropositive. Each participant completed a sociodemographic questionnaire, the Sign and Symptom Checklist for Persons with HIV Disease, the Spiritual Well-Being Scale, the Nowotny Hope Scale, State-Trait Inventory, and the Beck Depression Inventory. The findings suggest that existential well-being, a spiritual indicator of meaning and purpose, more than religious well-being, was significantly related to the participants' psychological well-being. In addition, HIV symptoms were found to be significant predictors of psychological well-being. These findings support the need for nurses to continue exploring ways to integrate and support spirituality within the domains of clinical practice.

HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: Manifestations, consequences and coping

NARCIS (Netherlands)

Stutterheim, S.E.; Bos, A.E.R.; Shiripinda, I.; Bruin, de M.; Pryor, J.B.; Schaalma, H.P.

2012-01-01

HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological

HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: manifestations, consequences and coping

NARCIS (Netherlands)

Stutterheim, S.E.; Bos, A.E.R.; Shiripinda, I.; de Bruin, M.; Pryor, J.B.; Schaalma, H.P.

2012-01-01

HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological

Hip-hop to prevent substance use and HIV among African-American youth: a preliminary investigation.

Science.gov (United States)

Turner-Musa, Jocelyn O; Rhodes, Warren A; Harper, P Thandi Hicks; Quinton, Sylvia L

2008-01-01

Substance use and HIV risk behaviors are increasing among African-American youth. Interventions that incorporate youth values and beliefs are needed to reduce this trajectory. Hip-hop plays an important role in the lives of many African-American youth and provides a context within which to prevent risky behaviors. The current study examines the efficacy of a hip-hop based substance use and HIV preventive intervention that targets African-American middle-school youth. The sample consists of 68 middle-school students who completed baseline and 6-month follow-up assessments. Findings suggest that students in the intervention group were significantly more likely to have higher knowledge of perception of drug risk and more knowledge about HIV/AIDS compared to students in the comparison group at the 6-month post-intervention assessment. Discussion is centered on implications of hip-hop as a viable approach for preventing substance use and HIV within a high-risk group.

Spectrum of female commercial sex work in Bangui, Central African ...

African Journals Online (AJOL)

Classification of professional and non-professional female sex workers (FSWs) into different categories, never previously reported in the Central African Republic (CAR), may be useful to assess the dynamics of the human immunodeficiency virus (HIV) epidemic, design operational intervention programmes to combat HIV ...

Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora.

Science.gov (United States)

Millett, Gregorio A; Jeffries, William L; Peterson, John L; Malebranche, David J; Lane, Tim; Flores, Stephen A; Fenton, Kevin A; Wilson, Patrick A; Steiner, Riley; Heilig, Charles M

2012-07-28

Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8·5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM across the African diaspora share common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality during HIV testing or treatment, low access to HIV drugs, threats of violence or incarceration, and few targeted HIV prevention resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention.

Science.gov (United States)

Dageid, Wenche; Govender, Kaymarlin; Gordon, Sarah F

2012-01-01

Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.

West African Platform for HIV Intervention Research (WAPHIR ...

International Development Research Centre (IDRC) Digital Library (Canada)

West African Platform for HIV Intervention Research (WAPHIR) : plateforme de recherche interventionnelle en matière de VIH en Afrique de l'Ouest. Grâce à cette subvention, on appuiera l'établissement d'un partenariat dirigé par des Africains de l'Ouest, en collaboration avec des partenaires canadiens et européens, afin ...

Preliminary evaluation of the impact of a Web-based HIV testing programme in Abruzzo Region on the prevention of late HIV presentation and associated mortality

Directory of Open Access Journals (Sweden)

Ennio Polilli

2018-04-01

Full Text Available Objective: This study aimed to analyze the efficacy of a Web-based testing programme in terms of the prevention of late HIV presentation. The clinical characteristics of patients diagnosed with HIV via the Web-based testing programme were compared to those of patients diagnosed in parallel via standard diagnostic care procedures. Methods: This study included the clinical and demographic data of newly diagnosed HIV patients enrolled at the study clinic between February 2014 and June 2017. These patients were diagnosed either via standard diagnostic procedures or as a result of the Web-based testing programme. Results: Eighty-eight new cases of HIV were consecutively enrolled; their mean age was 39.1 ± 13.0 years. Fifty-nine patients (67% were diagnosed through standard diagnostic procedures and 29 (33% patients came from the Web-based testing programme. Late presentation (62% vs. 34%, p = 0.01 and AIDS-defining conditions at presentation (13 vs. 1, p = 0.02 were significantly more frequent in the standard care group than in the Web-based group; four of 13 patients with AIDS diagnosed under standard diagnostic procedures died, versus none in the Web-based testing group (p < 0.001. Conclusions: Web-based recruitment for voluntary and free HIV testing helped to diagnose patients with less advanced HIV disease and no risk of death, from all at-risk groups, in comparison with standard care testing. Keywords: AIDS, HIV, Late presentation, Voluntary and free testing, HIV diagnosis, Sexually transmitted infections

HIV Stigma and Nurse Job Satisfaction in Five African Counties

OpenAIRE

Chirwa, Maureen L.; Greeff, Minrie; Kohi, Thecla W.; Naidoo, Joanne R.; Makoae, Lucy N.; Dlamini, Priscilla S.; Kaszubski, Christopher; Cuca, Yvette P.; Uys, Leana R.; Holzemer, William L.

2009-01-01

This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The subscale, Personal Satisfaction, was the highest in this ...

HIV Stigma and Nurse Job Satisfaction in Five African Countries

OpenAIRE

Greeff, Minrie; Chirwa, Maureen L; Kohi, Thecla W; Naidoo, Joanne R; Makoae, Lucy N; Dlamini, Priscilla S; Kaszubski, Christopher; Cuca, Yvette P; Uys, Leana R; Holzermer, William L

2009-01-01

This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sa...

V3-serotyping programme evaluated for HIV-1 variation in the Netherlands and Curacao

NARCIS (Netherlands)

Wolf F de; Akker R van den; Valk M; Bakker M; Goudsmit J; Loon AM van; VIR; UVA/HRL

1995-01-01

To obtain insight into the variation of the HIV-1 V3 neutralization domain of variants circulating in the Netherlands, 126 Dutch, 70 Curacao and 45 African serum samples from HIV-1 infected individuals were screened for antibody reactivity to a set of 16 to 17 mer synthetic peptides, representing

Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal

OpenAIRE

Wasti, Sharada Prasad; Simkhada, Padam; Randall, Julian; Van Teijlingen, Edwin

2009-01-01

This paper explores some of the key issues and challenges of government HIV/AIDS prevention and treatment programme in Nepal. Providing HIV/AIDS prevention and treatment services in Nepal is associated with a number of issues and challenges which are shaped mostly on cultural and managerial issues from grass root to policy level.\\ud Numerous efforts have been done and going on by Nepal government and non-government organization but still HIV\\ud prevention and treatment service is not able to ...

'Taking care' in the age of AIDS: older rural South Africans' strategies for surviving the HIV epidemic.

Science.gov (United States)

Angotti, Nicole; Mojola, Sanyu A; Schatz, Enid; Williams, Jill R; Gómez-Olivé, F Xavier

2018-03-01

Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme: ku ti hlayisa (to take care of yourself). For older adults, 'taking care' in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one's HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings.

Evaluating 5 years' NIMART mentoring in South Africa's HIV ...

African Journals Online (AJOL)

Evaluating 5 years' NIMART mentoring in South Africa's HIV treatment programme: Successes, challenges and future needs. ... South African Medical Journal ... targeted mentoring was introduced; this increased the percentage of primary nurses eligible for DoH certificates of clinical competence in NIMART from 12%, ...

The FAO programme for the control of African animal trypanosomiasis and related development

International Nuclear Information System (INIS)

Hursey, B.S.

1990-01-01

The FAO proposal for a long-term Programme for the Control of African Animal Trypanosomiasis and Related Development was presented to the World Food Conference in November 1974. A recommendation was adopted that the programme should be implemented as a matter of urgency and should receive high priority in the FAO programme of work and budget. Following recommendations of support by FAO statutory bodies the preparatory phase, which led to implementation of a large-scale programme, was launched in 1980

The FAO programme for the control of African animal trypanosomiasis and related development

Energy Technology Data Exchange (ETDEWEB)

Hursey, B S [FAO, Rome (Italy)

1990-04-01

The FAO proposal for a long-term Programme for the Control of African Animal Trypanosomiasis and Related Development was presented to the World Food Conference in November 1974. A recommendation was adopted that the programme should be implemented as a matter of urgency and should receive high priority in the FAO programme of work and budget. Following recommendations of support by FAO statutory bodies the preparatory phase, which led to implementation of a large-scale programme, was launched in 1980.

Taking it one day at a time: African American women aging with HIV and co-morbidities.

Science.gov (United States)

Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi

2014-07-01

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52-65. Topics included HIV and co-morbidity self-management, social support needs, medication adherence, and future plans for old age. A constant comparison approach was applied during data analysis. Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV. This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness. Social responsibilities, including caring for family, positively impacted participants' ability to self-manage HIV by serving as motivation to stay healthy in order to continue to help family members. In contrast, inflexible work schedules negatively impacted women's ability to sustain medication adherence. Overall, this study demonstrates that HIV and co-morbidity self-management are inextricably linked. We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations. Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies.

Interaction between HIV awareness, knowledge, safe sex practice and HIV prevalence: evidence from Botswana.

Science.gov (United States)

Ray, Ranjan; Sinha, Kompal

2012-05-01

This paper makes methodological and empirical contributions to the study of HIV in the context of Botswana, a country with high HIV prevalence. Comparable evidence is presented from India to put the Botswana results in perspective. The results point to the strong role played by affluence and education in increasing HIV knowledge, promoting safe sex and reducing HIV prevalence. The study presents African evidence on the role played by the empowerment of women in promoting safe sex practices such as condom use. The lack of significant association between HIV prevalence and safe sex practice points to the danger of HIV-infected individuals spreading the disease through multiple sex partners and unprotected sex. This danger is underlined by the finding that females with multiple sex partners are at higher risk of being infected with HIV. These results take on special policy significance in the context of Botswana, where the issue of multiple sex partners has not been adequately addressed in the programme to contain the spread of HIV.

Survival of patients with Kaposi's sarcoma in the South African ...

African Journals Online (AJOL)

When the South African (SA) antiretroviral therapy (ART) programme was rolled out in 2004, the treatment model for HIV- ... context of ART and affordable standard-of-care cancer regimens, KS ... for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences,.

HIV rapid diagnostic testing by lay providers in a key population-led health service programme in Thailand.

Science.gov (United States)

Wongkanya, Rapeeporn; Pankam, Tippawan; Wolf, Shauna; Pattanachaiwit, Supanit; Jantarapakde, Jureeporn; Pengnongyang, Supabhorn; Thapwong, Prasopsuk; Udomjirasirichot, Apichat; Churattanakraisri, Yutthana; Prawepray, Nanthika; Paksornsit, Apiluk; Sitthipau, Thidadaow; Petchaithong, Sarayut; Jitsakulchaidejt, Raruay; Nookhai, Somboon; Lertpiriyasuwat, Cheewanan; Ongwandee, Sumet; Phanuphak, Praphan; Phanuphak, Nittaya

2018-01-01

Introduction:  Rapid diagnostic testing (RDT) for HIV has a quick turn-around time, which increases the proportion of people testing who receive their result. HIV RDT in Thailand has traditionally been performed only by medical technologists (MTs), which is a barrier to its being scaled up. We evaluated the performance of HIV RDT conducted by trained lay providers who were members of, or worked closely with, a group of men who have sex with men (MSM) and with transgender women (TG) communities, and compared it to tests conducted by MTs. Methods:  Lay providers received a 3-day intensive training course on how to perform a finger-prick blood collection and an HIV RDT as part of the Key Population-led Health Services (KPLHS) programme among MSM and TG. All the samples were tested by lay providers using Alere Determine HIV 1/2. HIV-reactive samples were confirmed by DoubleCheckGold Ultra HIV 1&2 and SD Bioline HIV 1/2. All HIV-positive and 10% of HIV-negative samples were re-tested by MTs using Serodia HIV 1/2. Results:  Of 1680 finger-prick blood samples collected and tested using HIV RDT by lay providers in six drop-in centres in Bangkok, Chiang Mai, Chonburi and Songkhla, 252 (15%) were HIV-positive. MTs re-tested these HIV-positive samples and 143 randomly selected HIV-negative samples with 100% concordant test results. Conclusion:  Lay providers in Thailand can be trained and empowered to perform HIV RDT as they were found to achieve comparable results in sample testing with MTs. Based on the task-shifting concept, this rapid HIV testing performed by lay providers as part of the KPLHS programme has great potential to enhance HIV prevention and treatment programmes among key at-risk populations.

Engaging black sub-Saharan African communities and their gatekeepers in HIV prevention programs: Challenges and strategies from England

Directory of Open Access Journals (Sweden)

Mathew Nyashanu

2016-12-01

Full Text Available Objective: HIV infection is a sensitive issue in black communities [Serrant-Green L. Black Caribbean men, sexual health decisions and silences. Doctoral thesis. Nottingham School of Nursing, University of Nottingham; 2004]. Statistics show black sub-Saharan African (BSSA communities disproportionately constitute two-thirds of people with HIV [Heath Protection Agency. Health protection report: latest infection reports-GOV.UK; 2013]. African communities constitute 30% of people accessing HIV treatment in the United Kingdom yet represent less than 1% of the population [Health Protection Agency. HIV in the United Kingdom: 2012 report; 2012], [Department of Health. DVD about FGM. 2012. Available from fgm@dh.gsi.gov.uk.]. This article explores the sociocultural challenges in engaging BSSA communities in HIV prevention programs in England and possible strategies to improve their involvement. Methods: Twelve focus group discussions and 24 semistructured interviews were conducted in a 2-year period with participants from the BSSA communities and sexual health services in the West Midlands, England. The research was supported by the Ubuntu scheme, a sexual health initiative working with African communities in Birmingham, England. Results: Ineffective engagement with African communities can hinder the effectiveness of HIV prevention programs. Skills and strategies sensitive to BSSA culture are important for successful implementation of prevention programs. HIV prevention programs face challenges including stigma, denial, and marginalized views within BSSA communities. Conclusion: Networking, coordination, and cultural sensitivity training for health professionals are key strategies for engaging BSSA communities in HIV prevention programs.

Geographical patterns of Kaposi's sarcoma, nonHodgkin lymphomas, and cervical cancer associated with HIV infection in five African populations.

Science.gov (United States)

Chaabna, Karima; Boniol, Mathieu; de Vuyst, Hugo; Vanhems, Philippe; Antônio de Ávila Vitoria, Marco; Curado, Maria-Paula

2012-01-01

The objective of this study is to describe the most recent geographical patterns of incidence of AIDS-related cancers, Kaposi's sarcoma (KS), nonHodgkin lymphoma (NHL), and cervical cancer in North African and subSaharan African populations. Data were extracted for the period 1998-2002 from five African population-based cancer registries: Kyadondo, Harare, Setif, Sousse, and Gharbiah. Age-standardized rates were calculated using the African standard population; a comparison was made between these populations by computing the standardized incidence ratio and 95% confidence intervals. The KS rate was found to be significantly higher in men than in women, and higher in Harare (women: 26.3/100,000; men: 50.4/100,000) and Kyadondo (women: 23.6/100,000; men: 30.2/100,000) than in the North African sites for both sexes (HIV/AIDS (15-49 years), and these rates were 4.5-fold higher in subSaharan populations than those in the North African sites. Thus, it was observed that the pattern of HIV prevalence is variable with the lowest prevalence in North African countries, intermediate prevalence in Uganda, and the highest prevalence in Zimbabwe. Our findings show that the incidence of NHL and cervical cancer, considered to be HIV/AIDS-related cancers, does not follow the pattern of HIV prevalence in the five studied African populations. Thus, the highest NHL incidence rate in both sexes in Gambia may be explained, at least in great part, by the highest hepatitis C virus prevalence observed there. Indeed, factors other than HIV infection likely contribute to their geographical patterns.

Genital infections and syndromic diagnosis among HIV-infected women in HIV care programmes in Kenya.

Science.gov (United States)

Djomand, Gaston; Gao, Hongjiang; Singa, Benson; Hornston, Sureyya; Bennett, Eddas; Odek, James; McClelland, R Scott; John-Stewart, Grace; Bock, Naomi

2016-01-01

Control of genital infections remains challenging in most regions. Despite advocacy by the World Health Organization for syndromic case management, there are limited data on the syndromic approach, especially in HIV care settings. This study compared the syndromic approach with laboratory diagnosis among women in HIV care in Kenya. A mobile team visited 39 large HIV care programmes in Kenya and enrolled participants using population-proportionate sampling. Participants provided behavioural and clinical data with genital and blood specimens for lab testing. Among 1063 women, 68.4% had been on antiretroviral therapy >1 year; 58.9% were using cotrimoxazole prophylaxis; 51 % had CD4+T-lymphocytes Kenya have high rates of vaginal infections. Syndromic diagnosis was a poor predictor of those infections. © The Author(s) 2015.

Post-exposure prophylaxis | Smith | Southern African Journal of HIV ...

African Journals Online (AJOL)

Southern African Journal of HIV Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Post-exposure prophylaxis. C Smith. Abstract.

Developing a Measure of Stigma by Association with African American Adolescents Whose Mothers Have HIV

Science.gov (United States)

Mason, Sally; Berger, Barbara; Ferrans, Carol Estwing; Sultzman, Vickey; Fendrich, Michael

2010-01-01

Objectives: African American urban adolescents are one of the fastest growing groups of children affected by their mother's HIV status. These children experience HIV stigma by association with their HIV-positive mothers. Stigma may contribute to adverse outcomes for these teens. Methods: The authors describe a multistage process of scale…

Hypertension and obesity among HIV patients in a care programme ...

African Journals Online (AJOL)

Objective: To determine the prevalence of hypertension and obesity among HIV patients enrolled in the Sex Worker Outreach Programme (SWOP), Nairobi, Kenya. Design: A retrospective a study. Setting: SWOP managed by the University of Manitoba, Nairobi team. Subjects: We selected clinic visit records from HIV ...

Cancer and HIV infection in referral hospitals from four West African countries.

Science.gov (United States)

Jaquet, Antoine; Odutola, Michael; Ekouevi, Didier K; Tanon, Aristophane; Oga, Emmanuel; Akakpo, Jocelyn; Charurat, Manhattan; Zannou, Marcel D; Eholie, Serge P; Sasco, Annie J; Bissagnene, Emmanuel; Adebamowo, Clement; Dabis, Francois

2015-12-01

The consequences of the HIV epidemic on cancer epidemiology are sparsely documented in Africa. We aimed to estimate the association between HIV infection and selected types of cancers among patients hospitalized for cancer in four West African countries. A case-referent study was conducted in referral hospitals of Benin, Côte d'Ivoire, Nigeria and Togo. Each participating clinical ward included all adult patients seeking care with a confirmed diagnosis of cancer. All patients were systematically screened for HIV infection. HIV prevalence of AIDS-defining and some non-AIDS defining cancers (Hodgkin lymphoma, leukemia, liver, lung, skin, pharynx, larynx, oral cavity and anogenital cancers) were compared to a referent group of cancers reported in the literature as not associated with HIV. Odds ratios adjusted on age, gender and lifetime number of sexual partners (aOR) and their 95% confidence intervals (CI) were estimated. Among the 1644 cancer patients enrolled, 184 (11.2%) were identified as HIV-infected. The HIV prevalence in the referent group (n=792) was 4.4% [CI 3.0-5.8]. HIV infection was associated with Kaposi sarcoma (aOR 34.6 [CI: 17.3-69.0]), non-Hodgkin lymphoma (aOR 3.6 [CI 1.9-6.8]), cervical cancer (aOR 4.3 [CI 2.2-8.3]), anogenital cancer (aOR 17.7 [CI 6.9-45.2]) and squamous cell skin carcinoma (aOR 5.2 [CI 2.0-14.4]). A strong association is now reported between HIV infection and Human Papillomavirus (HPV)-related cancers including cervical cancer and anogenital cancer. As these cancers are amenable to prevention strategies, screening of HPV-related cancers among HIV-infected persons is of paramount importance in this African context. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preliminary evaluation of the impact of a Web-based HIV testing programme in Abruzzo Region on the prevention of late HIV presentation and associated mortality.

Science.gov (United States)

Polilli, Ennio; Sozio, Federica; Di Stefano, Paola; Clerico, Luigi; Di Iorio, Giancarlo; Parruti, Giustino

2018-04-01

This study aimed to analyze the efficacy of a Web-based testing programme in terms of the prevention of late HIV presentation. The clinical characteristics of patients diagnosed with HIV via the Web-based testing programme were compared to those of patients diagnosed in parallel via standard diagnostic care procedures. This study included the clinical and demographic data of newly diagnosed HIV patients enrolled at the study clinic between February 2014 and June 2017. These patients were diagnosed either via standard diagnostic procedures or as a result of the Web-based testing programme. Eighty-eight new cases of HIV were consecutively enrolled; their mean age was 39.1±13.0 years. Fifty-nine patients (67%) were diagnosed through standard diagnostic procedures and 29 (33%) patients came from the Web-based testing programme. Late presentation (62% vs. 34%, p=0.01) and AIDS-defining conditions at presentation (13 vs. 1, p=0.02) were significantly more frequent in the standard care group than in the Web-based group; four of 13 patients with AIDS diagnosed under standard diagnostic procedures died, versus none in the Web-based testing group (pWeb-based recruitment for voluntary and free HIV testing helped to diagnose patients with less advanced HIV disease and no risk of death, from all at-risk groups, in comparison with standard care testing. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Traditional African Religions (TARs): on HIV/AIDS, health and ...

African Journals Online (AJOL)

This is because the moral guidance put forward by. African religions is underestimated; hence making HIV/AIDS more of a moral problem. Rethinking the dialogue with TARs, will help in setting appropriate means of enhancing health in a broad sense and living in human dignity in Africa. Mtafiti Mwafrika Vol. 15 2005: pp.

Are routine tuberculosis programme data suitable to report on antiretroviral therapy use of HIV-infected tuberculosis patients?

NARCIS (Netherlands)

Brouwer, Miranda; Gudo, Paula Samo; Simbe, Chalice Mage; Perdigão, Paula; van Leth, Frank

2013-01-01

Antiretroviral therapy (ART) is lifesaving for HIV-infected tuberculosis (TB) patients. ART-use by these patients lag behind compared to HIV-testing and co-trimoxazole preventive therapy. TB programmes provide the data on ART-use by HIV-infected TB patients, however often the HIV services provide

'We have beaten HIV a bit': a qualitative study of experiences of peer support during pregnancy with an HIV Mentor Mother project in England.

Science.gov (United States)

McLeish, Jenny; Redshaw, Maggie

2016-06-20

To explore the experiences of women living with HIV in England who received or gave Mentor Mother (trained mother-to-mother) volunteer peer support during pregnancy and early motherhood. Qualitative descriptive study, using semistructured, in-depth interviews and inductive thematic analysis, theoretically informed by phenomenological social psychology. A London-based third sector peer support organisation for people living with HIV. 12 women living with HIV who had given or received Mentor Mother volunteer peer support (6 had given support and 6 had received support). 11 were black African. The key themes in participants' descriptions of their lives as pregnant women and mothers living with HIV were 'fear and distress', 'stigma and isolation' and 'the gap in maternity care'. The key themes related to Mentor Mother peer support during and after pregnancy were 'support to avoid mother-to-child transmission' (with subthemes 'reinforcing medical advice', 'reframing faith issues', 'prioritisation and problem-solving' and 'practical strategies for managing HIV and motherhood'), and 'emotional support' (with subthemes 'role modelling and inspiring hope', 'openness and non-judgemental acceptance', 'a caring relationship', 'recreating the lost family network', 'being understood from the inside' and 'self-confidence'). The Mentor Mothers' support appeared to be a successful hybrid between the peer education Mentor Mothers programmes in southern Africa and the more general pregnancy volunteer peer support models operating in England. A Mentor Mother peer support programme is acceptable to, and valued by, black African mothers with HIV in England. Peer support from trained volunteers during and after pregnancy can complement and reinforce medical advice on avoiding mother-to-child transmission of HIV, and can have a multidimensional positive impact on vulnerable mothers' emotional well-being. Mentor Mother peer support should be considered by those designing programmes for the

Factors affecting behaviours that address HIV risk among Black and White South Africans

OpenAIRE

K. Peltzer

2002-01-01

The aim of this study was to identify factors affecting HIV risk reduction among 150 Black and 150 White South Africans chosen by systematic random sampling. Main outcome measures included sexual behaviour and condom use, knowledge about correct condom use, intention of condom use, behavioural norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS health beliefs, and HIV risk behaviour. Bivariate analysis gave positive significant relations among being single, age, ...

HIV care continuum in Rwanda: a cross-sectional analysis of the national programme.

Science.gov (United States)

Nsanzimana, Sabin; Kanters, Steve; Remera, Eric; Forrest, Jamie I; Binagwaho, Agnes; Condo, Jeanine; Mills, Edward J

2015-05-01

Rwanda has made remarkable progress towards HIV care programme with strong national monitoring and surveillance. Knowledge about the HIV care continuum model can help to improve outcomes in patients. We aimed to quantify engagement, mortality, and loss to follow-up of patients along the HIV care continuum in Rwanda in 2013. We collated data for individuals with HIV who participated in the national HIV care programme in Rwanda and calculated the numbers of individuals or proportions of the population at each stage and the transition probabilities between stages of the continuum. We calculated factors associated with mortality and loss to follow-up by fitting Cox proportional hazards regression models, one for the stage of care before antiretroviral therapy (ART) initiation and another for stage of care during ART. An estimated 204,899 individuals were HIV-positive in Rwanda in 2013. Among these individuals, 176,174 (86%) were in pre-ART or in ART stages and 129,405 (63%) had initiated ART by the end of 2013. 82·1% (95% CI 80·7-83·4) of patients with viral load measurements (n=3066) were virally suppressed (translating to 106,371 individuals or 52% of HIV-positive individuals). Mortality was 0·6% (304 patients) in the pre-ART stage and 1·0% (1255 patients) in the ART stage; 2247 (3·9%) patients were lost to follow-up in pre-ART stage and 2847 (2·2%) lost in ART stage. Risk factors for mortality among patients in both pre-ART and ART stages included older age, CD4 cell count at initiation, and male sex. Risk factors for loss to follow-up among patients at both pre-ART and ART stages included younger age (age 10-29 year) and male sex. The HIV care continuum is a multitrajectory pathway in which patients have many opportunities to leave and re-engage in care. Knowledge about the points at which individuals are most likely to leave care could improve large-scale delivery of HIV programmes. The Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All

Control beliefs and health locus of control in Ugandan, German and migrated sub-Saharan African HIV infected individuals.

Science.gov (United States)

Milz, Ruth U; Husstedt, Ingo-W; Reichelt, Doris; Evers, Stefan

2016-04-01

Little is known about the influence of control beliefs on antiretroviral drug adherence in patients who migrated from sub-Saharan Africa to Europe. The aim of this study was to explore the differences in health locus of control and control beliefs between HIV infected patients from sub-Saharan Africa with and without a lifetime experience of migration. A sample of 62 HIV infected consecutive patients referred to the HIV clinics at the University Hospital of Münster (Germany) and at the Rubaga Hospital Kampala (Uganda) were enrolled into this study. We compared three groups of patients: sub-Saharan African migrants, German patients, and local Ugandan patients. We used the German health and illness related control beliefs questionnaire (KKG), the Competence and control beliefs questionnaire (FKK), and the Powe Fatalism Inventory-HIV/AIDS-Version (PFI-HIV/AIDS-Version) and translated these scales into English and Luganda. In addition, the patients' sociodemographic, acculturation, clinical, and immunological data were registered. Significant results were shown in HIV related external locus of control between migrated sub-Saharan African and local Ugandan patients compared to German patients. General control beliefs showed no significant differences. In the PFI-HIV-Version, there was a significant difference between migrated sub-Saharan African and Ugandan patients compared to German patients. Our data suggest that the experience of migration does not influence the locus of control. Compared to German HIV patients, African patients in general showed a significantly higher external health locus of control which might have implications for drug adherence. Copyright © 2016 Elsevier Inc. All rights reserved.

The convergence of American and Nigerian religious conservatism in a biopolitical shaping of Nigeria's HIV/AIDS prevention programmes.

Science.gov (United States)

Jappah, Jlateh V

2013-01-01

Nigeria has the largest number of HIV/AIDS cases in West Africa, with 3.3 million people estimated to be living with the disease. The country remains a fragile democratic state and has allocated insufficient resources to combat the spread of HIV/AIDS among its citizens. The preponderance of President's Emergency Plan for AIDS Relief (PEPFAR) dollars, expert knowledge, conservative ideology and activities has shaped the direction of HIV/AIDS sexual-transmission prevention programmes in Nigeria. PEPFAR channels significant resources through Nigerian faith-based organisations (FBOs), and considers these organisations integral for HIV prevention strategies. In many instances, HIV/AIDS prevention programmes managed by FBOs reflect their ideologies of morality and sexuality. There is a convergence of religious ideology concerning morality and HIV infectivity between American and Nigerian conservatives; this produces a fertile ground for the influence and expansion of the conservative activities of PEPFAR in Nigeria. The paper highlights this nexus and draws attention to the biopolitical underpinning of PEPFAR in shaping Nigeria's HIV prevention programmes. The paper further notes both positive and negative effects of PEPFAR activities and attempts by the Obama administration to redirect PEPFAR to a more holistic approach in order to optimise outcomes.

Programme for the control of African animal trypanosomiasis and related development

International Nuclear Information System (INIS)

Finelle, P.

1980-01-01

After a statement on the problems raised by African animal trypanosomiasis and its control, and the development of currently affected areas, the Programme is outlined describing the methodology for tsetse and trypanosomiasis control operations and the basic approach for implementation of related development. The activities carried out during the five-year preliminary phase are summarized. The operational phase of the Programme is now being launched. The possible use of the sterile male technique is mentioned marginally. No details of research programmes envisaged are presented. A series of Preliminary Assistance Missions to Governments for the evaluation and preparation of control schemes, development strategies and projects is being mounted

Case report: mechanisms of HIV elite control in two African women.

Science.gov (United States)

Moosa, Yumna; Tanko, Ramla F; Ramsuran, Veron; Singh, Ravesh; Madzivhandila, Mashudu; Yende-Zuma, Nonhlanhla; Abrahams, Melissa-Rose; Selhorst, Philippe; Gounder, Kamini; Moore, Penny L; Williamson, Carolyn; Abdool Karim, Salim S; Garrett, Nigel J; Burgers, Wendy A

2018-01-25

The majority of people living with HIV require antiretroviral therapy (ART) for controlling viral replication, however there are rare HIV controllers who spontaneously and durably control HIV in the absence of treatment. Understanding what mediates viral control in these individuals has provided us with insights into the immune mechanisms that may be important to induce for a vaccine or functional cure for HIV. To date, few African elite controllers from high incidence settings have been described. We identified virological controllers from the CAPRISA 002 cohort of HIV-1 subtype C infected women in KwaZulu Natal, South Africa, two (1%) of whom were elite controllers. We examined the genetic, clinical, immunological and virological characteristics of these two elite HIV controllers in detail, to determine whether they exhibit features of putative viral control similar to those described for elite controllers reported in the literature. In this case report, we present clinical features, CD4 + T cell and viral load trajectories for two African women over 7 years of HIV infection. Viral load became undetectable 10 months after HIV infection in Elite Controller 1 (EC1), and after 6 weeks in Elite Controller 2 (EC2), and remained undetectable for the duration of follow-up, in the absence of ART. Both elite controllers expressed multiple HLA Class I and II haplotypes previously associated with slower disease progression (HLA-A*74:01, HLA-B*44:03, HLA-B*81:01, HLA-B*57:03, HLA-DRB1*13). Fitness assays revealed that both women were infected with replication competent viruses, and both expressed higher mRNA levels of p21, a host restriction factor associated with viral control. HIV-specific T cell responses were examined using flow cytometry. EC1 mounted high frequency HIV-specific CD8+ T cell responses, including a B*81:01-restricted Gag TL9 response. Unusually, EC2 had evidence of pre-infection HIV-specific CD4+ T cell responses. We identified some features typical of

HIV risk behaviors among African American men in Los Angeles County who self-identify as heterosexual.

Science.gov (United States)

Wohl, Amy Rock; Johnson, Denise F; Lu, Sharon; Jordan, Wilbert; Beall, Gildon; Currier, Judith; Simon, Paul A

2002-11-01

There are limited data on high-risk behaviors among heterosexual African American men with HIV infection. Risk behaviors were examined in a case-control study of HIV-infected (n = 90) and uninfected (n = 272) African American men who self-identified as heterosexual. Of men who self-identified as heterosexual, 31% (n = 28) of the infected men and 16% (n = 43) of the uninfected men reported having had anal sex with men. Among the heterosexual men reporting anal sex with men, 100% of the infected and 67% of the uninfected men reported inconsistent condom use during anal sex with men. Few of the infected (12%) and uninfected (2%) men reported oral sex with other men. Of the men who self-identified as heterosexual, 46% of those who were HIV-positive and 37% of those who were HIV-negative reported anal sex with women with infrequent condom use. An increasing risk for HIV was associated with decreasing age at first sexual experience (chi2, 9.3; p = .002). A history of injecting drugs (odds ratio [OR], 3.1; 95% confidence intervals [CIs], 1.8, 5.4) and amphetamine (OR, 4.3; 95% CIs, 1.1, 16.7) and methamphetamine (OR, 2.9; 95% CIs, 1.4, 6.3) use were associated with HIV. Innovative HIV prevention strategies are needed that move beyond the traditional gay versus straight model to effectively access hard-to-reach African American men who self-identify as heterosexual.

Awareness of HIV/AIDS and its oral manifestations among people ...

African Journals Online (AJOL)

... in HIV/AIDS and that oral health professionals provide sound information to PLHIV in community-outreach oral healthcare programmes. Keywords: Africa, health knowledge, oral ulcers, oral candidiasis, oral hairy leukoplakia, oral hygiene, self evaluation, symptoms. African Journal of AIDS Research 2007, 6(1): 91–95 ...

"Not easy at all but I am trying": barriers and facilitators to physical activity in a South African cohort of people living with HIV participating in a home-based pedometer walking programme.

Science.gov (United States)

Roos, Ronel; Myezwa, Hellen; van Aswegen, Helena

2015-01-01

The promotion of physical activity is encouraged in people living with HIV and AIDS (PLWHA) as a means of promoting wellness and health. Adherence to programmes that promote exercise is often reduced, and home-based programmes are suggested to improve adherence. This study investigated the personal and environmental factors that cause barriers and facilitators of physical activity in a home-based pedometer walking programme as a means of highlighting adherence challenges. An observational study nested in a randomised controlled trial was conducted in a cohort of South African PLWHA on antiretroviral therapy over a six-month period. Descriptive analysis and qualitative content analysis of 42 participants who underwent physical activity modification assisted with data review. The mean age of the sample was 38.7 (±8.9) years, consisted mostly of women (n = 35; 83.3%) who were employed (n = 19; 45.2%) but earning very little (less than R500 per month) and often single or widowed (n = 23; 54.8%). Barriers to physical activity identified included physical complaints, e.g., low-energy levels; psychological complaints, e.g., stress levels; family responsibility, e.g., being primary caregivers; the physical environment, e.g., adverse weather conditions; social environment, e.g., domestic abuse and crime; and workplace, e.g., being in a sedentary job. Facilitators of physical activity included support and encouragement from friends and family, religious practices during worship and community environment, e.g., having access to parks and sport fields. The study is of benefit as it highlights personal and environmental factors that need to be considered when developing or implementing a home-based walking programme in PLWHA.

HIV/AIDS-related social anxieties in adolescents in three African countries.

Science.gov (United States)

Venier, J L; Ross, M W; Akande, A

1998-02-01

This study examines the social anxieties associated with HIV prevention in adolescents in three African countries (Nigeria, Kenya, and Zimbabwe). The subjects used in this study were black Africans in form 2 or grade 10 in public high schools (Nigeria, n = 387; Kenya, n = 274; Zimbabwe n = 313). Subjects responded to the 33 item AIDS Social Assertiveness Scale (ASAS). Data indicated similar factor structures for each of the three countries and included five factors. The combined sample factor intercorrelations were modestly but significantly correlated. The mean scores for each factor were compared, and ANOVA of the factors by country, by gender, and by interaction between country and gender were performed. The factor structures were very similar between countries, each including five factors that had similar themes: condom interactions, refusal of risk, confiding in significant others, contact with people with HIV/AIDS, and general assertiveness. These factor structures were also very similar to one found in previous studies of Australian adolescents on the ASAS. The Kenyan means for four of the five factors were significantly lower than those for Nigeria, and were also significantly lower than the Zimbabwean means for two of the five factors, suggesting that Kenyan students are less anxious about social situations related to HIV/AIDS than others. Significant variance was found for several factors due to gender, country, and the interaction between gender and country. These results have important implications for designing education programs. The similarities of anxieties regarding HIV/AIDS social situations suggest that these clusters of social barriers to reduction of HIV infection risk might form the basis of educational interventions, and that dimensions of HIV social anxieties are similar across countries.

Evaluation of a school-based intervention programme for South African children of divorce.

Science.gov (United States)

Botha, Cornelius J; Wild, Lauren G

2013-01-01

Parental divorce affects approximately 30 000 South African children annually. This pilot study aimed to evaluate the effectiveness of the Children of Divorce Intervention Programme (CODIP) at two South African schools. CODIP is a preventively oriented group programme which was developed to foster resilience by helping children cope more effectively with possible academic, behavioural, and emotional problems brought about by their parents' divorce. Twenty-five 10- to 14-year-old boys from two primary schools were randomly assigned to 2 experimental groups and 1 delayed intervention control group. The experimental groups attended 12 one-hour weekly sessions; the control group received no intervention until after the study was completed. Children's understanding of divorce related events and social, emotional and behavioural adjustment was assessed one week before the intervention and three months thereafter using a battery of self-rated, teacher-rated and parent-rated questionnaires. One-way ANOVAs indicated no statistically significant decline in children's self-reported problematic beliefs about divorce or total difficulties. However, teachers' and parents' ratings indicated that compared to the control group, the combined experimental groups showed significant improvement in their general behavioural, emotional and social adjustment after programme participation. The results suggest that South African children who experience parental divorce may benefit from participation in CODIP.

Spatial clustering of all-cause and HIV-related mortality in a rural South African population (2000-2006.

Directory of Open Access Journals (Sweden)

Elias Namosha

Full Text Available Sub-Saharan Africa bears a disproportionate burden of HIV infection. Knowledge of the spatial distribution of HIV outcomes is vital so that appropriate public health interventions can be directed at locations most in need. In this regard, spatial clustering analysis of HIV-related mortality events has not been performed in a rural sub-Saharan African setting.Kulldorff's spatial scan statistic was used to identify HIV-related and all-cause mortality clusters (p<0.05 in a population-based demographic surveillance survey in rural KwaZulu Natal, South Africa (2000-2006. The analysis was split pre (2000-2003 and post (2004-2006 rollout of antiretroviral therapy, respectively. Between 2000-2006 a total of 86,175 resident individuals ≥15 years of age were under surveillance and 5,875 deaths were recorded (of which 2,938 were HIV-related over 343,060 person-years of observation (crude all-cause mortality rate 17.1/1000. During both time periods a cluster of high HIV-related (RR = 1.46/1.51, p = 0.001 and high all-cause mortality (RR = 1.35/1.38, p = 0.001 was identified in peri-urban communities near the National Road. A consistent low-risk cluster was detected in the urban township in both time periods (RR = 0.60/0.39, p = 0.003/0.005 and in the first time period (2000-2003 a large cluster of low HIV-related and all-cause mortality in a remote rural area was identified.HIV-related and all-cause mortality exhibit strong spatial clustering tendencies in this population. Highest HIV-related mortality and all-cause mortality occurred in the peri-urban communities along the National Road and was lowest in the urban township and remote rural communities. The geography of HIV-related mortality corresponded closely to the geography of HIV prevalence, with the notable exception of the urban township where high HIV-related mortality would have been expected on the basis of the high HIV prevalence. Our results suggest that HIV treatment

Association of pol diversity with antiretroviral treatment outcomes among HIV-infected African children.

Directory of Open Access Journals (Sweden)

Iris Chen

Full Text Available In HIV-infected children, viral diversity tends to increase with age in the absence of antiretroviral treatment (ART. We measured HIV diversity in African children (ages 6-36 months enrolled in a randomized clinical trial comparing two ART regimens (Cohort I of the P1060 trial. Children in this cohort were exposed to single dose nevirapine (sdNVP at birth.HIV diversity was measured retrospectively using a high resolution melting (HRM diversity assay. Samples were obtained from 139 children at the enrollment visit prior to ART initiation. Six regions of the HIV genome were analyzed: two in gag, one in pol, and three in env. A single numeric HRM score that reflects HIV diversity was generated for each region; composite HRM scores were also calculated (mean and median for all six regions.In multivariable median regression models using backwards selection that started with demographic and clinical variables, older age was associated with higher HRM scores (higher HIV diversity in pol (P = 0.005 and with higher mean (P = 0.014 and median (P<0.001 HRM scores. In multivariable models adjusted for age, pre-treatment HIV viral load, pre-treatment CD4%, and randomized treatment regimen, higher HRM scores in pol were associated with shorter time to virologic suppression (P = 0.016 and longer time to study endpoints (virologic failure [VF], VF/death, and VF/off study treatment; P<0.001 for all measures.In this cohort of sdNVP-exposed, ART-naïve African children, higher levels of HIV diversity in the HIV pol region prior to ART initiation were associated with better treatment outcomes.

Beliefs Contributing to HIV-related Stigma in African and Afro-Caribbean Communities in the Netherlands

NARCIS (Netherlands)

Stutterheim, S.E.; Bos, A.E.R.; Kesteren, van N.M.C.; Shiripinda, I.; Pryor, J.B.; Bruin, de M.; Schaalma, H.P.

2012-01-01

Thirty years after the first diagnosis, people living with HIV (PLWH) around the world continue to report stigmatizing experiences. In this study, beliefs contributing to HIV-related stigma in African and Afro-Caribbean diaspora communities and their cultural context were explored through

Boundaries of confidentiality in nursing care for mother and child in HIV programmes.

Science.gov (United States)

Våga, Bodil Bø; Moland, Karen Marie; Blystad, Astrid

2016-08-01

Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses' follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party - the child - have attracted limited attention. The study explores challenges of confidentiality linked to a third party in nurse-patient relationships in a rural Tanzanian HIV/AIDS context. The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. The material indicates a delicate balance between the nurses' attempt to secure the HIV-free survival of the babies and the mothers' desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient's restricted disclosure came to light during follow-up of the HIV-positive women and the third party - the child who is at risk of HIV infection through mother's milk. World Health Organization

An action agenda for HIV and sex workers.

Science.gov (United States)

Beyrer, Chris; Crago, Anna-Louise; Bekker, Linda-Gail; Butler, Jenny; Shannon, Kate; Kerrigan, Deanna; Decker, Michele R; Baral, Stefan D; Poteat, Tonia; Wirtz, Andrea L; Weir, Brian W; Barré-Sinoussi, Françoise; Kazatchkine, Michel; Sidibé, Michel; Dehne, Karl-Lorenz; Boily, Marie-Claude; Strathdee, Steffanie A

2015-01-17

The women, men, and transgender people who sell sex globally have disproportionate risks and burdens of HIV in countries of low, middle, and high income, and in concentrated and generalised epidemic contexts. The greatest HIV burdens continue to be in African female sex workers. Worldwide, sex workers still face reduced access to needed HIV prevention, treatment, and care services. Legal environments, policies, police practices, absence of funding for research and HIV programmes, human rights violations, and stigma and discrimination continue to challenge sex workers' abilities to protect themselves, their families, and their sexual partners from HIV. These realities must change to realise the benefits of advances in HIV prevention and treatment and to achieve global control of the HIV pandemic. Effective combination prevention and treatment approaches are feasible, can be tailored for cultural competence, can be cost-saving, and can help to address the unmet needs of sex workers and their communities in ways that uphold their human rights. To address HIV in sex workers will need sustained community engagement and empowerment, continued research, political will, structural and policy reform, and innovative programmes. But such actions can and must be achieved for sex worker communities everywhere. Copyright © 2015 Elsevier Ltd. All rights reserved.

Interplay between air passengers' service quality, satisfaction, loyalty and loyalty programmes in South African owned airlines

OpenAIRE

Mantey, Nicholas O.; Naidoo, Vannie

2017-01-01

Orientation: Delivering service quality is crucial for the continuous operation and sustainability of South African owned airlines. The term ‘South African owned airlines’ refers to six South African owned registered airlines, and is used for purpose of anonymity and confidentiality. Research purpose: The main aim of this study was to examine the interplay between service quality delivery, satisfaction, loyalty programmes and passengers’ loyalty to South African owned airlines. Motivati...

Endothelial activation and cardiometabolic profiles of treated and never-treated HIV infected Africans.

Science.gov (United States)

Fourie, C M T; Schutte, A E; Smith, W; Kruger, A; van Rooyen, J M

2015-05-01

The role the human immunodeficiency virus (HIV) and antiretroviral treatment on endothelial activation, and the subsequent relationship with cardiovascular disease, is not well understood. We investigated endothelial activation, inflammatory and cardiometabolic profiles, and measures of vascular structure and function of 66 antiretroviral treated (ART), 78 never-treated (no-ART) HIV infected and 165 HIV free Africans. Blood samples were obtained for biochemical analysis and blood pressure, pulse wave velocity (PWV) and carotid intima-media thickness (IMT) measurements were performed. The HIV infection duration was at least five years and the treatment 2.86±0.13 years. The intracellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) levels were elevated in the HIV infected groups compared to the controls. The odds of higher adhesion molecule levels were increased when HIV infected (especially in the no-ART group); OR no-ART vs. no-HIV: ICAM 3.92 (2.2-7.0); VCAM 16.2 (7.5-35). ICAM and VCAM associated with HIV status and interleukin-6 (IL-6) in the total group (all pART: β=-0.28, p=0.01; ART: β=-0.22, p=0.07) and TC (no-ART: β=-0.36, pART: β=-0.27, p=0.03). The ART group had an unfavourable lipid profile compared to the no-ART group. The inflammatory markers (C-reactive protein (CRP) and IL-6), PWV and IMT did not differ between the three groups. HIV infected Africans showed endothelial activation when compared to HIV free controls. The endothelial activation was not accompanied by increased inflammation (as measured with CRP and IL-6), arterial stiffness or sub-clinical atherosclerosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

HIV/AIDS and African American men: urban-rural differentials in sexual behavior, HIV knowledge, and attitude towards condoms use.

Science.gov (United States)

Williams, Patrick Bassey; Sallar, Anthony M

2010-12-01

We assessed the differences and similarities in knowledge, attitude, beliefs, myths, and misconceptions; and the various high-risk behavioral factors that influence the rate of infectivity of human immunodeficiency virus (HIV)/AIDS among African American men in urban and rural communities of Mississippi. A cross-sectional sample survey was conducted on 466 African American men in 2 sites between 2005 and 2007. With the main outcome variables of knowledge, attitude/feelings, behavior/practices, and potentials for behavior change, we administered a 64-item, ethnically sensitive, gender-specific instrument to the subjects via a person-to-person interview. Of the 466 respondents (urban, 33%; rural, 67%), 70%, 14.4%, and 16.6%, respectively, were heterosexual, bisexual, and men who have sex with men (MSM). The number of the respondents' sexual partners in the previous 12 months were: 1 to 2 (54%), 3 to 4 (25.7%), and 5 or more (20.2%). Statistically significant differences were observed between the 2 populations on HIV knowledge (p sexually transmitted infection testing history (p sexual partners (p = .038), unprotected sexual intercourse with drug users (p sexual limits prior to intercourse (p = .027). Although the level of HIV/AIDS knowledge and education were lower among urban than rural respondents, subjects' negative overall beliefs, attitude/feelings, behavior and potentials for behavioral change did not differ significantly among the African American men in the 2 communities.

HIV/AIDS stigma among a sample of primarily African American and Latino men who have sex with men (MSM) social media users

OpenAIRE

Garett, Renee; Smith, Justin; Chiu, Jason; Young, Sean D.

2016-01-01

The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African Am...

Promoting HIV Vaccine Research in African American Communities: Does the Theory of Reasoned Action Explain Potential Outcomes of Involvement?

Science.gov (United States)

Frew, Paula M; Archibald, Matthew; Martinez, Nina; del Rio, Carlos; Mulligan, Mark J

2007-01-01

The HIV/AIDS pandemic continues to challenge the African American community with disproportionate rates of infection, particularly among young women ages 25 to 34 years. Development of a preventive HIV vaccine may bring a substantial turning point in this health crisis. Engagement of the African American community is necessary to improve awareness of the effort and favorably influence attitudes and referent norms. The Theory of Reasoned Action (TRA) may be a useful framework for exploration of community engagement outcomes including future attendance, community mobilization, and study participation. Within the context of HIV vaccine outreach, we conducted a cross-sectional survey in early 2007 with 175 African-American adults (>/= 18 years). Confirmatory factor analysis and structural equation modeling were performed and the findings support the potential of the model in understanding behavioral intentions toward HIV vaccine research.

HIV-related sexual risk behavior among African American adolescent girls.

Science.gov (United States)

Danielson, Carla Kmett; Walsh, Kate; McCauley, Jenna; Ruggiero, Kenneth J; Brown, Jennifer L; Sales, Jessica M; Rose, Eve; Wingood, Gina M; Diclemente, Ralph J

2014-05-01

Latent class analysis (LCA) is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls. Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Participants were African American girls (n=701) aged 14-20 years presenting to sexual health clinics. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. Two latent classes were identified with the probability statistics for the two groups in this model being 0.89 and 0.88, respectively. In the final multivariate model, class 1 (the "higher risk" group; n=331) was distinguished by a higher likelihood of >5 lifetime sexual partners, having sex while high on alcohol/drugs, less frequent condom use, and history of sexually transmitted diseases (STDs), when compared with class 2 (the "lower risk" group; n=370). The derived model correctly classified 85.3% of participants into the two groups and accounted for 71% of the variance in the latent HIV-related sexual behavior risk variable. The higher risk class also had worse scores on all hypothesized correlates (e.g., self-esteem, history of sexual assault or physical abuse) relative to the lower risk class. Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services.

HIV prevention policy and programme planning: What can mathematical modelling contribute?

NARCIS (Netherlands)

Hankins, C.A.

2014-01-01

This thesis explores the potential contribution of mathematical modelling to informed decision-making on policy and programme planning for novel HIV prevention tools. Its hypothesis is that, under certain conditions, modelling results can be a useful addition to the evidence and other factors that

Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

Science.gov (United States)

Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

2017-05-01

Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

Effects of PREPARE, a Multi-component, School-Based HIV and Intimate Partner Violence (IPV) Prevention Programme on Adolescent Sexual Risk Behaviour and IPV: Cluster Randomised Controlled Trial.

Science.gov (United States)

Mathews, Catherine; Eggers, Sander M; Townsend, Loraine; Aarø, Leif E; de Vries, Petrus J; Mason-Jones, Amanda J; De Koker, Petra; McClinton Appollis, Tracy; Mtshizana, Yolisa; Koech, Joy; Wubs, Annegreet; De Vries, Hein

2016-09-01

Young South Africans, especially women, are at high risk of HIV. We evaluated the effects of PREPARE, a multi-component, school-based HIV prevention intervention to delay sexual debut, increase condom use and decrease intimate partner violence (IPV) among young adolescents. We conducted a cluster RCT among Grade eights in 42 high schools. The intervention comprised education sessions, a school health service and a school sexual violence prevention programme. Participants completed questionnaires at baseline, 6 and 12 months. Regression was undertaken to provide ORs or coefficients adjusted for clustering. Of 6244 sampled adolescents, 55.3 % participated. At 12 months there were no differences between intervention and control arms in sexual risk behaviours. Participants in the intervention arm were less likely to report IPV victimisation (35.1 vs. 40.9 %; OR 0.77, 95 % CI 0.61-0.99; t(40) = 2.14) suggesting the intervention shaped intimate partnerships into safer ones, potentially lowering the risk for HIV.

Is khat-chewing associated with HIV risk behaviour? A community ...

African Journals Online (AJOL)

We suggest that HIV/AIDS programmes in certain regions should address the habitual use of khat and other substances of potential abuse as part of their intervention efforts to curb the epidemic. Keywords: alcohol, amphetamine, cathinone, drug use, khat, psychotropic drugs. African Journal of AIDS Research 2006, 5(1): ...

African Sexual Vulnerability to HIV Infection: Examples from Lesotho ...

African Journals Online (AJOL)

In an attempt to adequately respond to and redress the velocity of the HIV/AIDS pandemic, many countries of the world have embarked on intensive education and research programmes in pursuit of the most effective strategies and methods of prevention, care, mitigation and a possible cure. Successful as some of the ...

HIV/AIDS stigma among a sample of primarily African-American and Latino men who have sex with men social media users.

Science.gov (United States)

Garett, Renee; Smith, Justin; Chiu, Jason; Young, Sean D

2016-01-01

The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n = 98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean = 22.2/75, SD = 5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.

'It's my inner strength': spirituality, religion and HIV in the lives of young African American men who have sex with men.

Science.gov (United States)

Foster, Michael L; Arnold, Emily; Rebchook, Gregory; Kegeles, Susan M

2011-10-01

Young black men who have sex with men account for 48% of 13-29-year-old HIV-positive men who have sex with men in the USA. It is important to develop an effective HIV prevention approach that is grounded in the context of young men's lives. Towards this goal, we conducted 31 interviews with 18-30-year-old men who have sex with men in the San Francisco-Oakland Bay Area. This paper examines the roles of religion and spirituality in men who have sex with men's lives, which is central in the lives of many African Americans. Six prominent themes emerged: (1) childhood participation in formal religious institutions, (2) the continued importance of spirituality among men who have sex with men, (3) homophobia and stigmatisation in traditional black churches, (4) tension between being a man who has sex with men and being a Christian, (5) religion and spirituality's impact on men's sense of personal empowerment and coping abilities and (6) treatment of others and building compassion. Findings suggest that integrating spiritual practice into HIV prevention may help programmes be more culturally grounded, thereby attracting more men and resonating with their experiences and values. In addition, faith-based HIV/AIDS ministries that support HIV-positive men who have sex with men may be particularly helpful. Finally, targeting pastors and other church leaders through anti-stigma curricula is crucial.

A Scoring Tool to Identify East African HIV-1 Serodiscordant Partnerships with a High Likelihood of Pregnancy.

Science.gov (United States)

Heffron, Renee; Cohen, Craig R; Ngure, Kenneth; Bukusi, Elizabeth; Were, Edwin; Kiarie, James; Mugo, Nelly; Celum, Connie; Baeten, Jared M

2015-01-01

HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples that are likely to become pregnant to facilitate discussions about methods to minimize HIV-1 risk during pregnancy attempts (i.e. safer conception) or effective contraception when pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant couples with a high likelihood of pregnancy within one year. Using standardized clinical prediction methods, we developed and validated a tool to identify heterosexual East African HIV-1 serodiscordant couples with an increased likelihood of becoming pregnant in the next year. Datasets were from three prospectively followed cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention trials and delivery projects. The final score encompassed the age of the woman, woman's number of children living, partnership duration, having had condomless sex in the past month, and non-use of an effective contraceptive. The area under the curve (AUC) for the probability of the score to correctly predict pregnancy was 0.74 (95% CI 0.72-0.76). Scores ≥ 7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and external validation confirmed the predictive ability of the score. A pregnancy likelihood score encompassing basic demographic, clinical and behavioral factors defined African HIV-1 serodiscordant couples with high one-year pregnancy incidence rates. This tool could be used to engage African HIV-1 serodiscordant couples in counseling discussions about fertility intentions in order to offer services for safer conception or contraception that align with their reproductive goals.

Validity of impedance-based predictions of total body water as measured by 2H dilution in African HIV/AIDS outpatients

International Nuclear Information System (INIS)

Diouf, Adama; Idohou Dossou, Nicole; Wade, Salimata; Gartner, Agnes; Sanon, Dominique Alexis; Bluck, Les; Wright, Antony

2009-01-01

Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients. The second aim was to develop specific predictive equations. Thirty-four HIV-infected patients without antiretroviral treatment and oedema at the beginning of the study (age 39 (SD 7) years, BMI 18.7 (SD 3.7) kg/m2, TBW 30.4 (SD 7.2 kg) were measured at inclusion then 3 and 6 months later. In the resulting eighty-eight measurements, we compared TBW values predicted from BIA to those measured by 2H dilution. Range of bias values was 0.1-4.3, and errors showed acceptable values (2.2-3.4 kg) for fourteen equations and a high value (10.4) for one equation. Two equations developed in non-HIV-infected subjects showed non-significant bias and could be used in African HIV-infected patients. In the other cases, poor agreement indicated a lack of validity. Specific equations developed from our sample showed a higher precision of TBW prediction when using resistance at 1000kHz (1.7kg) than at 50kHz (2.3kg), this latter precision being similar to that of the valid published equations (2.3 and 2.8kg). The valid published or developed predictive equations should be cross-validated in large independent samples of African HIV-infected patients. (Authors)

‘It’s my inner strength’: Spirituality, religion and HIV in the lives of young African American men who have sex with men

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Foster, Michael L.; Arnold, Emily; Rebchook, Gregory

2014-01-01

Young black men who have sex with men (YBMSM) account for 48% of 13–29 year old HIV-positive men who have sex with men (MSM) in the USA. It is important to develop an effective HIV prevention approach that is grounded in the context of young men’s lives. Towards this goal, we conducted 31 interviews with 18–30 year old YBMSM in the San Francisco-Oakland Bay Area. This paper examines the roles of religion and spirituality in YBMSM’s lives, which is central in the lives of many African Americans. Six prominent themes emerged: (1) childhood participation in formal religious institutions; (2) the continued importance of spirituality among YBMSM; (3) homophobia and stigmatisation in traditional black churches; (4) tension between being an MSM and Christian; (5) religion and spirituality’s impact on men’s sense of personal empowerment and coping abilities; and (6) treatment of others and building compassion. Findings suggest that integrating spiritual practice into HIV prevention may help programmes be more culturally grounded, thereby attracting more men and resonating with their experiences and values. In addition, faith-based HIV/AIDS ministries that support HIV-positive YBMSM may be particularly helpful. Finally, targeting pastors and other church leaders through anti-stigma curricula is crucial. PMID:21824017

HIV Stigma and Nurse Job Satisfaction in Five African Counties

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Chirwa, Maureen L.; Greeff, Minrie; Kohi, Thecla W.; Naidoo, Joanne R.; Makoae, Lucy N.; Dlamini, Priscilla S.; Kaszubski, Christopher; Cuca, Yvette P.; Uys, Leana R.; Holzemer, William L.

2009-01-01

This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The subscale, Personal Satisfaction, was the highest in this sample as in the other 2. Job Satisfaction scores differed significantly among the 5 countries and these differences were consistent across all subscales. A hierarchical regression demonstrated that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influences on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These findings provide new areas for intervention strategies that might enhance the work environment for nurses in these countries. PMID:19118767

HIV stigma and nurse job satisfaction in five African countries.

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Chirwa, Maureen L; Greeff, Minrie; Kohi, Thecla W; Naidoo, Joanne R; Makoae, Lucy N; Dlamini, Priscilla S; Kaszubski, Christopher; Cuca, Yvette P; Uys, Leana R; Holzemer, William L

2009-01-01

This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sample, as in the other 2. Job satisfaction scores differed significantly among the 5 countries, and these differences were consistent across all subscales. A hierarchical regression showed that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influence on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These results provide new areas for intervention strategies that might enhance the work environment for nurses in these countries.

Women's health, HIV/AIDS and the workplace in South Africa.

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Sprague, Courtenay

2008-11-01

This work explores the connections between gender inequality, HIV/AIDS and women's health in the world of work in South Africa. These connections are located within a context of significant reversals in development, specifically declining life expectancy and premature mortality for South Africans - particularly for women. By relying on the existing literature and interviews with 33 key informants, the paper examines the extent to which South African workplaces are recognising women's social and biological vulnerability to HIV. In particular, the paper considers the potential role of the workplace in responding to growing evidence that links gender and health by establishing targeted HIV/AIDS interventions. The findings suggest that the vast majority of company representatives do not recognise women's social and biological vulnerability and related social norms vis-à-vis HIV and AIDS. Importantly, most workplaces are not initiating programmes that specifically address women's or men's health. The author briefly identifies factors that may help explain the current state of knowledge and practice in the realm of HIV and women's health in the workplace, and puts forward suggestions for future research.

Progress in Harmonizing Tiered HIV Laboratory Systems: Challenges and Opportunities in 8 African Countries.

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Williams, Jason; Umaru, Farouk; Edgil, Dianna; Kuritsky, Joel

2016-09-28

In 2014, the Joint United Nations Programme on HIV/AIDS released its 90-90-90 targets, which make laboratory diagnostics a cornerstone for measuring efforts toward the epidemic control of HIV. A data-driven laboratory harmonization and standardization approach is one way to create efficiencies and ensure optimal laboratory procurements. Following the 2008 "Maputo Declaration on Strengthening of Laboratory Systems"-a call for government leadership in harmonizing tiered laboratory networks and standardizing testing services-several national ministries of health requested that the United States Government and in-country partners help implement the recommendations by facilitating laboratory harmonization and standardization workshops, with a primary focus on improving HIV laboratory service delivery. Between 2007 and 2015, harmonization and standardization workshops were held in 8 African countries. This article reviews progress in the harmonization of laboratory systems in these 8 countries. We examined agreed-upon instrument lists established at the workshops and compared them against instrument data from laboratory quantification exercises over time. We used this measure as an indicator of adherence to national procurement policies. We found high levels of diversity across laboratories' diagnostic instruments, equipment, and services. This diversity contributes to different levels of compliance with expected service delivery standards. We believe the following challenges to be the most important to address: (1) lack of adherence to procurement policies, (2) absence or limited influence of a coordinating body to fully implement harmonization proposals, and (3) misalignment of laboratory policies with minimum packages of care and with national HIV care and treatment guidelines. Overall, the effort to implement the recommendations from the Maputo Declaration has had mixed success and is a work in progress. Program managers should continue efforts to advance the

Progress in Harmonizing Tiered HIV Laboratory Systems: Challenges and Opportunities in 8 African Countries

Science.gov (United States)

Williams, Jason; Umaru, Farouk; Edgil, Dianna; Kuritsky, Joel

2016-01-01

ABSTRACT In 2014, the Joint United Nations Programme on HIV/AIDS released its 90-90-90 targets, which make laboratory diagnostics a cornerstone for measuring efforts toward the epidemic control of HIV. A data-driven laboratory harmonization and standardization approach is one way to create efficiencies and ensure optimal laboratory procurements. Following the 2008 “Maputo Declaration on Strengthening of Laboratory Systems”—a call for government leadership in harmonizing tiered laboratory networks and standardizing testing services—several national ministries of health requested that the United States Government and in-country partners help implement the recommendations by facilitating laboratory harmonization and standardization workshops, with a primary focus on improving HIV laboratory service delivery. Between 2007 and 2015, harmonization and standardization workshops were held in 8 African countries. This article reviews progress in the harmonization of laboratory systems in these 8 countries. We examined agreed-upon instrument lists established at the workshops and compared them against instrument data from laboratory quantification exercises over time. We used this measure as an indicator of adherence to national procurement policies. We found high levels of diversity across laboratories’ diagnostic instruments, equipment, and services. This diversity contributes to different levels of compliance with expected service delivery standards. We believe the following challenges to be the most important to address: (1) lack of adherence to procurement policies, (2) absence or limited influence of a coordinating body to fully implement harmonization proposals, and (3) misalignment of laboratory policies with minimum packages of care and with national HIV care and treatment guidelines. Overall, the effort to implement the recommendations from the Maputo Declaration has had mixed success and is a work in progress. Program managers should continue efforts to

Monitoring HIV Prevention Programme Outcomes among Key Populations in Kenya: Findings from a National Survey.

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Parinita Bhattacharjee

Full Text Available In preparation for the implementation of the Kenya AIDS Strategic Framework 2014/15-2018/19, the Kenya National AIDS and STI Control Programme facilitated a national polling booth survey as part of a baseline assessment of HIV-related risk behaviours among FSWs, MSM, and PWID, and their utilization of existing preventive interventions, as well as structural factors that may influence KPs' vulnerability to HIV. The survey was conducted among "key populations" (female sex workers, men who have sex with men, and people who inject drugs to understand current HIV risk and prevention behaviours, utilization of existing programmes and services, and experiences of violence. In total, 3,448 female sex workers, 1,308 men who have sex with men, and 690 people who inject drugs were randomly selected to participate in polling booth survey sessions from seven priority sites. Survey responses were aggregated and descriptive statistics derived. In general, reported condom use among all key populations was quite high with paying clients, and lower with regular, non-paying partners. Many participants reported unavailability of condoms or clean injecting equipment within the past month. Exposure to, and utilization of, existing HIV prevention services varied significantly among the groups, and was reported least commonly by female sex workers. Encouragingly, approximately three-quarters of all key population members reported receiving an HIV test in the past three months. All key population groups reported experiencing high levels of physical and sexual violence from partners/clients, and/or arrest and violence by law enforcement officials. Although some of the findings are encouraging, there is room for improvement in HIV prevention programmes and services for key populations across Kenya.

Peer led HIV/AIDS prevention for women in South African informal settlements.

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O'Hara Murdock, Peggy; Garbharran, Hari; Edwards, Mary Jo; Smith, Maria A; Lutchmiah, Johnny; Mkhize, Makhosi

2003-07-01

South African women who live in informal settlement communities are at high risk of HIV/AIDS infection due to their poor economic and social status. Prevention programs must include methods for improving their social conditions as well as their sexual risk behaviors. Members of Partners trained 24 women from informal settlements to lead HIV/AIDS education workshops for 480 residents. When these participants reached out to their neighbors, this participatory community-based approach resulted in providing HIV/AIDS prevention messages to more than 1,440 residents. Program leaders from three settlements said in focus group discussions that results from this social influences peer led approach demonstrated that women residents are a valuable resource in providing effective HIV/AIDS prevention programs to South Africa's most vulnerable residents.

HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV.

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Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska

2017-08-21

Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed ( n  = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV

Implementing universal HIV treatment in a high HIV prevalence and rural South African setting - Field experiences and recommendations of health care providers.

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Melanie Plazy

Full Text Available We aimed to describe the field experiences and recommendations of clinic-based health care providers (HCP regarding the implementation of universal antiretroviral therapy (ART in rural KwaZulu-Natal, South Africa.In Hlabisa sub-district, the local HIV programme of the Department of Health (DoH is decentralized in 18 clinics, where ART was offered at a CD4 count ≤500 cells/μL from January 2015 to September 2016. Within the ANRS 12249 TasP trial, implemented in part of the sub-district, universal ART (no eligibility criteria was offered in 11 mobile clinics between March 2012 and June 2016. A cross-sectional qualitative survey was conducted in April-July 2016 among clinic-based nurses and counsellors providing HIV care in the DoH and TasP trial clinics. In total, 13 individual interviews and two focus groups discussions (including 6 and 7 participants were conducted, audio-recorded, transcribed, and thematically analyzed.All HCPs reported an overall good experience of delivering ART early in the course of HIV infection, with most patients willing to initiate ART before being symptomatic. Yet, HCPs underlined that not feeling sick could challenge early ART initiation and adherence, and thus highlighted the need to take time for counselling as an important component to achieve universal ART. HCPs also foresaw logistical challenges of universal ART, and were especially concerned about increasing workload and ART shortage. HCPs finally recommended the need to strengthen the existing model of care to facilitate access to ART, e.g., community-based and integrated HIV services.The provision of universal ART is feasible and acceptable according to HCPs in this rural South-African area. However their experiences suggest that universal ART, and more generally the 90-90-90 UNAIDS targets, will be difficult to achieve without the implementation of new models of health service delivery.

Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda.

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Nuwagaba-Biribonwoha, H; Mayon-White, R T; Okong, P; Carpenter, L M

2007-09-01

To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda. Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach. The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families. Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.

Manual of methods for use in the South African Marine Pollution Monitoring Programme

CSIR Research Space (South Africa)

Watling, RJ

1981-07-01

Full Text Available Methods used in the South African Marine Pollution Monitoring Programme for the analysis of toxic metals, nutrients, oxygen absorbed, chlorophyll, pesticides and bacteria are described. Sample types include biological material, sediments, estuarine...

Correlation between national income, HIV/AIDS and political status and mortalities in African countries.

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Andoh, S Y; Umezaki, M; Nakamura, K; Kizuki, M; Takano, T

2006-07-01

To investigate associations between mortalities in African countries and problems that emerged in Africa in the 1990s (reduction of national income, HIV/AIDS and political instability) by adjusting for the influences of development, sanitation and education. We compiled country-level indicators of mortalities, national net income (the reduction of national income by the debt), infection rate of HIV/AIDS, political instability, demography, education, sanitation and infrastructure, from 1990 to 2000 of all African countries (n=53). To extract major factors from indicators of the latter four categories, we carried out principal component analysis. We used multiple regression analysis to examine the associations between mortality indicators and national net income per capita, infection rate of HIV/AIDS, and political instability by adjusting the influence of other possible mortality determinants. Mean of infant mortality per 1000 live births (IMR); maternal mortality per 100,000 live birth (MMR); adult female mortality per 1000 population (AMRF); adult male mortality per 1000 population (AMRM); and life expectancy at birth (LE) in 2000 were 83, 733, 381, 435, and 51, respectively. Three factors were identified as major influences on development: education, sanitation and infrastructure. National net income per capita showed independent negative associations with MMR and AMRF, and a positive association with LE. Infection rate of HIV/AIDS was independently positively associated with AMRM and AMRF, and negatively associated with LE in 2000. Political instability score was independently positively associated with MMR. National net income per capita, HIV/AIDS and political status were predictors of mortality indicators in African countries. This study provided evidence for supporting health policies that take economic and political stability into account.

An HIV/AIDS intervention programme with Buddhist aid in Yunnan Province.

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Wu, Feng; Zhang, Kong-lai; Shan, Guang-liang

2010-04-20

The prevalence of HIV/AIDS in Chinese ethnic minorities is an important component of China's AIDS issues. In this study, we launched an intervention programme in Yunnan Province of China, where the Dai people live, to carry out the community-based HIV/AIDS health education and behavioral interventions on ordinary Dai farmers. The Dai people believe in Theravada Buddhism. Four rural communities were randomly divided into two groups. In one group (Buddhist group), HIV/AIDS health education and behavioral intervention were carried out by monks. The other group (women group) was instructed by women volunteers. The intervention continued for one year and the data were collected before and after the intervention project. In the Buddhist group, the villagers' AIDS related knowledge score was boosted from 3.11 to 3.65 (P Buddhist group, the villager's attitude score towards the people living with HIV and AIDS (PLWHA) also increased significantly from 1.51 to 2.16 (P Buddhist organization has limited success in promoting the use of condoms, but plays an important role in eliminating HIV/AIDS related discrimination.

Conceptualizing community mobilization for HIV prevention: implications for HIV prevention programming in the African context.

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Sheri A Lippman

Full Text Available Community mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation.We aimed to identify the key domains of community mobilization (CM essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting.We studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge.CM DOMAINS INCLUDE: 1 shared concerns, 2 critical consciousness, 3 organizational structures/networks, 4 leadership (individual and/or institutional, 5 collective activities/actions, and 6 social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks.To date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of

The South African National Accelerator Centre and its research programme

Energy Technology Data Exchange (ETDEWEB)

Watanabe, Y. [Kyushu Univ., Fukuoka (Japan)

1997-03-01

An overview of the South African National Accelerator Centre and its research activities is given with emphasis on medium energy nuclear physics and nuclear data measurements for medical use. Also presented is a preliminary result of {sup 40}Ca(p,p`x) spectrum measurement for 392 MeV which has been carried out at RCNP, Osaka University, under the South Africa-Japan collaborative programme. (author)

The Epidemiology of Meningitis among Adults in a South African Province with a High HIV Prevalence, 2009-2012

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Britz, Erika; Perovic, Olga; von Mollendorf, Claire; von Gottberg, Anne; Iyaloo, Samantha; Quan, Vanessa; Chetty, Verushka; Sriruttan, Charlotte; Ismail, Nazir A.; Nanoo, Ananta; Musekiwa, Alfred; Reddy, Carl; Viljoen, Karien; Cohen, Cheryl; Govender, Nelesh P.

2016-01-01

Introduction Meningitis is a major cause of mortality in southern Africa. We aimed to describe the aetiologies and frequencies of laboratory-confirmed fungal and bacterial meningitis among adults in a South African province with an 11% HIV prevalence, over 4 years. Methods We conducted a retrospective, observational study of secondary laboratory data, extracted on all cerebrospinal fluid (CSF) specimens submitted to public-sector laboratories in Gauteng province from 2009 through 2012. We calculated cause-specific incidence rates in the general and HIV-infected populations and used Poisson regression to determine if trends were significant. Results We identified 11,891 (10.7%) incident cases of meningitis from 110,885 CSF specimens. Cryptococcal meningitis, tuberculous meningitis and pneumococcal meningitis accounted for 62.3% (n = 7,406), 24.6% (n = 2,928) and 10.1% (n = 1,197) of cases over the four-year period. The overall incidence (cases per 100,000 persons) of cryptococcal meningitis declined by 23% from 24.4 in 2009 to 18.7 in 2012 (p meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p meningitis (248/11,891, 2.1%), Neisseria meningitidis (n = 93), Escherichia coli (n = 72) and Haemophilus influenzae (n = 20) were the most common organisms identified. Conclusions In this high HIV-prevalence province, cryptococcal meningitis was the leading cause of laboratory-confirmed meningitis among adults. Over a 4-year period, there was a significant decrease in incidence of cryptococcal, tuberculous and pneumococcal meningitis. This coincided with expansion of the national antiretroviral treatment programme, enhanced tuberculosis control programme and routine childhood immunisation with pneumococcal conjugate vaccines. PMID:27669564

A Scoring Tool to Identify East African HIV-1 Serodiscordant Partnerships with a High Likelihood of Pregnancy.

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Renee Heffron

Full Text Available HIV-1 prevention programs targeting HIV-1 serodiscordant couples need to identify couples that are likely to become pregnant to facilitate discussions about methods to minimize HIV-1 risk during pregnancy attempts (i.e. safer conception or effective contraception when pregnancy is unintended. A clinical prediction tool could be used to identify HIV-1 serodiscordant couples with a high likelihood of pregnancy within one year.Using standardized clinical prediction methods, we developed and validated a tool to identify heterosexual East African HIV-1 serodiscordant couples with an increased likelihood of becoming pregnant in the next year. Datasets were from three prospectively followed cohorts, including nearly 7,000 couples from Kenya and Uganda participating in HIV-1 prevention trials and delivery projects.The final score encompassed the age of the woman, woman's number of children living, partnership duration, having had condomless sex in the past month, and non-use of an effective contraceptive. The area under the curve (AUC for the probability of the score to correctly predict pregnancy was 0.74 (95% CI 0.72-0.76. Scores ≥ 7 predicted a pregnancy incidence of >17% per year and captured 78% of the pregnancies. Internal and external validation confirmed the predictive ability of the score.A pregnancy likelihood score encompassing basic demographic, clinical and behavioral factors defined African HIV-1 serodiscordant couples with high one-year pregnancy incidence rates. This tool could be used to engage African HIV-1 serodiscordant couples in counseling discussions about fertility intentions in order to offer services for safer conception or contraception that align with their reproductive goals.

Science Theatre: Changing South African Students' Intended Behaviour towards HIV AIDS

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Walker, Graham J.; Stocklmayer, Susan M.; Grant, Will J.

2013-01-01

Science centres and other informal learning environments are increasingly becoming venues in which socioscientific issues are presented, sometimes with the aim of influencing attitudes and behaviour. This study investigated the effects of an HIV AIDS science theatre presentation on the behavioural intentions of 697 South African students, a…

Myths or theories? Alternative beliefs about HIV and AIDS in South African working class communities.

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Dickinson, David

2013-09-01

Despite three decades of public health promotion based on the scientific explanation of HIV/AIDS, alternative explanations of the disease continue to circulate. While these are seen as counter-productive to health education efforts, what is rarely analysed is their plurality and their tenacity. This article analyses the 'AIDS myths' collected by African HIV/AIDS workplace peer educators during an action research project. These beliefs about HIV/AIDS are organised, in this article, around core ideas that form the basis of 'folk' and 'lay theories' of HIV/AIDS. These constitute non-scientific explanations of HIV/AIDS, with folk theories drawing on bodies of knowledge that are independent of HIV/AIDS while lay theories are generated in response to the disease. A categorisation of alternative beliefs about HIV/AIDS is presented which comprises three folk theories - African traditional beliefs, Christian theology, and racial conspiracy - and three lay theories, all focused on avoiding HIV infection. Using this schema, the article describes how the plausibility of these alternative theories of HIV/AIDS lies not in their scientific validity, but in the robustness of the core idea at the heart of each folk or lay theory. Folk and lay theories of HIV/AIDS are also often highly palatable in that they provide hope and comfort in terms of prevention, cure, and the allocation of blame. This study argue that there is coherence and value to these alternative HIV/AIDS beliefs which should not be dismissed as ignorance, idle speculation or simple misunderstandings. A serious engagement with folk and lay theories of HIV/AIDS helps explain the continued circulation of alternative beliefs of HIV/AIDS and the slow uptake of behavioural change messages around the disease.

HIV risk and barriers to care for African-born immigrant women: a sociocultural outlook

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Okoro ON

2017-06-01

Full Text Available Olihe N Okoro,1 Shanasha O Whitson2 1Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, 2Community Partnership Collaborative 2.0, Minneapolis, MN, USA Background: Data from the Minnesota Department of Health (MDH HIV/AIDS Surveillance Report 2015 show that African-born (AB women continue to be disproportionately affected by HIV. In 2015, these women accounted for more than half (54% of all new cases of HIV reported among females in Minnesota and 34% of all known female cases in the state. This study was a needs assessment for HIV pre-exposure prophylaxis (PrEP in vulnerable subgroups within the AB population and adequacy of HIV care for AB persons. The primary objective of this study was to gain an insight into the strategies that will limit the spread of HIV infection and enhance HIV care among AB immigrants. Methods: Community advocates, community-based organizations (CBOs, clinicians, and other HIV-related service providers were invited to participate in a focus group, structured interview or complete an assessment tool using the same questionnaire about HIV and PrEP among AB persons. A thematic analysis was then conducted on the open-ended questions addressing perceived barriers. Results: Findings suggest the following gender-specific sociocultural factors that drive HIV transmission and constitute barriers to HIV treatment for AB women: domestic/intimate partner violence, gender-biased stigma, discriminatory cultural beliefs and normative values/expectations, unprotected sex with husbands who have sex with other men, gender discordance in health care (preference for female provider, and sexual/reproductive health illiteracy. Recommendation: Based on recommendations, a community-based sexual and reproductive health education is being initiated with a curriculum that will be 1 broad (inclusive but not limited to HIV, 2 culturally sensitive/responsive, and 3 at appropriate

Implementation of prevention of mother-to-child transmission of HIV programme through private hospitals of Delhi--policy implications.

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Gupta, A K; Garg, C R; Joshi, B C; Rawat, N; Dabla, V; Gupta, A

2015-01-01

In India, programme for prevention of mother-to-child transmission (PMTCT) of HIV is primarily implemented through public health system. State AIDS Control Societies (SACSs) encourage private hospitals to set up integrated counselling and testing centres (ICTCs). However, private hospitals of Delhi did not set up ICTCs. Consequently, there is no information on PMTCT interventions in private hospitals of Delhi. This study was undertaken by Delhi SACS during March 2013 through September 2013 to assess status of implementation of PMTCT programme in various private hospitals of Delhi to assist programme managers in framing national policy to facilitate uniform implementation of National PMTCT guidelines. Out of total 575 private hospitals registered with Government of Delhi, 336 (58.4%) catering to pregnant women were identified. About 100 private hospitals with facility of antenatal care, vaginal/caesarean delivery and postnatal care and minimum 10 indoor beds were selected for study. Study sample comprised of large corporate hospitals (≥100 beds; n = 29), medium-sized hospitals (25 to women tested, 52 (0.14%) were detected HIV-positive. However, against National Policy, HIV testing was done without pre/post-test counselling/or consent of women, no PMTCT protocol existed, delivery of HIV-positive women was not undertaken and no efforts were made to link HIV-positive women to antiretroviral treatment. Major intervention observed was medical termination of pregnancy, which indicates lack of awareness in private hospitals about available interventions under national programme. The role of private hospitals in management of HIV in pregnant women must be recognized and mainstreamed in HIV control efforts. There is an urgent need for capacity building of private health care providers to improve standards of practice. National AIDS Control Organization may consider establishing linkages or adopting model developed by some countries with generalized epidemic for delivering

African herbal medicines in the treatment of HIV: Hypoxis and Sutherlandia. An overview of evidence and pharmacology

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Seely Dugald

2005-05-01

Full Text Available Abstract In Africa, herbal medicines are often used as primary treatment for HIV/AIDS and for HIV-related problems. In general, traditional medicines are not well researched, and are poorly regulated. We review the evidence and safety concerns related to the use of two specific African herbals, which are currently recommended by the Ministry of Health in South Africa and member states for use in HIV: African Potato and Sutherlandia. We review the pharmacology, toxicology and pharmacokinetics of these herbal medicines. Despite the popularity of their use and the support of Ministries of Health and NGOs in some African countries, no clinical trials of efficacy exist, and low-level evidence of harm identifies the potential for drug interactions with antiretroviral drugs. Efforts should be made by mainstream health professionals to provide validated information to traditional healers and patients on the judicious use of herbal remedies. This may reduce harm through failed expectations, pharmacologic adverse events including possible drug/herb interactions and unnecessary added therapeutic costs. Efforts should also be directed at evaluating the possible benefits of natural products in HIV/AIDS treatment.

Weighing the Consequences: Self-Disclosure of HIV-Positive Status among African American Injection Drug Users

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Valle, Maribel; Levy, Judith

2009-01-01

Theorists posit that personal decisions to disclose being HIV positive are made based on the perceived consequences of that disclosure. This study examines the perceived costs and benefits of self-disclosure among African American injection drug users (IDUs). A total of 80 African American IDUs were interviewed in-depth subsequent to testing HIV…

The tuberculosis challenge in a rural South African HIV programme

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Cooke Graham S

2010-02-01

Full Text Available Abstract Background South Africa remains the country with the greatest burden of HIV-infected individuals and the second highest estimated TB incidence per capita worldwide. Within South Africa, KwaZulu-Natal has one of the highest rates of TB incidence and an emerging epidemic of drug-resistant tuberculosis. Methods Review of records of consecutive HIV-infected people initiated onto ART between 1st January 2005 and 31st March 2006. Patients were screened for TB at initiation and incident episodes recorded. CD4 counts, viral loads and follow-up status were recorded; data was censored on 5th August 2008. Geographic cluster analysis was performed using spatial scanning. Results 801 patients were initiated. TB prevalence was 25.3%, associated with lower CD4 (AHR 2.61 p = 0.01 for CD4 25 copies/ml (OR 1.75 p = 0.11. A low-risk cluster for incident TB was identified for patients living near the local hospital in the geospatial analysis. Conclusion There is a large burden of TB in this population. Rate of incident TB stabilises at a rate higher than that of the overall population. These data highlight the need for greater research on strategies for active case finding in rural settings and the need to focus on strengthening primary health care.

High cancer-related mortality in an urban, predominantly African-American, HIV-infected population.

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Riedel, David J; Mwangi, Evelyn Ivy W; Fantry, Lori E; Alexander, Carla; Hossain, Mian B; Pauza, C David; Redfield, Robert R; Gilliam, Bruce L

2013-04-24

To determine mortality associated with a new cancer diagnosis in an urban, predominantly African-American, HIV-infected population. Retrospective cohort study. All HIV-infected patients diagnosed with cancer between 1 January 2000 and 30 June 2010 were reviewed. Mortality was examined using Kaplan-Meier estimates and Cox proportional hazards models. There were 470 cases of cancer among 447 patients. Patients were predominantly African-American (85%) and male (79%). Non-AIDS-defining cancers (NADCs, 69%) were more common than AIDS-defining cancers (ADCs, 31%). Cumulative cancer incidence increased significantly over the study period. The majority (55.9%) was taking antiretroviral therapy (ART) at cancer diagnosis or started afterward (26.9%); 17.2% never received ART. Stage 3 or 4 cancer was diagnosed in 67%. There were 226 deaths during 1096 person years of follow-up, yielding an overall mortality rate of 206 per 1000 person years. The cumulative mortality rate at 30 days, 1 year, and 2 years was 6.5, 32.2, and 41.4%, respectively. Mortality was similar between patients on ART whether they started before or after the cancer diagnosis but was higher in patients who never received ART. In patients with a known cause of death, 68% were related to progression of the underlying cancer. In a large cohort of urban, predominantly African-American patients with HIV and cancer, many patients presented with late-stage cancer. There was substantial 30-day and 2-year mortality, although ART had a significant mortality benefit. Deaths were most often caused by progression of cancer and not from another HIV-related or AIDS-related event.

KHOMANANI: AN HIV AND AIDS COMMUNITY MOBILISATION PROGRAMME FOR RESOURCE-CONSTRAINED SETTINGS

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Shilubane, Tlangelani

2013-05-01

Full Text Available An overview of HIV and AIDS statistics indicates that there were 31.6 million people living with HIV in 2010, and that 68% of those people were from Sub-Saharan Africa (UNAIDS, 2011:07. In South Africa, one of the countries in Sub-Saharan Africa, HIV prevalence among people between the ages of 15 and 49 has stabilised at 17.8%, with the absolute number of people living with HIV (PLHIV showing a steep increase of approximately 100 000 additional PLHIV each year. The number of people aged 15 and older living with HIV is estimated to be 5 300 000. These figures actually mean that one out of every six people with HIV in the world lives in South Africa (UNAIDS, 2011:21. The authors therefore postulate that these statistics encapsulate the devastation that HIV and AIDS is causing, particularly in South Africa, which arguably carries the heaviest HIV and AIDS burden in the world. Initially South Africa’s efforts to mitigate the impact of HIV and AIDS were characterised by programme designs which followed an inflexible biomedical approach that did not focus on the influence of socio-economic and structural factors in addressing the pandemic. This situation, among others, contributed to raise the country’s HIV infection growth rate to among the highest in the world (Kahn, 2006:4.

Assessing behavioural intention of small and medium enterprises in implementing an HIV/AIDS policy and programme

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A. Parsadh

2005-10-01

Full Text Available Small and Medium Enterprises (SMEs are likely to feel the impact of an HIV/AIDS epidemic through reduced productivity and an increased percentage of absenteeism; staff turnover; recruitment and training costs; cost of employee benefits; and poor staff morale. One of the interventions is to implement an HIV/AIDS policy and programme, yet a literature search showed that psychological studies of SMEs in implementing an HIV/AIDS policy and programme are limited. The present study utilised the model of the theory of planned behaviour (Ajzen, 1988, 1991, which is an extension of the theory of reasoned action (Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980. The intention to implement an HIV/AIDS policy and programme was predicted by the theory of planned behaviour constructs such as attitude, subjective norm and perceived behavioural control. The theory of planned behaviour was found to have limited use in assessing behavioural intention of SMEs in implementing an HIV/AIDS policy and programme. Opsomming Die uitwerking van die MIV/VIGS pandemie op Klein en Medium Sake-ondernemings sal tot gevolg hê ’n afname in produktiwiteit; ’n toename in personeelafwesigheid, personeelomset, personeelwerwing en –opleidingskoste, personeelvoordele; en swak personeel moraal tot gevolg hê. Een manier om die probleem aan te spreek is om ’n MIV/VIGS beleid en program te implimenteer. Navorsing toon dat psigologiese studies van klein en medium sakeondernemings om ’n HIV/VIGS beleid en program te implimenteer, beperk is. Hierdie navorsing steun op die teorie van planmatige gedrag (Ajzen, 1988; 1991, wat ’n verlenging is van die teorie van beredeneerde optrede (Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980. Die oogmerk met die implimentering van ’n MIV/VIGS beleid en program is bepaal deur die teorie van planmagtige gedrag soos waargeneem in houding, subjektiewe norme en waargenome gedragskontrole. Die resultate toon dat die teorie van planmagtige gedrag

Can "Any" Teacher Teach Sexuality and HIV/AIDS? Perspectives of South African Life Orientation Teachers

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Helleve, Arnfinn; Flisher, Alan J.; Onya, Hans; Mukoma, Wanjiru; Klepp, Knut-Inge

2011-01-01

In this paper we explore the perceived desirable characteristics of South African Life Orientation teachers for teaching sexuality and HIV/AIDS. We also investigate the extent to which these characteristics can be understood as parts of a role script for teaching HIV/AIDS and sexuality. Data were collected from teachers who taught Grade Eight and…

Health challenges in South African automotive companies: Wellness in the workplace

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Anna Meyer-Weitz

2015-11-01

Full Text Available Orientation: In South Africa, workplace programmes in the automotive industry focus predominantly on occupational health and safety and HIV and AIDS. The implementation of focused workplace interventions might be hampered when companies are not convinced that the condition (i.e. HIV and AIDS is the main negative health influencing factor responsible for increased production costs. Research purpose: The study investigated the health influencing conditions perceived to negatively impact company production costs and related interventions. Motivation for the study: Apart from HIV and AIDS, little information is available about the health challenges in the South African workplace and focused HIV and AIDS programmes might only partly respond to the key health challenges of workplaces. The inter-relatedness of various risky lifestyle factors linked to health conditions necessitates a comprehensive health promotion approach. Research approach, design and method: A cross-sectional survey was conducted amongst 74 companies selected through stratified random sampling. Non-parametric tests were conducted to investigate the health influencing factors perceived to impact production costs, the monitoring thereof, extent of containment and the implementation of interventions in terms of company size and ownership. Main findings: The health factors perceived to have a moderate to large impact were HIV and AIDS, smoking, alcohol use, stress, back and neck ache and tuberculosis, also reported to be better monitored and managed by medium and large organisations. Small organisations reported a smaller impact, fewer efforts and less success. HIV and AIDS programmes were more evident in large companies and those with wellness programmes (52%. Workplace programmes enabled better monitoring and managing of impacting health conditions. Smaller organisations were not convinced of the benefits of interventions in addressing health challenges. Practical

Implementing universal HIV treatment in a high HIV prevalence and rural South African setting – Field experiences and recommendations of health care providers

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Gumede, Dumile; Boyer, Sylvie; Pillay, Deenan; Dabis, François; Seeley, Janet; Orne-Gliemann, Joanna

2017-01-01

Background We aimed to describe the field experiences and recommendations of clinic-based health care providers (HCP) regarding the implementation of universal antiretroviral therapy (ART) in rural KwaZulu-Natal, South Africa. Methods In Hlabisa sub-district, the local HIV programme of the Department of Health (DoH) is decentralized in 18 clinics, where ART was offered at a CD4 count ≤500 cells/μL from January 2015 to September 2016. Within the ANRS 12249 TasP trial, implemented in part of the sub-district, universal ART (no eligibility criteria) was offered in 11 mobile clinics between March 2012 and June 2016. A cross-sectional qualitative survey was conducted in April–July 2016 among clinic-based nurses and counsellors providing HIV care in the DoH and TasP trial clinics. In total, 13 individual interviews and two focus groups discussions (including 6 and 7 participants) were conducted, audio-recorded, transcribed, and thematically analyzed. Results All HCPs reported an overall good experience of delivering ART early in the course of HIV infection, with most patients willing to initiate ART before being symptomatic. Yet, HCPs underlined that not feeling sick could challenge early ART initiation and adherence, and thus highlighted the need to take time for counselling as an important component to achieve universal ART. HCPs also foresaw logistical challenges of universal ART, and were especially concerned about increasing workload and ART shortage. HCPs finally recommended the need to strengthen the existing model of care to facilitate access to ART, e.g., community-based and integrated HIV services. Conclusions The provision of universal ART is feasible and acceptable according to HCPs in this rural South-African area. However their experiences suggest that universal ART, and more generally the 90-90-90 UNAIDS targets, will be difficult to achieve without the implementation of new models of health service delivery. PMID:29155832

"Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV.

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Fletcher, Faith; Ingram, Lucy Annang; Kerr, Jelani; Buchberg, Meredith; Richter, Donna L; Sowell, Richard

2016-01-01

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Culturally Sensitive Approaches to Identification and Treatment of Depression among HIV Infected African American Adults: A Qualitative Study of Primary Care Providers' Perspectives.

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Le, Huynh-Nhu; Hipolito, Maria Mananita S; Lambert, Sharon; Terrell-Hamilton, Flora; Rai, Narayan; McLean, Charlee; Kapetanovic, Suad; Nwulia, Evaristus

2016-04-01

Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment. A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers. Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression. This study reflects the views of providers from one clinic in this community. Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances.

HIV/AIDS prevention, faith, and spirituality among black/African American and Latino communities in the United States: strengthening scientific faith-based efforts to shift the course of the epidemic and reduce HIV-related health disparities.

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Sutton, Madeline Y; Parks, Carolyn P

2013-06-01

Black/African American and Latino communities are disproportionately affected by the domestic HIV/AIDS epidemic. Blacks/African Americans and Latinos are also more likely to report a formal, religious, or faith affiliation when compared with non-Hispanic whites. As such, faith leaders and their institutions have been identified in the National HIV/AIDS Strategy as having a vital role to serve in reducing: (1) HIV-related health disparities and (2) the number of new HIV infections by promoting non-judgmental support for persons living with and at risk for HIV/AIDS and by serving as trusted information resources for their congregants and communities. We describe faith doctrines and faith-science partnerships that are increasing in support of faith-based HIV prevention and service delivery activities and discuss the vital role of these faith-based efforts in highly affected black/African American and Latino communities.

Lover, mother or worker: women\\'s multiple roles and the HIV/AIDS ...

African Journals Online (AJOL)

Yet, we still hear most often of abstinence, anti-retrovirals and condom use as the primary focus of HIV/AIDS prevention and intervention in Africa. Keywords: Africa, communication, ethnography, health care provision, family planning, national health care programmes. African Journal of AIDS Research 2005, 4(2): 83–90 ...

Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: Systematic Review.

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Córdova, David; Mendoza Lua, Frania; Ovadje, Lauretta; Hong, Ethan; Castillo, Berenice; Salas-Wright, Christopher P

2017-12-13

HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth. The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth. We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included. Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts. Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed. ©David Córdova, Frania Mendoza Lua, Lauretta Ovadje, Ethan Hong, Berenice Castillo, Christopher P Salas-Wright. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 13.12.2017.

Analysis of queries from nurses to the South African National HIV ...

African Journals Online (AJOL)

Care Worker Hotline which provides free information on patient treatment to all healthcare workers in South Africa. With ... DOI:10.7196/SAJHIVMED.948. ORIGINAL ARTICLE. Analysis of queries from nurses to the. South African National HIV & TB Health. Care Worker Hotline. A M Swart,1 ..... Improving the quality of life of ...

Efavirenz poisoning in a 12 year old HIV negative African boy ...

African Journals Online (AJOL)

Efavirenz is an oral antiretroviral drug in the class of non nucleoside reverse transcriptase inhibitors. Toxicity at therapeutic doses has been documented but there is scarcity of data on presentation and management of Efavirenz overdose. We describe a case of Efavirenz poisoning in a 12-year old HIV Negative African boy ...

Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1 Serodiscordant Couples

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MUGO, Nelly R.; HEFFRON, Renee; DONNELL, Deborah; WALD, Anna; WERE, Edwin O.; REES, Helen; CELUM, Connie; KIARIE, James N.; COHEN, Craig R.; KAYINTEKORE, Kayitesi; BAETEN, Jared M.

2011-01-01

Background Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. Methods In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. Results 3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and non-pregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33–4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93–3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22–4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26–4.85). Conclusions HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness. PMID:21785321

African Programme for Onchocerciasis Control 1995-2015: Model-Estimated Health Impact and Cost

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L.E. Coffeng (Luc); W.A. Stolk (Wilma); H.G.M. Zouré (Honorat G.); J.L. Veerman (Lennert); K.B. Agblewonu (Koffi); M.E. Murdoch (Michele); M. Noma (Mounkaila); G. Fobi (Grace); J.H. Richardus (Jan Hendrik); D.A.P. Bundy (Donald A.); J.D.F. Habbema (Dik); S.J. de Vlas (Sake); U.V. Amazigo (Uche)

2013-01-01

textabstractBackground: Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health

Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective.

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Amutah-Onukagha, Ndidiamaka; Mahadevan, Meena; Opara, Ijeoma; Rodriguez, Monica; Trusdell, Megan; Kelly, Jessica

2018-04-01

Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants' ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs.

Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system.

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Maher, Dermot

2010-07-05

The global financial crisis threatens global health, particularly exacerbating diseases of inequality, e.g. HIV/AIDS, and diseases of poverty, e.g. tuberculosis. The aim of this paper is to reconsider established practices and policies for HIV and tuberculosis epidemic control, aiming at delivering better results and value for money. This may be achieved by promoting greater integration of HIV and tuberculosis control programme activities within a strengthened health system. HIV and tuberculosis share many similarities in terms of their disease burden and the recommended stratagems for their control. HIV and tuberculosis programmes implement similar sorts of control activities, e.g. case finding and treatment, which depend for success on generic health system issues, including vital registration, drug procurement and supply, laboratory network, human resources, and financing. However, the current health system approach to HIV and tuberculosis control often involves separate specialised services. Despite some recent progress, collaboration between the programmes remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve universal access to key interventions. A fundamental re-think of the current strategic approach involves promoting integrated delivery of HIV and tuberculosis programme activities as part of strengthened general health services: epidemiological surveillance, programme monitoring and evaluation, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens), drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens), research and development, global advocacy and global partnership. Health agencies should review policies and progress in HIV and tuberculosis epidemic control, learn mutual lessons for policy development and scaling up interventions, and identify ways

Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system

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Maher Dermot

2010-07-01

Full Text Available Abstract Background The global financial crisis threatens global health, particularly exacerbating diseases of inequality, e.g. HIV/AIDS, and diseases of poverty, e.g. tuberculosis. The aim of this paper is to reconsider established practices and policies for HIV and tuberculosis epidemic control, aiming at delivering better results and value for money. This may be achieved by promoting greater integration of HIV and tuberculosis control programme activities within a strengthened health system. Discussion HIV and tuberculosis share many similarities in terms of their disease burden and the recommended stratagems for their control. HIV and tuberculosis programmes implement similar sorts of control activities, e.g. case finding and treatment, which depend for success on generic health system issues, including vital registration, drug procurement and supply, laboratory network, human resources, and financing. However, the current health system approach to HIV and tuberculosis control often involves separate specialised services. Despite some recent progress, collaboration between the programmes remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve universal access to key interventions. A fundamental re-think of the current strategic approach involves promoting integrated delivery of HIV and tuberculosis programme activities as part of strengthened general health services: epidemiological surveillance, programme monitoring and evaluation, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens, drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens, research and development, global advocacy and global partnership. Health agencies should review policies and progress in HIV and tuberculosis epidemic control, learn mutual lessons for policy

Intersectionality of HIV stigma and masculinity in eastern Uganda: implications for involving men in HIV programmes.

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Mburu, Gitau; Ram, Mala; Siu, Godfrey; Bitira, David; Skovdal, Morten; Holland, Paula

2014-10-11

considered. In particular, better integration of and linkage between gender transformative interventions that support men to reconstruct their male identities and reject signifiers of masculinity that prevent their access to HIV services, and stigma-reduction interventions that target social and structural drivers of stigma is required within HIV programmes.

Re-testing and misclassification of HIV-2 and HIV-1&2 dually reactive patients among the HIV-2 cohort of The West African Database to evaluate AIDS collaboration

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Tchounga, Boris K; Inwoley, Andre; Coffie, Patrick A; Minta, Daouda; Messou, Eugene; Bado, Guillaume; Minga, Albert; Hawerlander, Denise; Kane, Coumba; Eholie, Serge P; Dabis, François; Ekouevi, Didier K

2014-01-01

Introduction West Africa is characterized by the circulation of HIV-1 and HIV-2. The laboratory diagnosis of these two infections as well as the choice of a first-line antiretroviral therapy (ART) is challenging, considering the limited access to second-line regimens. This study aimed at confirming the classification of HIV-2 and HIV-1&2 dually reactive patients followed up in the HIV-2 cohort of the West African Database to evaluate AIDS collaboration. Method A cross-sectional survey was conducted from March to December 2012 in Burkina Faso, Côte d’Ivoire and Mali among patients classified as HIV-2 or HIV-1&2 dually reactive according to the national HIV testing algorithms. A 5-ml blood sample was collected from each patient and tested in a single reference laboratory in Côte d’Ivoire (CeDReS, Abidjan) with two immuno-enzymatic tests: ImmunoCombII® (HIV-1&2 ImmunoComb BiSpot – Alere) and an in-house ELISA test, approved by the French National AIDS and hepatitis Research Agency (ANRS). Results A total of 547 patients were included; 57% of them were initially classified as HIV-2 and 43% as HIV-1&2 dually reactive. Half of the patients had CD4≥500 cells/mm3 and 68.6% were on ART. Of the 312 patients initially classified as HIV-2, 267 (85.7%) were confirmed as HIV-2 with ImmunoCombII® and in-house ELISA while 16 (5.1%) and 9 (2.9%) were reclassified as HIV-1 and HIV-1&2, respectively (Kappa=0.69; p<0.001). Among the 235 patients initially classified as HIV-1&2 dually reactive, only 54 (23.0%) were confirmed as dually reactive with ImmunoCombII® and in-house ELISA, while 103 (43.8%) and 33 (14.0%) were reclassified as HIV-1 and HIV-2 mono-infected, respectively (kappa= 0.70; p<0.001). Overall, 300 samples (54.8%) were concordantly classified as HIV-2, 63 (11.5%) as HIV-1&2 dually reactive and 119 (21.8%) as HIV-1 (kappa=0.79; p<0.001). The two tests gave discordant results for 65 samples (11.9%). Conclusions Patients with HIV-2 mono-infection are correctly

Transitioning from antenatal surveillance surveys to routine HIV testing: a turning point in the mother-to-child transmission prevention programme for HIV surveillance in Brazil.

Science.gov (United States)

Pereira, Gerson Fernando Mendes; Sabidó, Meritxell; Caruso, Alessandro; Benzaken, Adele Schwartz

2017-07-05

In Brazil, due to the rapid increase in programmes for the prevention of mother-to-child transmission (PMTCT), routine programme data are widely available. The objective of this study was to assess the utility of programmatic data to replace HIV surveillance based on the antenatal care (ANC) surveillance survey (SS). We analysed ANC SS data from 219 maternity service clinics. PMTCT variables were extracted from the ANC SS data collection form, which allowed us to capture and compare the ANC SS data and PMTCT HIV test results for each pregnant woman who completed the ANC SS. Both the PMTCT programme and the ANC SS tested for HIV using sequential ELISA and western blot for confirmation. We assessed the completeness (% missing) of the PMTC data included in the ANC SS. Of the 36,713 pregnant women who had ANC SS HIV tests performed, 30,588 also underwent PMTCT HIV testing. The HIV prevalence rate from routine PMTCT testing was 0.36%, compared to 0.38% from the ANC SS testing (relative difference -0.05%; absolute difference -0.02%). The relative difference in prevalence rates between pregnant women in northern Brazil and pregnant women central-west Brazil was -0.98 and 0.66, respectively. Of the 29,856 women who had HIV test results from both the PMTCT and ANC SS, the positive percent agreement of the PMTCT versus the surveillance test was 84.1% (95% confidence interval [CI]: 74.8-91.0), and the negative percent agreement was 99.9% (95% CI: 99.9-100.0). The PMTCT HIV testing uptake was 86.4%. The ANC SS HIV prevalence was 0.33% among PMTCT non-refusers and 0.59% among refusers, with a percent bias of -10.80% and a differential prevalence ratio of 0.56. Syphilis and HIV testing results were complete in 98% and 97.6% of PMTCT reports, respectively. The reported HIV status for the women at clinic entry was missing. Although there were consistent HIV prevalence estimates from the PMTCT data and the ANC SS, the overall positive percent agreement of 84.1% falls below the

Differences in HIV natural history among African and non-African seroconverters in Europe and seroconverters in sub-Saharan Africa

NARCIS (Netherlands)

Pantazis, Nikos; Morrison, Charles; Amornkul, Pauli N.; Lewden, Charlotte; Salata, Robert A.; Minga, Albert; Chipato, Tsungai; Jaffe, Harold; Lakhi, Shabir; Karita, Etienne; Porter, Kholoud; Meyer, Laurence; Touloumi, Giota; del Amo, Julia; Bucher, Heiner C.; Chêne, Geneviève; Hamouda, Osamah; Pillay, Deenan; Prins, Maria; Rosinska, Magda; Sabin, Caroline; Lodi, Sara; Coughlin, Kate; Walker, Sarah; Babiker, Abdel; de Luca, Andrea; Fisher, Martin; Muga, Roberto; Zangerle, Robert; Kelleher, A. D.; Cooper, D. A.; Grey, Pat; Finlayson, Robert; Bloch, Mark; Kelleher, Tony; Ramacciotti, Tim; Gelgor, Linda; Cooper, David; Smith, Don; Gill, John; Jørgensen, Louise Bruun; Lutsar, Irja; Dabis, Francois; Thiebaut, Rodolphe; Masquelier, Bernard; Costagliola, Dominique; Guiguet, Marguerite; Geskus, Ronald; van der Helm, Jannie; Schuitemaker, Hanneke

2012-01-01

It is unknown whether HIV treatment guidelines, based on resource-rich country cohorts, are applicable to African populations. We estimated CD4 cell loss in ART-naïve, AIDS-free individuals using mixed models allowing for random intercept and slope, and time from seroconversion to clinical AIDS,

Social support, psychological vulnerability, and HIV risk among African American men who have sex with men.

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Saleh, Lena D; van den Berg, Jacob J; Chambers, Christopher S; Operario, Don

2016-05-01

Previous research has suggested a need to understand the social-psychological factors contributing to HIV risk among African American men who have sex with men (MSM). We conducted individual in-depth interviews with 34 adult African American MSM to examine their personal experiences about: (i) sources of social support, (ii) psychological responses to the presence or absence of social support and (iii) influences of social support on sexual behaviours. The majority of participants described limited positive encouragement and lack of emotional support from family, as well as few meaningful personal relationships. Feelings of isolation and mistrust about personal relationships led many participants to avoid emotional intimacy and seek physical intimacy through sexual encounters. Findings highlight a need for multilevel interventions that enhance social support networks and address the social-psychological, emotional and interpersonal factors that contribute to HIV risk among African American MSM.

South African Research Ethics Committee Review of Standards of Prevention in HIV Vaccine Trial Protocols.

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Essack, Zaynab; Wassenaar, Douglas R

2018-04-01

HIV prevention trials provide a prevention package to participants to help prevent HIV acquisition. As new prevention methods are proven effective, this raises ethical and scientific design complexities regarding the prevention package or standard of prevention. Given its high HIV incidence and prevalence, South Africa has become a hub for HIV prevention research. For this reason, it is critical to study the implementation of relevant ethical-legal frameworks for such research in South Africa. This qualitative study used in-depth interviews to explore the practices and perspectives of eight members of South African research ethics committees (RECs) who have reviewed protocols for HIV vaccine trials. Their practices and perspectives are compared with ethics guideline requirements for standards of prevention.

Occult hepatitis B virus coinfection in HIV-positive African migrants to the UK: a point prevalence study.

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Chadwick, D; Doyle, T; Ellis, S; Price, D; Abbas, I; Valappil, M; Geretti, A M

2014-03-01

Occult (surface antigen-negative/DNA-positive) hepatitis B virus (HBV) infection is common in areas of the world where HBV is endemic. The main objectives of this study were to determine the prevalence of occult HBV infection in HIV-infected African migrants to the UK and to determine factors associated with occult coinfection. This anonymized point-prevalence study identified Africans attending three HIV clinics, focussing on patients naïve to antiretroviral therapy (ART). Stored blood samples were tested for HBV DNA. Prevalence was calculated in the entire cohort, as well as in subpopulations. Risk factors for occult HBV coinfection were identified using logistic regression analysis. Among 335 HIV-positive African migrants, the prevalence of occult HBV coinfection was 4.5% [95% confidence interval (CI) 2.8-7.4%] overall, and 6.5% (95% CI 3.9-10.6%) and 0.8% (95% CI 0.2-4.6%) in ART-naïve and ART-experienced patients, respectively. Among ART-naïve anti-HBV core (anti-HBc)-positive patients, the prevalence was 16.4% (95% CI 8.3-25.6%). The strongest predictor of occult coinfection was anti-HBc positivity [odds ratio (OR) 7.4; 95% CI 2.0-27.6]. Median HBV DNA and ALT levels were 54 IU/mL [interquartile range (IQR) 33-513 IU/mL] and 22 U/L (IQR 13-27 U/L), respectively. Occult HBV coinfection remains under-diagnosed in African HIV-infected patients in the UK. Given the range of HBV DNA levels observed, further studies are warranted to determine its clinical significance and to guide screening strategies and ART selection in these patients. © 2013 British HIV Association.

Teaching Modules to Build HIV/AIDS Knowledge and Safer Sex Skills among African-American College Students

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Kanekar, Amar; Sharma, Manoj

2011-01-01

The HIV/AIDS epidemic has taken a tremendous toll on the population of the United States. College students, including African-Americans aged 13-24 years, across the nation are susceptible to contracting sexually transmitted diseases including HIV/AIDS as they participate in unsafe sex practices. The purpose of this article is to provide teaching…

Association of Internalized and Social Network Level HIV Stigma With High-Risk Condomless Sex Among HIV-Positive African American Men.

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Wagner, Glenn J; Bogart, Laura M; Klein, David J; Green, Harold D; Mutchler, Matt G; McDavitt, Bryce; Hilliard, Charles

2016-08-01

We examined whether internalized HIV stigma and perceived HIV stigma from social network members (alters), including the most popular and most similar alter, predicted condomless intercourse with negative or unknown HIV status partners among 125 African American HIV-positive men. In a prospective, observational study, participants were administered surveys at baseline and months 6 and 12, with measures including sexual behavior, internalized HIV stigma, and an egocentric social network assessment that included several measures of perceived HIV stigma among alters. In longitudinal multivariable models comparing the relative predictive value of internalized stigma versus various measures of alter stigma, significant predictors of having had condomless intercourse included greater internalized HIV stigma (in all models), the perception that a popular (well-connected) alter or alter most like the participant agrees with an HIV stigma belief, and the interaction of network density with having any alter that agrees with a stigma belief. The interaction indicated that the protective effect of greater density (connectedness between alters) in terms of reduced risk behavior dissipated in the presence of perceived alter stigma. These findings call for interventions that help people living with HIV to cope with their diagnosis and reduce stigma, and inform the targets of social network-based and peer-driven HIV prevention interventions.

The experience of African American women living with HIV: creating a prevention film for teens.

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Norris, Anne E; DeMarco, Rosanna

2005-01-01

The personal and social costs of HIV are well documented. What remains unknown is the effect of public disclosure of HIV status on the individual who is doing the disclosing. This study describes the experience of four African American women living with HIV who participated in the development of an intergenerational education intervention for African American adolescent girls. These women suggested that they be filmed discussing the "dark side" of HIV in an effort to create an intergenerational education intervention that would alter the risk-taking behavior that they observed in young women in their community. After a rough cut of the film was completed, these women viewed the film and participated in a focus group during which they discussed what it was like to reveal and revisit their own painful experiences associated with becoming infected and then living with HIV. Findings from content analysis of transcribed dialogue included the following positive themes: (a) self-acceptance by telling one's own story and hearing the stories of the other women, (b) a sense of liberation by disclosing publicly one's image and message and letting go of others' judgments, (c) feeling supported by meeting other women who share the same experience, (d) value of using the film to impact or save young people from the pain one has experienced. A negative theme emerged related to personal pain in reliving the individual's history with HIV.

Cost Effective Ways of Implementing Nuclear Power Programme in African Countries

International Nuclear Information System (INIS)

Aderojua, Abraham; Choi, Kwang Sik

2011-01-01

still growing fast and hence are characterized by a foreseeable increase in electricity demand to drive the factors of production. 1.3 Objective of this Paper The purpose of this paper is to explore the efficient means of building nuclear power plants and associated infra structure in African countries. The concept adopted in this paper to achieve efficient allocation of resources is sharing of infrastructural items. The paper lists examples of sharing arrangement on the African continent for other purposes other than nuclear power programme. This is an attempt to justify the workability of the concept for nuclear power programme. Mention has also been made of similar sharing arrangement in other countries for the purpose of nuclear power programme. The factors that will enhance the success of sharing concept in African countries have also been highlighted

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

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Boeras, Debrah I; Peeling, Rosanna W; Onyebujoh, Philip; Yahaya, Ali A; Gumede-Moeletsi, Hieronyma N; Ndihokubwayo, Jean B

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events

Developing and implementing an anti-corruption ethics and compliance programme in the African environment

Directory of Open Access Journals (Sweden)

Alain Ndedi

2015-12-01

Full Text Available This article discusses the development and implementation of anti-corruption ethics and compliance programme in the African business environment. In the past decade, an international legal framework has been developed to tackle corruption both in public and private sectors. This framework includes the United Nations Convention against Corruption (UNCAC, which entered into force in 2005, and the Convention on Combating Bribery of Foreign Public Officials in International Business Transactions, which entered into force in 1999. These instruments mandate that State Parties must criminalise and punish a variety of corrupt practices. Relevant domestic laws have a direct impact on business, especially in States Parties instruments that require the establishment of liability of legal persons for corrupt acts. The African Union Convention also requires States Parties to establish mechanisms to encourage participation by the private sector in the fight against unfair competition, respect of the tender procedures and property rights. The paper details various steps needed to efficiently and effectively implement anti-corruption ethics and compliance programme in the African context. The first part of the paper develops the primary objective of the corruption risk assessment which is to better understand the risk exposure so that informed risk management decisions may be taken. A structured approach for how enterprises could conduct an anti-corruption risk assessment will be outlined in this first section. The author argued in this same first section that each enterprise’s own risk assessment exercise is unique, depending on that enterprise’s industry, size, location, and other factors inherent to that organisation. The second part of the paper drafts the development and the implementation of an anti-corruption programme. The paper concludes by stating that an anti-corruption and compliance programme is not a panacea for fighting all the ills on

Development and formative evaluation of a family-centred adolescent HIV prevention programme in South Africa.

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Visser, Maretha; Thurman, Tonya R; Spyrelis, Alexandra; Taylor, Tory M; Nice, Johanna K; Finestone, Michelle

2018-03-06

Preventing HIV among young people is critical to achieving and sustaining global epidemic control. Evidence from Western settings suggests that family-centred prevention interventions may be associated with greater reductions in risk behaviour than standard adolescent-only models. Despite this, family-centred models for adolescent HIV prevention are nearly non-existent in South Africa - home to more people living with HIV than any other country. This paper describes the development and formative evaluation of one such intervention: an evidence-informed, locally relevant, adolescent prevention intervention engaging caregivers as co-participants. The programme, originally consisting of 19 sessions for caregivers and 14 for adolescents, was piloted with 12 groups of caregiver-adolescent dyads by community-based organizations (CBOs) in KwaZulu-Natal and Gauteng provinces. Literature and expert reviews were employed in the development process, and evaluation methods included analysis of attendance records, session-level fidelity checklists and facilitator feedback forms collected during the programme pilot. Facilitator focus group discussions and an implementer programme workshop were also held. Results highlighted the need to enhance training content related to cognitive behavioural theory and group management techniques, as well as increase the cultural relevance of activities in the curriculum. Participant attendance challenges were also identified, leading to a shortened and simplified session set. Findings overall were used to finalize materials and guidance for a revised 14-week group programme consisting of individual and joint sessions for adolescents and their caregivers, which may be implemented by community-based facilitators in other settings. Copyright © 2018 Elsevier Ltd. All rights reserved.

Rotavirus vaccination within the South African Expanded Programme on Immunisation.

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Seheri, L Mapaseka; Page, Nicola A; Mawela, Mothahadini P B; Mphahlele, M Jeffrey; Steele, A Duncan

2012-09-07

Diarrhoeal diseases are ranked the third major cause of childhood mortality in South African children less than 5 years, where the majority of deaths are among black children. Acute severe dehydrating rotavirus diarrhoea remains an important contributor towards childhood mortality and morbidity and has been well documented in South Africa. As the preventive strategy to control rotavirus diarrhoea, South Africa became the first country in the WHO African Region to adopt the rotavirus vaccine in the national childhood immunisation programme in August 2009. The rotavirus vaccine in use, Rotarix, GSK Biologicals, is given at 6 and 14 weeks of age, along with other vaccines as part of Expanded Programme on Immunisation (EPI). Studies which facilitated the introduction of rotavirus vaccine in South Africa included the burden of rotavirus disease and strain surveillance, economic burden of rotavirus infection and clinical trials to assess the safety and efficacy of vaccine candidates. This paper reviews the epidemiology of rotavirus in South Africa, outlines some of the steps followed to introduce rotavirus vaccine in the EPI, and highlights the early positive impact of vaccination in reducing the rotavirus burden of disease based on the post-marketing surveillance studies at Dr George Mukhari hospital, a sentinel site at University of Limpopo teaching hospital in Pretoria, South Africa, which has conducted rotavirus surveillance for >20 years. Copyright © 2012 Elsevier Ltd. All rights reserved.

Mycobacterium sherrisii visceral disseminated infection in an African HIV-infected adolescent

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Francesco Santoro

2016-04-01

Full Text Available A case of visceral disseminated infection by Mycobacterium sherrisii in an African HIV-infected adolescent with multiple abdominal abscesses is reported. Despite multiple drug resistance to first-line antibiotics in vitro, long-term treatment with clarithromycin, moxifloxacin, and clindamycin, together with appropriate antiretroviral treatment, resulted in clinical and radiological cure after 19 months of therapy and follow-up.

The impact of African ethnicity and migration on pregnancy in women living with HIV in the UK: design and methods

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Tariq Shema

2012-08-01

Full Text Available Abstract Background The number of reported pregnancies in women with diagnosed HIV in the UK increased from 80 in 1990 to over 1400 in 2010; the majority were among women born in sub-Saharan Africa. There is a paucity of research on how social adversity impacts upon pregnancy in HIV positive women in the UK; furthermore, little is known about important outcomes such as treatment uptake and return for follow-up after pregnancy. The aim of this study was to examine pregnancy in African women living with HIV in the UK. Methods and design This was a two phase mixed methods study. The first phase involved analysis of data on approximately 12,000 pregnancies occurring between 2000 and 2010 reported to the UK’s National Study of HIV in Pregnancy and Childhood (NSHPC. The second phase was based in London and comprised: (i semi-structured interviews with 23 pregnant African women living with HIV, 4 health care professionals and 2 voluntary sector workers; (ii approximately 90 hours of ethnographic fieldwork in an HIV charity; and (iii approximately 40 hours of ethnographic fieldwork in a Pentecostal church. Discussion We have developed an innovative methodology utilising epidemiological and anthropological methods to explore pregnancy in African women living with HIV in the UK. The data collected in this mixed methods study are currently being analysed and will facilitate the development of appropriate services for this group.

Medication therapy management services in community pharmacy: a pilot programme in HIV specialty pharmacies.

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Rosenquist, Ashley; Best, Brookie M; Miller, Teresa A; Gilmer, Todd P; Hirsch, Jan D

2010-12-01

Pharmacist-provided medication therapy management services (MTMS) have been shown to increase patient's adherence to medications, improve health outcomes and reduce overall medical costs. The purpose of this study was to describe a pilot programme that provided pharmacy-based MTMS for patients with HIV/AIDS in the state of California, USA. Pharmacists from the 10 pilot pharmacies were surveyed using an online data collection tool. Information was collected to describe the types of MTMS offered, proportion of patients actively using specific MTMS, pharmacist beliefs regarding effect on patient outcomes and barriers to providing MTMS, ability to offer MTMS without pilot programme funding and specialized pharmacist or staff training. Each responding pharmacy (7 of 10) varied in the number of HIV/AIDS patients served and prescription volume. All pharmacists had completed HIV/AIDS-related continuing education programmes, and some had other advanced training. The type of MTMS being offered varied at each pharmacy with 'individualized counselling by a pharmacist when overuse or underuse was detected' and 'refill reminders by telephone' being actively used by the largest proportion of patients. Most, but not all, pharmacists cited reimbursement as a barrier to MTMS provision. Pharmacists believed the MTMS they provide resulted in improved satisfaction (patient and provider), medication usage, therapeutics response and patient quality of life. The type of MTMS offered, and proportion of patients actively using, varied among participating pilot pharmacies. © 2010 Blackwell Publishing Ltd.

Underutilisation of routinely collected data in the HIV programme in Zambia: a review of quantitatively analysed peer-reviewed articles.

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Munthali, Tendai; Musonda, Patrick; Mee, Paul; Gumede, Sehlulekile; Schaap, Ab; Mwinga, Alwyn; Phiri, Caroline; Kapata, Nathan; Michelo, Charles; Todd, Jim

2017-06-13

The extent to which routinely collected HIV data from Zambia has been used in peer-reviewed published articles remains unexplored. This paper is an analysis of peer-reviewed articles that utilised routinely collected HIV data from Zambia within six programme areas from 2004 to 2014. Articles on HIV, published in English, listed in the Directory of open access journals, African Journals Online, Google scholar, and PubMed were reviewed. Only articles from peer-reviewed journals, that utilised routinely collected data and included quantitative data analysis methods were included. Multi-country studies involving Zambia and another country, where the specific results for Zambia were not reported, as well as clinical trials and intervention studies that did not take place under routine care conditions were excluded, although community trials which referred patients to the routine clinics were included. Independent extraction was conducted using a predesigned data collection form. Pooled analysis was not possible due to diversity in topics reviewed. A total of 69 articles were extracted for review. Of these, 7 were excluded. From the 62 articles reviewed, 39 focused on HIV treatment and retention in care, 15 addressed prevention of mother-to-child transmission, 4 assessed social behavioural change, and 4 reported on voluntary counselling and testing. In our search, no articles were found on condom programming or voluntary male medical circumcision. The most common outcome measures reported were CD4+ count, clinical failure or mortality. The population analysed was children in 13 articles, women in 16 articles, and both adult men and women in 33 articles. During the 10 year period of review, only 62 articles were published analysing routinely collected HIV data in Zambia. Serious consideration needs to be made to maximise the utility of routinely collected data, and to benefit from the funds and efforts to collect these data. This could be achieved with government support

The WHO AFRO external quality assessment programme (EQAP: Linking laboratory networks through EQA programmes

Directory of Open Access Journals (Sweden)

Debrah I. Boeras

2016-10-01

Full Text Available External Quality Assessment (EQA surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO revealed the need for the strengthening of publichealth microbiology laboratories, particularly for testing of epidemic-prone diseases in theAfrican Region. These surveys revealed common issues such as supply chain managementskilled personnel, logistical support and overall lack of quality standards. For sustainableimprovements to health systems as well as global health security, deficiencies identified needto be actively corrected through robust quality assurance programmes and implementation oflaboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programmewith a focus on vaccine-preventable diseases and emerging and re-emerging dangerouspathogens is important, and should not be stand-alone, but integrated within laboratorynetworks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Preventionthe London School of Hygiene & Tropical Medicine and partners in a series of consultationswith countries and national and regional EQA providers for the development of qualityassurance models to support HIV point-of-care testing and monitoring. These consultationsrevealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forthits experience in implementing quality standards for health programmes, and also openeddiscussions on how lessons learned through such established programmes can be utilised tosupporting and strengthening the introduction of early infant diagnosis of HIV and viralload point-of-care testing. An optimised external quality assessment programme will impact the ability of countries tomeet core capacities, providing improved quality management systems, improving theconfidence of diagnostic network services in Africa, and including capacities to detect eventsof

Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples.

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El-Bassel, Nabila; Jemmott, John B; Bellamy, Scarlett L; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Landis, J Richard; Remien, Robert H

2016-06-01

Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.

The private sector role in HIV/AIDS in the context of an expanded global response: expenditure trends in five sub-Saharan African countries.

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Sulzbach, Sara; De, Susna; Wang, Wenjuan

2011-07-01

Global financing for the HIV response has reached unprecedented levels in recent years. Over US$10 billion were mobilized in 2007, an effort credited with saving the lives of millions of people living with HIV (PLHIV). A relatively unexamined aspect of the global HIV response is the role of the private sector in financing HIV/AIDS services. As the nature of the response evolves from emergency relief to long-term sustainability, understanding current and potential contributions from the private sector is critical. This paper examines trends in private sector financing, management and resource consumption related to HIV/AIDS in five sub-Saharan African countries, with a particular emphasis on the effects of recently scaled-up donor funding on private sector contributions. We analysed National Health Accounts HIV/AIDS subaccount data for Kenya, Malawi, Rwanda, Tanzania and Zambia between 2002 and 2006. HIV subaccounts provide comparable data on the flow of HIV/AIDS funding from source to use. Findings indicate that private sector contributions decreased in all countries except Tanzania. With regards to managing HIV/AIDS funds, non-governmental organizations are increasingly controlling the largest share of resources relative to other stakeholders, whereas private for-profit entities are managing fewer HIV/AIDS resources since the donor influx. The majority of HIV/AIDS funds were spent in the public sector, although a considerable amount was spent at private facilities, largely fuelled by out-of-pocket (OOP) payments. On the whole, OOP spending by PLHIV decreased over the 4-year period, with the exception of Malawi, demonstrating that PLHIV have increased access to free or subsidized HIV/AIDS services. Our findings suggest that the influx of donor funding has led to decreased private contributions for HIV/AIDS. The reduction in private sector investment and engagement raises concerns about the sustainability of HIV/AIDS programmes over the long term, particularly in

Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

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Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

2017-07-21

Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and

Blood Group Antigens C, Lub and P1 May Have a Role in HIV Infection in Africans.

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Motswaledi, Modisa Sekhamo; Kasvosve, Ishmael; Oguntibeju, Oluwafemi Omoniyi

2016-01-01

Botswana is among the world's countries with the highest rates of HIV infection. It is not known whether or not this susceptibility to infection is due to genetic factors in the population. Accumulating evidence, however, points to the role of erythrocytes as potential mediators of infection. We therefore sought to establish the role, if any, of some erythrocyte antigens in HIV infection in a cross-section of the population. 348 (346 HIV-negative and 2 HIV-positive) samples were obtained from the National Blood Transfusion Service as residual samples, while 194 HIV-positive samples were obtained from the Botswana-Harvard HIV Reference Laboratory. Samples were grouped for twenty three antigens. Chi-square or Fischer Exact analyses were used to compare the frequencies of the antigens in the two groups. A stepwise, binary logistic regression was used to study the interaction of the various antigens in the light of HIV-status. The Rh antigens C and E were associated with HIV-negative status, while blood group Jka, P1 and Lub were associated with HIV-positive status. A stepwise binary logistic regression analysis yielded group C as the most significant protective blood group while Lub and P1 were associated with significantly higher odds ratio in favor of HIV-infection. The lower-risk-associated group C was significantly lower in Africans compared to published data for Caucasians and might partially explain the difference in susceptibility to HIV-1. The most influential antigen C, which also appears to be protective, is significantly lower in Africans than published data for Caucasians or Asians. On the other hand, there appear to be multiple antigens associated with increased risk that may override the protective role of C. A study of the distribution of these antigens in other populations may shed light on their roles in the HIV pandemic.

The sins of the fathers--Africans with HIV infection in London; lessons for others?

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Bingham, J S

2002-12-01

Many European countries have taken in immigrants from sub-Saharan Africa. The reasons for this are discussed and the particular problems experienced by HIV-infected Africans in London, and the approach to their care at St Thomas' Hospital, is delineated.

The Lifecycle of a South African Non-governmental Organisation: Primary Science Programme, 1983-1999.

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Harvey, Stephen; Peacock, Alan

2001-01-01

Traces the lifecycle of the Primary Science Programme (PSP), 1983-99, a representative South African nongovernmental organization. Shows how the social and economic environment shaped PSP development and demise. Highlights tensions between quality versus quantity, subject versus holistic focus, and participatory versus authoritarian management…

Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents.

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Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine

2016-01-01

Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can "cash plus care" social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Structural drivers were associated with increased onset of adolescent HIV risk behaviour (psocial protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=-0.08, psocial protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV

HIV/TB: When is it safe to start HAART? | Wood | Southern African ...

African Journals Online (AJOL)

Southern African Journal of HIV Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 4 (2008) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected ...

Evaluating 5 years' NIMART mentoring in South Africa's HIV treatment programme: Successes, challenges and future needs.

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Jones, M; Cameron, D

2017-09-22

Task shifting has enabled South Africa (SA) to rapidly expand its HIV treatment programme. This has been achieved by training and mentoring primary-care nurses in nurse initiation and management of antiretroviral therapy (NIMART). Five years into its clinical mentoring programme, the Foundation for Professional Development conducted an evaluation that identified improved knowledge, attitudes and confidence perceived by nurses who received NIMART mentoring. Low completion rates for the Department of Health (DoH) NIMART training process were identified and therefore targeted mentoring was introduced; this increased the percentage of primary nurses eligible for DoH certificates of clinical competence in NIMART from 12%, adding a further 30%. There remain a large number of primary nurses who require mentoring in order to complete the NIMART process. For those who have completed the process, there remains a need for ongoing mentoring as SA's HIV programme evolves, complex cases emerge and primary care undergoes change.

Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008.

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Ngwende, Stella; Gombe, Notion T; Midzi, Stanley; Tshimanga, Mufuta; Shambira, Gerald; Chadambuka, Addmore

2013-12-14

Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic with HIV infection contributing increasingly to childhood morbidity and mortality. Among the children born to HIV positive mothers participating in the PMTCT programme, 25% tested positive to HIV. We investigated factors associated with HIV infection among children born to mothers on the PMTCT programme. A 1:1 unmatched case-control study was conducted at Chitungwiza Hospital, Zimbabwe, 2008. A case was defined as a child who tested HIV positive, born to a mother who had been on PMTCT programme. A control was a HIV negative child born to a mother who had been on PMTCT programme. An interviewer-administered questionnaire was used to collect data on demographic characteristics, risk factors associated with HIV infection and immunization status. A total of 120 mothers were interviewed. Independent risk factors associated with HIV infection among children included maternal CD4 count of less than 200 during pregnancy [aOR = 7.1, 95% CI (2.6-17)], mixed feeding [aOR = 29, 95% CI (4.2-208)], being hospitalized since birth [aOR = 2.9, 95% CI (1.2-4.8)] whilst being exclusively breast fed for less than 6 months [aOR = 0.1 (95% CI 0.03-0.4)] was protective. HIV infection among children increased if the mother's CD4 count was ≤200 cells/μL and if the child was exposed to mixed feeding. Breastfeeding exclusively for less than six months was protective. We recommended exclusive breast feeding period for the first six months and stop breast feeding after 6 months if affordable, sustainable and safe.

National South African HIV prevalence estimates robust despite substantial test non-participation

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Guy Harling

2017-07-01

Full Text Available Background. South African (SA national HIV seroprevalence estimates are of crucial policy relevance in the country, and for the worldwide HIV response. However, the most recent nationally representative HIV test survey in 2012 had 22% test non-participation, leaving the potential for substantial bias in current seroprevalence estimates, even after controlling for selection on observed factors. Objective. To re-estimate national HIV prevalence in SA, controlling for bias due to selection on both observed and unobserved factors in the 2012 SA National HIV Prevalence, Incidence and Behaviour Survey. Methods. We jointly estimated regression models for consent to test and HIV status in a Heckman-type bivariate probit framework. As selection variable, we used assigned interviewer identity, a variable known to predict consent but highly unlikely to be associated with interviewees’ HIV status. From these models, we estimated the HIV status of interviewed participants who did not test. Results. Of 26 710 interviewed participants who were invited to test for HIV, 21.3% of females and 24.3% of males declined. Interviewer identity was strongly correlated with consent to test for HIV; declining a test was weakly associated with HIV serostatus. Our HIV prevalence estimates were not significantly different from those using standard methods to control for bias due to selection on observed factors: 15.1% (95% confidence interval (CI 12.1 - 18.6 v. 14.5% (95% CI 12.8 - 16.3 for 15 - 49-year-old males; 23.3% (95% CI 21.7 - 25.8 v. 23.2% (95% CI 21.3 - 25.1 for 15 - 49-year-old females. Conclusion. The most recent SA HIV prevalence estimates are robust under the strongest available test for selection bias due to missing data. Our findings support the reliability of inferences drawn from such data.

Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African-American men with HIV.

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Bogart, Laura M; Wagner, Glenn J; Galvan, Frank H; Klein, David J

2010-10-01

African-Americans show worse HIV disease outcomes compared to Whites. Health disparities may be aggravated by discrimination, which is associated with worse health and maladaptive health behaviors. We examined longitudinal effects of discrimination on antiretroviral treatment adherence among 152 HIV-positive Black men who have sex with men. We measured adherence and discrimination due to HIV-serostatus, race/ethnicity, and sexual orientation at baseline and monthly for 6 months. Hierarchical repeated-measures models tested longitudinal effects of each discrimination type on adherence. Over 6 months, participants took 60% of prescribed medications on average; substantial percentages experienced discrimination (HIV-serostatus, 38%; race/ethnicity, 40%; and sexual orientation, 33%). Greater discrimination due to all three characteristics was significantly bivariately associated with lower adherence (all p's discrimination was significant (p < 0.05). Efforts to improve HIV treatment adherence should consider the context of multiple stigmas, especially racism.

The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV.

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McDermott, Adam; Zaporojan, Lilia; McNamara, Patricia; Doherty, Colin P; Redmond, Janice; Forde, Cuisle; Gormley, John; Egaña, Mikel; Bergin, Colm

2017-06-01

High levels of cardiovascular fitness and physical activity are associated with higher levels of cognitive function in people with HIV, thus, they may reduce the risk of developing HIV-associated neurocognitive disorder (HAND). This study aimed to investigate the effects of a 16-week aerobic exercise intervention on cognitive function in people with HIV. Eleven participants living with HIV were recruited into the study. Participants were randomised into either an exercise group (n = 5), that completed a 16-week aerobic exercise programme training, 3 times per week (2 supervised sessions and one unsupervised session) or a control group (n = 6) that received no intervention. Outcomes measured included cognitive function (Montreal cognitive assessment (MOCA) and the Trail making tests A and B), aerobic fitness (modified Bruce protocol), sleep quality (Pittsburgh sleep quality index; PSQI) and physical activity levels (seven-day accelerometry). At baseline, higher levels of moderate physical activity were positively correlated with higher MOCA scores and levels of aerobic fitness were negatively associated with Trail A scores (P = 0.04 and P = 0.001 respectively). However, exercise training did not induce any significant improvements in cognitive function or aerobic fitness. The overall mean adherence rate to the exercise programme was 60%. In conclusion, in the present study a 16-week aerobic exercise intervention did not affect the cognitive function of participants with HIV. It is likely that longer intervention periods and/or higher adherence rates to exercise might be needed for an aerobic exercise programme to be effective in improving cognitive function in a cohort with no baseline cognitive impairments.

Integration of HIV Care into Community Management of Acute Childhood Malnutrition Permits Good Outcomes: Retrospective Analysis of Three Years of a Programme in Lusaka.

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Amadi, Beatrice; Imikendu, Mercy; Sakala, Milika; Banda, Rosemary; Kelly, Paul

2016-01-01

While HIV has had a major impact on health care in southern Africa, there are few data on its impact on acute malnutrition in children in the community. We report an analysis of outcomes in a large programme of community management of acute malnutrition in the south of Lusaka. Over 3 years, 68,707 assessments for undernutrition were conducted house-to-house, and children with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) were enrolled into either Outpatient Therapeutic Programme (OTP) or Supplementary Feeding Programme (SFP) respectively. Case records were analysed using tabulation and unconditional logistic regression. 1,859 children (889 boys, 970 girls; median age 16 months) with MAM (n = 664) or SAM (n = 1,195) were identified. Of 1,796 children whose parents consented to testing, 185 (10.3%) were HIV positive. Altogether 1,163 (62.6%) were discharged as recovered from acute malnutrition. Case fatality while in the programme was 4.2% in children with SAM and 0.5% in those with MAM (RR of SAM 10.9; 95%CI 3.4,34.8; Pmalnutrition programme, incorporating HIV care, can achieve low mortality even in a population heavily affected by HIV.

Neighborhood Condition and Geographic Locale in Assessing HIV/STI Risk Among African American Adolescents.

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Kerr, Jelani C; Valois, Robert F; Siddiqi, Arjumand; Vanable, Peter; Carey, Michael P; DiClemente, Ralph J; Romer, Daniel; Brown, Larry K; Farber, Naomi B; Salazar, Laura F

2015-06-01

Although region and neighborhood condition's effect on HIV/sexually transmitted infection (STI) risk has been studied separately, there is little research examining their interplay. African American adolescents (n = 1,602) from four matched cities in the Northeastern and Southeastern US completed Audio Computer Assisted Self-Interviews and submitted biospecimen samples to detect Sexually Transmitted Infections (chlamydia, gonorrhea, and trichomonas). Logistic and negative binomial regressions determined HIV/STI risk differences by region, neighborhood stress, and stress-region dyads. Northeastern participants demonstrated lower HIV/STI risk while participants from higher stress neighborhoods exhibited greater risk. Relationships between neighborhood condition and ever having anal sex (p use (p partners (p partners than participants in comparable Southeastern neighborhoods (p risk.

"Views from the Nano Edge": Women on Doctoral Preparation Programmes in Selected African Contexts

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Williamson, Charmaine

2016-01-01

The study explored the conceptual views of "critical mass", alongside micro experiences, of women, at a practice level, on a doctoral preparation programme which was implemented within the South African Development Community (SADC) and Ethiopian contexts. At the strategising level of policies, insufficient attention has been paid to the…

Mortality among blacks or African Americans with HIV infection--United States, 2008-2012.

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Siddiqi, Azfar-e-Alam; Hu, Xiaohong; Hall, H Irene

2015-02-06

A primary goal of the National HIV/AIDS Strategy is to reduce HIV-related health disparities, including HIV-related mortality in communities at high risk for human immunodeficiency virus (HIV) infection. As a group, persons who self-identify as blacks or African Americans (referred to as blacks in this report), have been affected by HIV more than any other racial/ethnic population. Forty-seven percent of persons who received an HIV diagnosis in the United States in 2012 and 43% of all persons living with diagnosed HIV infection in 2011 were black. Blacks also experienced a low 3-year survival rate among persons with HIV infection diagnosed during 2003-2008. CDC and its partners have been pursuing a high-impact prevention approach and supporting projects focusing on minorities to improve diagnosis, linkage to care, and retention in care, and to reduce disparities in HIV-related health outcomes. To measure trends in disparities in mortality among blacks, CDC analyzed data from the National HIV Surveillance System. The results of that analysis indicated that among blacks aged ≥13 years the death rate per 1,000 persons living with diagnosed HIV decreased from 28.4 in 2008 to 20.5 in 2012. Despite this improvement, in 2012 the death rate per 1,000 persons living with HIV among blacks was 13% higher than the rate for whites and 47% higher than the rate for Hispanics or Latinos. These data demonstrate the need for implementation of interventions and public health strategies to further reduce disparities in deaths.

A Snapshot: South African University Students' Attitudes, Perceptions and Knowledge of HIV/AIDS

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Raijmakers, L. R.; Pretorius, J. D.

2006-01-01

This article presents the findings of a survey conducted in August 2004 of students' attitudes, perceptions and knowledge about sexually transmitted infections, HIV/AIDS and sexual practices at an Institution of Higher Education. The study was set against the backdrop of the 2004 South African national survey, conducted by the Reproductive Health…

Improving skills and institutional capacity to strengthen adolescent immunisation programmes and health systems in African countries through HPV vaccine introduction

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Carine Dochez

2017-12-01

Full Text Available Several African countries have recently introduced or are currently introducing the HPV vaccine, either nationwide or through demonstration projects, while some countries are planning for introduction. A collaborative project was developed to strengthen country adolescent immunisation programmes and health systems in the African Region, addressing unique public health considerations of HPV vaccination: adolescents as the primary target group, delivery platforms (e.g. school-based and facility based, socio-behavioural issues, and the opportunity to deliver other health interventions alongside HPV vaccination.Following a successful “taking-stock” meeting, a training programme was drafted to assist countries to strengthen the integration of adolescent health interventions using HPV vaccination as an entry point. Two workshops were conducted in the Eastern and Southern African Regions. All countries reported on progress made during a final joint symposium.Of the 20 countries invited to participate in either of the workshops and/or final symposium, 17 countries participated: Angola, Botswana, Ethiopia, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Countries that are currently implementing HPV vaccination programmes, either nationally or through demonstration projects, reported varying degrees of integration with other adolescent health interventions. The most commonly reported adolescent health interventions alongside HPV vaccination include health education (including sexually transmitted infections, deworming and delivering of other vaccines like tetanus toxoid (TT or tetanus diphtheria (Td.The project has successfully (a established an African-based network that will advocate for incorporating the HPV vaccine into national immunisation programmes; (b created a platform for experience exchange and thereby contributed to novel ideas of

Gender and HIV/AIDS: Exploring Men and Vulnerability Towards Effective HIV/AIDS Policy Interventions and Sub-Saharan Africa

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Ogochukwu Nzewi

2012-06-01

Full Text Available This article examines the dynamics between HIV/Aids gender policy strategies and the socio-political demands on HIV/Aids interventions in sub-Saharan Africa. Gender in HIV/Aids intervention seems inescapable. Nowhere else is this more marked than in the social dimensions of HIV/Aids prevention in sub-Saharan Africa. This has resulted in prevention strategies, which are encumbered by the reality of poverty, gender, access, power and the various debates on behavioural change. The social constructions of gender roles and power relations play a significant role in the region’s HIV /Aids dynamic. To this end, the mainstreaming of gender issues into national political, social and economic agenda and policies has been championed by international development and economic institutions. In developing HIV/Aids intervention policies, gender has also been mainstreamed, especially where epidemiological data show the disparity in infection rates between men and women, where women are seen as more susceptible to infection. The gendered approach to HIV/Aids appears to typecast women as the vulnerable and suffering face of HIV/Aids, while men, as ‘the other’, are generally regarded as the perpetuators and spreaders of the virus. While there is no doubt that women’s vulnerability in this milieu has been proven within known research evidence to exist, the neglect of institutional (social, cultural and economic and historical vulnerabilities of African men’s realities are sometimes overlooked. Recently, greater focus has shifted to curbing infection rates in men based on new scientific evidence that shows that risk of transmission in circumcised men is reduced. The article argues that such movement towards showing areas of men’s vulnerability as a focus in HIV/Aids policy interventions may have the potential to shift the observed burden that current HIV/Aids policy thrusts inadvertently place on African women. The article will put forward an argument for

Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples.

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Craig R Cohen

Full Text Available Bacterial vaginosis (BV, a disruption of the normal vaginal flora, has been associated with a 60% increased risk of HIV-1 acquisition in women and higher concentration of HIV-1 RNA in the genital tract of HIV-1-infected women. However, whether BV, which is present in up to half of African HIV-1-infected women, is associated with an increase in HIV-1 transmission to male partners has not been assessed in previous studies.We assessed the association between BV on female-to-male HIV-1 transmission risk in a prospective study of 2,236 HIV-1-seropositive women and their HIV-1 uninfected male partners from seven African countries from a randomized placebo-controlled trial that enrolled heterosexual African adults who were seropositive for both HIV-1 and herpes simplex virus (HSV-2, and their HIV-1-seronegative partners. Participants were followed for up to 24 months; every three months, vaginal swabs were obtained from female partners for Gram stain and male partners were tested for HIV-1. BV and normal vaginal flora were defined as a Nugent score of 7-10 and 0-3, respectively. To reduce misclassification, HIV-1 sequence analysis of viruses from seroconverters and their partners was performed to determine linkage of HIV-1 transmissions. Overall, 50 incident HIV-1 infections occurred in men in which the HIV-1-infected female partner had an evaluable vaginal Gram stain. HIV-1 incidence in men whose HIV-1-infected female partners had BV was 2.91 versus 0.76 per 100 person-years in men whose female partners had normal vaginal flora (hazard ratio 3.62, 95% CI 1.74-7.52. After controlling for sociodemographic factors, sexual behavior, male circumcision, sexually transmitted infections, pregnancy, and plasma HIV-1 RNA levels in female partners, BV was associated with a greater than 3-fold increased risk of female-to-male HIV-1 transmission (adjusted hazard ratio 3.17, 95% CI 1.37-7.33.This study identified an association between BV and increased risk of HIV

Prevalence and correlates of knowledge of male partner HIV testing and serostatus among African-American women living in high poverty, high HIV prevalence communities (HPTN 064)

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Jennings, Larissa; Rompalo, Anne M.; Wang, Jing; Hughes, James; Adimora, Adaora A.; Hodder, Sally; Soto-Torres, Lydia E.; Frew, Paula M.; Haley, Danielle F.

2014-01-01

Knowledge of sexual partners' HIV infection can reduce risky sexual behaviors. Yet, there are no published studies to-date examining prevalence and characteristics associated with knowledge among African-American women living in high poverty communities disproportionately affected by HIV. Using the HIV Prevention Trial Network's (HPTN) 064 Study data, multivariable logistic regression was used to examine individual, partner, and partnership-level determinants of women's knowledge (n=1,768 women). Results showed that women's demographic characteristics alone did not account for the variation in serostatus awareness. Rather, lower knowledge of partner serostatus was associated with having two or more sex partners (OR=0.49, 95%CI: 0.37-0.65), food insecurity (OR=0.68, 95%CI: 0.49-0.94), partner age>35 (OR=0.68, 95%CI: 0.49-0.94), and partner concurrency (OR=0.63, 95%CI: 0.49-0.83). Access to financial support (OR=1.42, 95%CI: 1.05-1.92) and coresidence (OR=1.43, 95%CI: 1.05-1.95) were associated with higher knowledge of partner serostatus. HIV prevention efforts addressing African-American women's vulnerabilities should employ integrated behavioral, economic, and empowerment approaches. PMID:25160901

Healthcare Programmes for Truck Drivers in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

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Lalla-Edward, Samanta Tresha; Fobosi, Siyabulela Christopher; Hankins, Catherine; Case, Kelsey; Venter, W D Francois; Gomez, Gabriela

2016-01-01

Truck drivers have unique health needs, and by virtue of their continuous travel, experience difficulty in accessing healthcare. Currently, planning for effective care is hindered by lack of knowledge about their health needs and about the impact of on-going programmes on this population's health outcomes. We reviewed healthcare programmes implemented for sub-Saharan African truck drivers, assessed the evaluation methods, and examined impact on health outcomes. We searched scientific and institutional databases, and online search engines to include all publications describing a healthcare programme in sub-Saharan Africa where the main clients were truck drivers. We consulted experts and organisations working with mobile populations to identify unpublished reports. Forest plots of impact and outcome indicators with unadjusted risk ratios and 95% confidence intervals were created to map the impact of these programmes. We performed a subgroup analysis by type of indicator using a random-effects model to assess between-study heterogeneity. We conducted a sensitivity analysis to examine both the summary effect estimate chosen (risk difference vs. risk ratio) and model to summarise results (fixed vs. random effects). Thirty-seven publications describing 22 healthcare programmes across 30 countries were included from 5,599 unique records. All programmes had an HIV-prevention focus with only three expanding their services to cover conditions other primary healthcare services. Twelve programmes were evaluated and most evaluations assessed changes in input, output, and outcome indicators. Absence of comparison groups, preventing attribution of the effect observed to the programme and lack of biologically confirmed outcomes were the main limitations. Four programmes estimated a quantitative change in HIV prevalence or reported STI incidence, with mixed results, and one provided anecdotal evidence of changes in AIDS-related mortality and social norms. Most programmes showed

When HIV is ordinary and diabetes new: remaking suffering in a South African township.

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Mendenhall, Emily; Norris, Shane A

2015-01-01

Escalation of non-communicable diseases (NCDs) among urban South African populations disproportionately afflicted by HIV/AIDS presents not only medical challenges but also new ways in which people understand and experience sickness. In Soweto, the psychological imprints of political violence of the Apartheid era and structural violence of HIV/AIDS have shaped social and health discourses. Yet, as NCDs increasingly become part of social and biomedical discussions in South African townships, new frames for elucidating sickness are emerging. This article employs the concept of syndemic suffering to critically examine how 27 women living with Type 2 diabetes in Soweto, a township adjacent to Johannesburg known for socio-economic mobility as well as inequality, experience and understand syndemic social and health problems. For example, women described how reconstructing families and raising grandchildren after losing children to AIDS was not only socially challenging but also affected how they ate, and how they accepted and managed their diabetes. Although previously diagnosed with diabetes, women illustrated how a myriad of social and health concerns shaped sickness. Many related diabetes treatment to shared AIDS nosologies, referring to diabetes as 'the same' or 'worse'. These narratives demonstrate how suffering weaves a social history where HIV becomes ordinary, and diabetes new.

An appraisal of female sex work in Nigeria--implications for designing and scaling up HIV prevention programmes.

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Ikpeazu, Akudo; Momah-Haruna, Amaka; Madu Mari, Baba; Thompson, Laura H; Ogungbemi, Kayode; Daniel, Uduak; Aboki, Hafsatu; Isac, Shajy; Gorgens, Marelize; Mziray, Elizabeth; Njie, Ndella; Akala, Francisca Ayodeji; Emmanuel, Faran; Odek, Willis Omondi; Blanchard, James F

2014-01-01

The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs)--a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients ("hotspots"). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for scaling up focused HIV prevention programmes.

A decade of an HIV workplace programme in armed conflict zones; a social responsibility response of the International Committee of the Red Cross.

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Du Mortier, Stéphane; Mukangu, Silas; Sagna, Charles; Nyffenegger, Laurent; Aebischer Perone, Sigiriya

2016-01-01

The International Committee of the Red Cross (ICRC) works in fragile States and in armed conflict zones. Some of them are affected by the HIV pandemic. Within the framework of its social responsibility programme concerning HIV affecting its staff members, the organization has implemented an HIV workplace programme since 2004. We carried out a retrospective analysis over 10 years. Data collected were initially essentially qualitative and process-oriented, but were complemented over the years by data on annual voluntary counselling and testing (VCT) uptake and on direct annual costs covering awareness, testing and antiretroviral therapy. The number of people covered by the programme grew from none in 2003 to 4,438 in 2015, with an increase in annual VCT uptake over the years increasing from 376 persons (14 %) in 2007 to 2,663 in 2015 (60 %). Over the years, the services were expanded from awareness raising to bringing VCT to the workplace, as well as offering testing and health coverage of other conditions and innovative approaches to facing challenges linked to situations of violence. Within its social responsibility framework, the ICRC has shown the importance and feasibility of a workplace HIV programme in conflict zones. A sustainable workplace programme in these conflict settings requires constant adaptation, with regular follow-up given the relatively high turnover of staff, and ensuring sustainable stocks of condoms and antiretroviral drugs.

Understanding social capital and HIV risk in rural African American communities.

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Cené, Crystal W; Akers, Aletha Y; Lloyd, Stacey W; Albritton, Tashuna; Powell Hammond, Wizdom; Corbie-Smith, Giselle

2011-07-01

African Americans (AA) and rural communities often suffer disproportionately from poorer health. Theory-guided research examining how individual- and community-level factors influence health behaviors and contribute to disparities is needed. To understand how a social network model that captures the interplay between individual and community factors might inform community-based interventions to reduce HIV risk in rural AA communities. Qualitative study. Eleven focus groups with 38 AA 16-24 year olds, 42 adults over age 25, and 13 formerly incarcerated individuals held in community settings in two rural, predominantly AA counties in North Carolina. Thirty-seven semi-structured interviews with multiethnic key informants. Semi-structured interviews and focus groups with open-ended questions assessed a) perceptions of multi-level HIV risk determinants from a social network model (individual, interpersonal, social, economic, political and structural) identified through literature review and b) community needs and assets affecting local HIV rates. Qualitative data was analyzed using directive content analysis guided by a social network model. We identified four themes regarding the interaction between individuals and their communities that mediate HIV risk: interpersonal processes, community structural environment, social disorder, and civic engagement. Communities were characterized as having a high degree of cohesiveness, tension, and HIV-related stigma. The community structural environment-characterized by neighborhood poverty, lack of skilled jobs, segregation, political disenfranchisement and institutional racism-was felt to reduce the availability and accessibility of resources to combat HIV. Adults noted an inability to combat social problems due to social disorder, which fuels HIV risk behaviors. Civic engagement as a means of identifying community concerns and developing solutions is limited by churches' reluctance to address HIV-related issues. To combat HIV

Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting.

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Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-09-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, 'Know Your Rights' information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes

Costing Human Rights and Community Support Interventions as a Part of Universal Access to HIV Treatment and Care in a Southern African Setting

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Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-01-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall

Correlates of HIV infection among people visiting public HIV ...

African Journals Online (AJOL)

Correlates of HIV infection among people visiting public HIV counseling and testing clinics in Mpumalanga, ... Background: HIV voluntary counselling and testing (VCT) reduces high-risk sexual behaviour. ... AJOL African Journals Online.

Understanding the Adolescent Gap in HIV Testing Among Clients of Antenatal Care Services in West and Central African Countries.

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Helleringer, Stephane

2017-09-01

New HIV infections among children have declined significantly more slowly in West and central African countries (WCA) than in eastern and southern African countries between 2009 and 2015. Since adolescent fertility is particularly high in WCA countries, frequent mother-to-child transmission (MTCT) of HIV may in part be due to low coverage of HIV testing among adolescents during antenatal care (ANC). We investigated this adolescent gap in HIV testing using survey data from the demographic and health surveys and multiple indicators cluster surveys collected in 21 WCA countries since 2009. We found significant adolescent gaps in HIV testing in 12 out of 21 WCA countries, with the largest gap observed in Nigeria. In countries with a significant adolescent gap in HIV testing, we used Fairlie decompositions to assess what proportion of these gaps were explained by age-related differences in the distribution of (a) marital status, (b) socioeconomic status (SES), (c) MTCT-related knowledge, and (d) patterns of ANC utilization. Differences in SES and MTCT-related knowledge were the most consistent determinants of adolescent gaps in HIV testing during ANC. Differences in ANC utilization (e.g., fewer and possibly delayed ANC visits) also contributed to the adolescent gap in 8 out of 12 countries. Interventions that improve knowledge of MTCT risks, and/or promote the sustained use of ANC services, could help engage HIV-infected adolescents who become pregnant in PMTCT services. Targeting these interventions at the most disadvantaged households will be crucial in further reducing HIV infections among children.

A controlled study of an HIV/AIDS/STI/TB intervention with faith healers in Vhembe District, South Africa.

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Mashamba, Tshilidzi; Peltzer, Karl; Maluleke, Thelma X; Sodi, Tholene

2011-01-01

The aim of the study was to develop an HIV and AIDS training manual, and to evaluate the knowledge, attitudes and management of faith healers of Apostolic churches regarding HIV and AIDS, before and after they attended an HIV and AIDS training programme. A quasi-experimental intervention design was used with faith healers affiliated with the United African Apostolic Church (UAAC) in the Thulamela and Musina municipalities of Vhembe District, Limpopo Province, South Africa. A total of 103 faith healers were included in this study, 58 were systematically assigned to an intervention and 45 to a control group. The intervention group received training for 2 days. At follow-up after 2 months, intervention effects were significant for HIV knowledge and to a lesser extent TB knowledge. No significant improvement was found in HIV/STI (sexually transmitted infection) management strategies such as HIV/STI risk behaviour counselling, referral of clients for HIV testing, keeping condoms at stock in church, and church community HIV/AIDS/STI education. It is important to note that faith healers address some of the major known behavioural risk and protective factors such as partner reduction and condom use. Therefore, faith healers could be more widely utilized in HIV prevention programmes as risk reduction counsellors, in particular on matters of community-level education.

Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study.

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Dutta, Anupriya; Uno, Hajime; Holman, Alex; Lorenz, David R; Gabuzda, Dana

2017-07-01

African American men have the highest incidence of prostate cancer among ethnic groups, and racial disparity is highest in younger men. Prostate cancer prevalence is rising in HIV-infected men due to improved survival on antiretroviral therapies, yet little is known about racial differences in prostate cancer risk by HIV-infection status and age. This is a prospective cohort study of prostate cancer risk in 2,800 HIV-infected and -uninfected men who have sex with men (MSM) aged 40-70 years (22% African American) who were enrolled in the multicenter AIDS cohort study from 1996 to 2010. Poisson regression models were used to examine associations between race and HIV-infection status and prostate cancer risk among men aged 40-70, 40-55, and 56-70 years. Among men aged 40-70 years, incidence rates (IR) per 100,000 person-years were 169 among all men and 276 among African American HIV-infected men. Prostate cancer risk was similar by HIV-infection status (IRR 1.0, 95% CI 0.55-1.82), but nearly threefold higher in African Americans compared to non-African Americans in adjusted models (IRRs 2.66 and 3.22, 95% CIs 1.36-5.18 and 1.27-8.16 for all or HIV-infected men, respectively). Racial disparity in prostate cancer risk was greatest in African American men aged 40-55 years (adjusted IRR 3.31, 95% CI 1.19-9.22). Prostate cancer risk showed associations with family history of prostate cancer (p = 0.001), but not heavy smoking, androgen supplement use, or HIV-related factors. Among MSM, African American HIV-positive and HIV-negative men aged 40-55 years have threefold increased risk of young-onset prostate cancer compared to non-African American men, highlighting the need to make informed decisions about screening in this population.

A Pilot Trial Examining African American and White Responses to Algorithm-Guided Smoking Cessation Medication Selection in Persons Living with HIV.

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Valera, Pamela; McClernon, F Joseph; Burkholder, Greer; Mugavero, Michael J; Willig, James; O'Cleirigh, Conall; Cropsey, Karen L

2017-07-01

Algorithm-based treatments (AT) may be an effective clinical tool to aid HIV clinicians in prescribing pharmacotherapy to increase smoking cessation among people living with HIV (PLWH). Initial results from AT indicated significant increases in abstinence self-efficacy and medication utilization and declines in cigarettes smoked per day across time. Given historical racial disparities, it is unclear if both African Americans and White smokers would benefit equally from this type of intervention. Thus, the aim of this study was to examine racial differences in response to AT guided smoking cessation for African American and White smokers living with HIV. One hundred PLWH smokers (n = 100) were randomized to receive either AT guided smoking cessation or Treatment as Usual (TAU) which consisted of instructing participants to talk to a provider about smoking cessation assistance when ready to make a quit attempt. Participants were African American (75%) and White (25%) and majority men (71%) who had never been married (56%). African Americans smoked fewer cigarettes and were more likely to smoke mentholated cigarettes compared to White smokers at baseline. African Americans increased their use of other tobacco products (cigars/cigarillos) over time relative to White smokers. A significant interaction between race and quit goal was observed, with White smokers who reported complete abstinence as their goal having higher quit rates, while African Americans who reported a goal other than complete abstinence demonstrating higher quit rates. The increased use of cigars/cigarillos during quit attempts as well as having a goal other than complete abstinence should be considered when applying algorithm based interventions for PLWH African American smokers.

South African Breast Cancer and HIV Outcomes Study: Methods and Baseline Assessment

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Herbert Cubasch

2017-04-01

Full Text Available Purpose: In low- and middle-income, HIV-endemic regions of sub-Saharan Africa, morbidity and mortality from the common epithelial cancers of the developed world are rising. Even among HIV-infected individuals, access to antiretroviral therapy has enhanced life expectancy, shifting the distribution of cancer diagnoses toward non–AIDS-defining malignancies, including breast cancer. Building on our prior research, we recently initiated the South African Breast Cancer and HIV Outcomes study. Methods: We will recruit a cohort of 3,000 women newly diagnosed with breast cancer at hospitals in high (average, 20% HIV prevalence areas, in Johannesburg, Durban, Pietermaritzburg, and Empangeni. At baseline, we will collect information on demographic, behavioral, clinical, and other factors related to access to health care. Every 3 months in year 1 and every 6 months thereafter, we will collect interview and chart data on treatment, symptoms, cancer progression, comorbidities, and other factors. We will compare survival rates of HIV-infected and uninfected women with newly diagnosed breast cancer and their likelihood of receiving suboptimal anticancer therapy. We will identify determinants of suboptimal therapy and context-specific modifiable factors that future interventions can target to improve outcomes. We will explore molecular mechanisms underlying potentially aggressive breast cancer in both HIV-infected and uninfected patients, as well as the roles of pathogens, states of immune activation, and inflammation in disease progression. Conclusion: Our goals are to contribute to development of evidence-based guidelines for the management of breast cancer in HIV-positive women and to improve outcomes for all patients with breast cancer in resource-constrained settings.

Renal impairment in a rural African antiretroviral programme

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Lessells Richard J

2009-08-01

Full Text Available Abstract Background There is little knowledge regarding the prevalence and nature of renal impairment in African populations initiating antiretroviral treatment, nor evidence to inform the most cost effective methods of screening for renal impairment. With the increasing availability of the potentially nephrotixic drug, tenofovir, such information is important for the planning of antiretroviral programmes Methods (i Retrospective review of the prevalence and risk factors for impaired renal function in 2189 individuals initiating antiretroviral treatment in a rural African setting between 2004 and 2007 (ii A prospective study of 149 consecutive patients initiating antiretrovirals to assess the utility of urine analysis for the detection of impaired renal function. Severe renal and moderately impaired renal function were defined as an estimated GFR of ≤ 30 mls/min/1.73 m2 and 30–60 mls/min/1.73 m2 respectively. Logistic regression was used to determine odds ratio (OR of significantly impaired renal function (combining severe and moderate impairment. Co-variates for analysis were age, sex and CD4 count at initiation. Results (i There was a low prevalence of severe renal impairment (29/2189, 1.3% 95% C.I. 0.8–1.8 whereas moderate renal impairment was more frequent (287/2189, 13.1% 95% C.I. 11.6–14.5 with many patients having advanced immunosuppression at treatment initiation (median CD4 120 cells/μl. In multivariable logistic regression age over 40 (aOR 4.65, 95% C.I. 3.54–6.1, male gender (aOR 1.89, 95% C.I. 1.39–2.56 and CD4 Conclusion In this rural African setting, significant renal impairment is uncommon in patients initiating antiretrovirals. Urine analysis alone may be inadequate for identification of those with impaired renal function where resources for biochemistry are limited.

Intervention induced changes on parenting practices, youth self-pride and sexual norms to reduce HIV-related behaviors among rural African American youths.

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Murry, Velma McBride; Berkel, Cady; Chen, Yi-Fu; Brody, Gene H; Gibbons, Frederick X; Gerrard, Meg

2011-09-01

AIDS is the leading killer of African Americans between the ages of 25 and 44, many of whom became infected when they were teenagers or young adults. The disparity in HIV infection rate among African Americans youth residing in rural Southern regions of the United States suggests that there is an urgent need to identify ways to promote early preventive intervention to reduce HIV-related risk behavior. The Strong African American Families (SAAF) program, a preventive intervention for rural African American parents and their 11-year-olds, was specially designed to deter early sexual onset and the initiation and escalation of alcohol and drug use among rural African American preadolescents. A clustered-randomized prevention trial was conducted, contrasting families who took part in SAAF with control families. The trial, which included 332 families, indicated that intervention-induced changes occurred in intervention-targeted parenting, which in turn facilitated changes in youths' internal protective processes and positive sexual norms. Long-term follow up assessments when youth were 17 years old revealed that intervention-induced changes in parenting practices mediated the effect of intervention-group influences on changes in the onset and escalation of risky sexual behaviors over 65 months through its positive influence on adolescents' self-pride and their sexual norms. The findings underscore the powerful effects of parenting practices among rural African American families that over time serve a protective role in reducing youth's risk behavior, including HIV vulnerable behaviors.

The meaning and use of spirituality among African American women living with HIV/AIDS.

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Dalmida, Safiya George; Holstad, Marcia McDonnell; DiIorio, Colleen; Laderman, Gary

2012-10-01

The purpose of this qualitative study was to explore the meaning and use of spirituality among African American (AA), predominantly Christian women with HIV. A nonrandom sample of 20 AA women from a large infectious disease clinic in Metro-Atlanta participated in the study. The study used focus groups and individual interviews to interview women about their lived spiritual experience. Content analysis and NUDIST software were used to analyze transcripts. The findings revealed the spiritual views and practices of AA women with HIV. The following themes (and subthemes) emerged: Spirituality is a process/journey or connection (connection to God, higher power, or spirit and HIV brought me closer to God), spiritual expression (religion/church attendance, prayer, helping others, having faith), and spiritual benefits (health/healing, spiritual support, inner peace/strength/ability to keep going, and here for a reason or purpose/a second chance). Findings highlight the importance of spirituality in health and well-being among AA women with HIV/AIDS.

Do hernia operations in african international cooperation programmes provide good quality?

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Gil, J; Rodríguez, J M; Hernández, Q; Gil, E; Balsalobre, M D; González, M; Torregrosa, N; Verdú, T; Alcaráz, M; Parrilla, P

2012-12-01

Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was to evaluate the quality of hernia repair processes carried out by the Surgical Solidarity Charity in Central African States. A total of 524 cases of inguinal hernia repair carried out in Cameroon and Mali during 2005 to 2009 were compared with 386 cases treated in a Multicentre Spanish Study (2003). General data (clinical, demographic, etc.), type of surgery, complications, and effectiveness and efficiency indicators were collected. Preoperative studies in the Spanish group were greater in number than in the African group. The use of local anesthesia was similar. Antibiotic prophylaxis was higher in the African group (100% to 75.4%). The use of mesh was similar. The incidence of hematomas was higher in the Spanish group (11.61% to 4.61%), but the incidence of infection of the wound and of hernia recurrence was similar, although follow-up was only carried out in 20.97% in the African group (70% in the Spanish group). Hospital stay of more than 24 h was higher in the Spanish group. The standard quality of surgery for the treatment of hernia in developing countries with few instrumental means, and in sub-optimal surgical conditions is similar to that provided in Spain.

Contraceptive method and pregnancy incidence among African women in HIV-1 serodiscordant partnerships

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NGURE, Kenneth; HEFFRON, Renee; MUGO, Nelly R.; CELUM, Connie; COHEN, Craig R.; ODOYO, Josephine; REES, Helen; KIARIE, James N.; WERE, Edwin; BAETEN, Jared M.

2014-01-01

Background Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1 infected women. Methods Among 2269 HIV-1 seropositive and 1085 seronegative women from 7 African countries who were members of HIV-1 serodiscordant heterosexual partnerships and who were participating in an HIV-1 prevention clinical trial, we assessed pregnancy incidence for women using various contraceptive methods using multivariate Andersen-Gill analysis. Results Compared with women using no contraceptive method, pregnancy incidence was significantly reduced among HIV-1 seropositive and seronegative women using injectable contraception (adjusted hazard ratio (aHR) 0.24, p=0.001 and aHR 0.25, ppregnancy risk only among HIV-1 seropositive women (aHR 0.51, p=0.004) but not seronegative women (aHR 0.64, p=0.3), and, for both seropositive and seronegative women, oral contraceptive pill users were more likely to become pregnant than injectable contraceptive users (aHR 2.22, p=0.01 for HIV-1 seropositive women and aHR 2.65, p=0.09 for HIV-1 seronegative women). Condoms, when reported as being used as the primary contraceptive method, marginally reduced pregnancy incidence (aHR 0.85, p=0.1 for seropositive women and aHR 0.67, p=0.02 for seronegative women). There were no pregnancies among women using intrauterine devices, implantable methods or who had undergone surgical sterilization, although these methods were used relatively infrequently. Conclusions Family planning programs and HIV-1 prevention trials need innovative ways to motivate uptake and sustained use of longer acting, less user-dependent contraception for women who do not desire pregnancy. PMID:22156966

Workplace programmes for HIV and tuberculosis: a systematic review to support development of international guidelines for the health workforce.

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Yassi, Annalee; O'Hara, Lyndsay M; Lockhart, Karen; Spiegel, Jerry M

2013-01-01

The health service sector has a vital role to play in delivering human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment and care, yet evidence indicates that healthcare workers (HCWs) themselves lack adequate access to HIV and TB services. HCWs are also at increased risk from TB and other infectious diseases at work, and therefore accessing HIV services is particularly important. A systematic review was therefore conducted to inform the development of World Health Organization (WHO) guidelines to improve access to HIV and TB services, and specifically, to assess the evidence regarding providing such services through workplace-based programmes. We identified any study published since 1984 that addressed outcomes of interest as defined through multi-stakeholder consultations, and were related to workplace interventions in (1) the healthcare workplace and (2) any workplace that included HIV and/or TB diagnosis and/or treatment. Interventions focusing solely on primary prevention with no diagnostic or treatment services were excluded, as they were the subject of other guidelines. A minimum of two reviewers independently extracted data and assessed the articles against pre-set selection criteria; studies were also profiled and quality assessed by a minimum of two reviewers. Three studies met these criteria specifically for HCWs; all showed a preponderance of positive benefits, with minimal negative outcome. Seven studies met these criteria regarding workplace HIV and/or TB diagnosis and/or treatment from other sectors, public or private. Again, all showed positive results. The paucity of high-quality evidence in this field of research was itself an important finding, beckoning further research on workplace-based programmes for health workers. Nonetheless, while more well-designed intervention studies are definitely desirable, providing programmes for HCWs to obtain HIV and TB diagnosis and treatment at the workplace is supported by the literature

To Test or Not to Test: Barriers and Solutions to Testing African American College Students for HIV at a Historically Black College/University.

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Hall, Naomi M; Peterson, Jennifer; Johnson, Malynnda

2014-01-01

Young African Americans are disproportionately affected by sexually transmitted infections, including HIV. The purpose was to identify reasons that African American college students at a historically Black college/university (HBCU) identified as barriers to HIV testing, and how these barriers can be removed. Fifty-seven heterosexual-identified undergraduate students (ages 18-25) attending an HBCU in the southeastern US participated in a mixed method study. Latent content analytic techniques were used to code the transcripts for themes and categories, and representative quotations were used in the findings. Quantitative data indicates high levels of perceived knowledge about HIV transmission, low perception of risk and concern of contracting HIV, yet continued sexual risk behavior. Qualitative data indicates three main themes used to avoid testing and three themes to encourage testing. Students were forthcoming in discussing the themes around avoidance of HIV testing (being scared to know, preferring not to know, and lack of discussion about HIV) and encouraging testing (group testing, increasing basic knowledge, and showing the reality of HIV). It is important for college healthcare professionals, researchers, and officials to identify appropriate ways to encourage HIV testing, and promote testing as part of overall health.

The evaluation of a rapid in situ HIV confirmation test in a programme with a high failure rate of the WHO HIV two-test diagnostic algorithm.

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Derryck B Klarkowski

Full Text Available BACKGROUND: Concerns about false-positive HIV results led to a review of testing procedures used in a Médecins Sans Frontières (MSF HIV programme in Bukavu, eastern Democratic Republic of Congo. In addition to the WHO HIV rapid diagnostic test algorithm (RDT (two positive RDTs alone for HIV diagnosis used in voluntary counselling and testing (VCT sites we evaluated in situ a practical field-based confirmation test against western blot WB. In addition, we aimed to determine the false-positive rate of the WHO two-test algorithm compared with our adapted protocol including confirmation testing, and whether weakly reactive compared with strongly reactive rapid test results were more likely to be false positives. METHODOLOGY/PRINCIPAL FINDINGS: 2864 clients presenting to MSF VCT centres in Bukavu during January to May 2006 were tested using Determine HIV-1/2 and UniGold HIV rapid tests in parallel by nurse counsellors. Plasma samples on 229 clients confirmed as double RDT positive by laboratory retesting were further tested using both WB and the Orgenics Immunocomb Combfirm HIV confirmation test (OIC-HIV. Of these, 24 samples were negative or indeterminate by WB representing a false-positive rate of the WHO two-test algorithm of 10.5% (95%CI 6.6-15.2. 17 of the 229 samples were weakly positive on rapid testing and all were negative or indeterminate by WB. The false-positive rate fell to 3.3% (95%CI 1.3-6.7 when only strong-positive rapid test results were considered. Agreement between OIC-HIV and WB was 99.1% (95%CI 96.9-99.9% with no false OIC-HIV positives if stringent criteria for positive OIC-HIV diagnoses were used. CONCLUSIONS: The WHO HIV two-test diagnostic algorithm produced an unacceptably high level of false-positive diagnoses in our setting, especially if results were weakly positive. The most probable causes of the false-positive results were serological cross-reactivity or non-specific immune reactivity. Our findings show that the OIC-HIV

Contraceptive Use and Uptake of HIV-Testing among Sub-Saharan African Women.

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Katherine E Center

Full Text Available Despite improved availability of simple, relatively inexpensive, and highly effective antiretroviral treatment for HIV/AIDS, the disease remains a major public health challenge for women in sub-Saharan Africa (SSA. Given the numerous barriers in access to care for women in this region, every health issue that brings them into contact with the health system should be optimized as an opportunity to integrate HIV/AIDS prevention. Because most non-condom forms of modern contraception require a clinical appointment for use, contraception appointments could provide a confidential opportunity for access to HIV counseling, testing, and referral to care. This study sought to investigate the relationship between contraceptive methods and HIV testing among women in SSA. Data from the Demographic and Health Survey from four African countries-Congo, Mozambique, Nigeria, and Uganda-was used to examine whether modern (e.g., pills, condom or traditional (e.g., periodic abstinence, withdrawal forms of contraception were associated with uptake of HIV testing. Data for the current analyses were restricted to 35,748 women with complete information on the variables of interest. Chi-square tests and logistic regression models were used to assess the relationship between uptake of HIV testing and respondents' baseline characteristics and contraceptive methods. In the total sample and in Mozambique, women who used modern forms of contraception were more likely to be tested for HIV compared to those who did not use contraception. This positive association was not demonstrated in Congo, Nigeria, or Uganda. That many women who access modern contraception are not tested for HIV in high HIV burden areas highlights a missed opportunity to deliver an important intervention to promote maternal and child health. Given the increasing popularity of hormonal contraception methods in low-income countries, there is an urgent need to integrate HIV counseling, testing, and treatment

“No ‘til we know” fela ba a tseba naa? On using African languages to communicate HIV and AIDS to young South Africans

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Lubinga, E.; Jansen, Carel

2011-01-01

An experiment was conducted in order to determine the extent to which the presentation of HIV and AIDS messages in different languages would affect the appreciation and comprehension of these messages among young South Africans. Interviews were carried out with 60 learners in rural and peri-rural

Nutritional status is the major factor affecting grip strength of African HIV patients before and during antiretroviral treatment

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Filteau, Suzanne; PrayGod, G; Woodd, Susannah L

2017-01-01

OBJECTIVES: Low grip strength is a marker of frailty and a risk factor for mortality among HIV patients and other populations. We investigated factors associated with grip strength in malnourished HIV patients at referral to ART, and at 12 weeks and 2-3 years after starting ART. METHODS: The study...... involved HIV-infected Zambian and Tanzanian participants recruited to the NUSTART trial when malnourished (body mass index .... CONCLUSIONS: In this population of originally malnourished HIV patients, poor grip strength was more strongly and independently associated with nutritional than with infection and inflammation variables. Programmes to improve health and survival of HIV patients should incorporate nutritional assessment...

Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario, Canada.

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Logie, Carmen; James, Llana; Tharao, Wangari; Loutfy, Mona

2013-02-01

Abstract African, Caribbean, and Black (ACB) women are greatly overrepresented in new HIV infections in comparison with Canada's general population. Social and structural factors such as HIV-related stigma, gender discrimination, and racial discrimination converge to increase vulnerability to HIV infection among ACB women by reducing access to HIV prevention services. Stigma and discrimination also present barriers to treatment, care, and support and may contribute to mental health problems. We administered a cross-sectional survey to HIV-positive ACB women (n=173) across Ontario in order to examine the relationships between HIV-related stigma, gender discrimination, racial discrimination, and depression. One-third of participants reported moderate/severe depression scores using the Beck Depression Inventory Fast-Screen guidelines. Hierarchical block regression, moderation, and mediation analyses were conducted to measure associations between independent (HIV-related stigma, gender discrimination, racial discrimination), moderator/mediator (social support, resilient coping), and dependent (depression) variables. Findings included: (1) HIV-related stigma was associated with increased depression; (2) resilient coping was associated with reduced depression but did not moderate the influence of HIV-related stigma on depression; and (3) the effects of HIV-related stigma on depression were partially mediated through resilient coping. HIV-related stigma, gender discrimination, and racial discrimination were significantly correlated with one another and with depression, highlighting the salience of examining multiple intersecting forms of stigma. Generalizability of findings may be limited due to nonrandom sampling. Findings emphasize the importance of multi-component interventions, including building resilient coping skills, mental health promotion and assessment, and stigma reduction programs.

Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India.

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Vassall, Anna; Pickles, Michael; Chandrashekar, Sudhashree; Boily, Marie-Claude; Shetty, Govindraj; Guinness, Lorna; Lowndes, Catherine M; Bradley, Janet; Moses, Stephen; Alary, Michel; Vickerman, Peter

2014-09-01

Avahan is a large-scale, HIV preventive intervention, targeting high-risk populations in south India. We assessed the cost-effectiveness of Avahan to inform global and national funding institutions who are considering investing in worldwide HIV prevention in concentrated epidemics. We estimated cost effectiveness from a programme perspective in 22 districts in four high-prevalence states. We used the UNAIDS Costing Guidelines for HIV Prevention Strategies as the basis for our costing method, and calculated effect estimates using a dynamic transmission model of HIV and sexually transmitted disease transmission that was parameterised and fitted to locally observed behavioural and prevalence trends. We calculated incremental cost-effective ratios (ICERs), comparing the incremental cost of Avahan per disability-adjusted life-year (DALY) averted versus a no-Avahan counterfactual scenario. We also estimated incremental cost per HIV infection averted and incremental cost per person reached. Avahan reached roughly 150 000 high-risk individuals between 2004 and 2008 in the 22 districts studied, at a mean cost per person reached of US$327 during the 4 years. This reach resulted in an estimated 61 000 HIV infections averted, with roughly 11 000 HIV infections averted in the general population, at a mean incremental cost per HIV infection averted of $785 (SD 166). We estimate that roughly 1 million DALYs were averted across the 22 districts, at a mean incremental cost per DALY averted of $46 (SD 10). Future antiretroviral treatment (ART) cost savings during the lifetime of the cohort exposed to HIV prevention were estimated to be more than $77 million (compared with the slightly more than $50 million spent on Avahan in the 22 districts during the 4 years of the study). This study provides evidence that the investment in targeted HIV prevention programmes in south India has been cost effective, and is likely to be cost saving if a commitment is made to provide ART to all

An Appraisal of Female Sex Work in Nigeria - Implications for Designing and Scaling Up HIV Prevention Programmes

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Ikpeazu, Akudo; Momah-Haruna, Amaka; Madu Mari, Baba; Thompson, Laura H.; Ogungbemi, Kayode; Daniel, Uduak; Aboki, Hafsatu; Isac, Shajy; Gorgens, Marelize; Mziray, Elizabeth; Njie, Ndella; Akala, Francisca Ayodeji; Emmanuel, Faran; Odek, Willis Omondi; Blanchard, James F.

2014-01-01

Background The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs) - a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. Methodology It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients (“hotspots”). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. Results Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. Conclusion FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for

An appraisal of female sex work in Nigeria--implications for designing and scaling up HIV prevention programmes.

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Akudo Ikpeazu

Full Text Available BACKGROUND: The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs--a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. METHODOLOGY: It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients ("hotspots". In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. RESULTS: Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%, hotels/lodges (29.6%, streets (16.6%, and brothels (14.6%. Furthermore, the population density of FSWs (per thousand adult men across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. CONCLUSION: FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning

Capacity building among african american faith leaders to promote HIV prevention and vaccine research.

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Alio, Amina P; Lewis, Cindi A; Bunce, Catherine A; Wakefield, Steven; Thomas, Weldon G; Sanders, Edwin; Keefer, Michael C

2014-01-01

In light of the increasing rates of HIV infection in African Americans, it is essential that black faith leaders become more proactive in the fight against the epidemic. The study aim was to engage faith leaders in a sustainable partnership to increase community participation in preventive HIV vaccine clinical research while improving their access to and utilization of HIV/AIDS prevention services. Leadership Development Seminars were adapted for faith leaders in Rochester, NY, with topics ranging from the importance of preventive HIV vaccine research to social issues surrounding HIV/AIDs within a theological framework. Seminars were taught by field-specific experts from the black community and included the development of action plans to institute HIV preventive ministries. To assess the outcome of the Seminars, baseline and post-training surveys were administered and analyzed through paired sample t Tests and informal interviews. 19 faith leaders completed the intervention. In general, the majority of clergy felt that their understanding of HIV vaccine research and its goals had increased postintervention. A critical outcome was the subsequent formation of the Rochester Faith Collaborative by participating clergy seeking to sustain the collaborative and address the implementation of community action plans. Providing scientific HIV/AIDS knowledge within the context of clergy members' belief structure was an effective method for engaging black Church leaders in Rochester, NY. Collaborative efforts with various local institutions and community-based organizations were essential in building trust with the faith leaders, thereby building bridges for better understanding of HIV/AIDS prevention efforts, including HIV vaccine research.

Theoretical Implications of Gender, Power, and Sexual Scripts for HIV Prevention Programs Aimed at Young, Substance-Using African-American Women.

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Hill, Mandy; Granado, Misha; Stotts, Angela

2017-12-01

HIV continues to be a major public health problem for African-American (AA) women, and the burden of new cases to our society is significant because each case is at risk of infecting others. Substance use worsens the risk of HIV transmission to AA women. We provide specific recommendations to move the concept of tailoring HIV prevention interventions for substance users forward by focusing on young, sexually active, substance-using AA women and applying a culturally relevant revision to existing theoretical frameworks to include the Sexual Script Theory and the Theory of Gender and Power. We encourage use of these theories to guide adaptation of interventions to demonstrate efficacy within this hard-to-reach population. Consistent use of theories designed to exploit powerlessness and sexual scripts as barriers to adoption of protective sexual behaviors has potential to permeate sexual and substance use networks among African-Americans. This recommendation is being made because this theoretical framework has not been used in HIV prevention interventions targeting young, sexually active, substance-using AA women.

Rumor, gossip and blame: implications for HIV/AIDS prevention in the South African lowveld.

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Stadler, Jonathan

2003-08-01

The HIV/AIDS epidemic provides fertile breeding ground for theories of the origin of HIV/AIDS, its mode of transmission, and the allocation of blame. Drawing on ethnographic research in the Bushbuckridge region of the South African lowveld, this article examines the articulation of AIDS through gossip and rumor. These oral forms create moral readings of behavior and shape folk discourses of AIDS that resist dominant epidemiological explanations. Significantly, constructions of AIDS are not uniform. Although elders claim AIDS as traditional and curable, younger men and women support theories of AIDS as a modern, foreign disease. Witchcraft beliefs are popular in explaining why certain people die and not others. At times, rumor may escalate into a moral panic. The implications of these findings for social responses to the AIDS epidemic and HIV/AIDS prevention are explored.

Contextualizing gender differences and methamphetamine use with HIV prevalence within a South African community.

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Wechsberg, Wendee M; Doherty, Irene A; Myers, Bronwyn; Morgan-Lopez, Antonio A; Emanuel, Andrea; Carney, Tara; Kline, Tracy L; Zule, William A

2014-05-01

This study was conducted in a large Black African township outside of Cape Town, South Africa, where HIV infection has been endemic at extremely high levels for years. Problems associated with high HIV prevalence are compounded by gender inequality and high rates of gender-based violence exacerbated by heavy alcohol use and increasing methamphetamine use. Informal drinking establishments (known as shebeens) were geocoded and mapped. Based on visual examination, we identified 36 neighbourhoods, each of which contained between three to seven drinking venues clustered together. Neighbourhoods were separated from each other by at least 200m. We randomly selected 30 of the 36 neighbourhoods. Outreach workers screened males in shebeens and screened their female partners. This analysis includes 580 study participants recruited from 30 neighbourhoods between 2010 and 2012. All participants completed a baseline questionnaire that included individual-level, couple-level, and neighbourhood-level measures of alcohol and other drug use, HIV infection, and HIV risk behaviours. Multilevel fixed effects regression analyses stratified by gender were conducted to examine correlates of HIV infection. Women were twice as likely as men to be HIV infected, yet they reported fewer sex partners. Neighbourhood prevalence of HIV was correlated with greater likelihood of HIV infection among women, but not men. Neighbourhood methamphetamine use was marginally associated with HIV among women but not among men. At the individual level, heavy alcohol use was marginally associated with HIV infection among men but not among women. Having an HIV positive partner was the strongest correlate of being HIV positive among both men and women. Findings from this study underscore the need for policy makers to direct scarce resources to the communities, places within communities, and populations, especially vulnerable women, where the impact on HIV prevention and onward transmission will be greatest

Gender ideologies, socioeconomic opportunities, and HIV/STI-related vulnerability among female, African-American adolescents.

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Kerrigan, Deanna; Andrinopoulos, Katherine; Chung, Shang-en; Glass, Barbara; Ellen, Jonathan

2008-09-01

The importance of gender within HIV/STI prevention has become widely recognized. However, gender ideologies associated with vulnerability to HIV/STI are often examined and addressed without sufficient attention to the larger socioeconomic context within which they arise and evolve. We conducted a cross-sectional survey with 155 female, African-American adolescents recruited from two health clinics in Baltimore, Maryland. Multivariate logistic regression was utilized to assess the relationships between HIV/STI vulnerability resulting from male partner concurrency, adherence to traditional female gender norms, using a measure of hyperfemininity, and perceived socioeconomic opportunity structures. The likelihood of reported partner concurrency increased significantly among participants reporting higher levels of hyperfemininity (OR = 2.08; 95%CI = 1.01-4.30). Hyperfeminine thinking and behavior was significantly lower in the context of higher perceived socioeconomic opportunity structures (OR = 0.87; 95%CI = 0.79-0.95). Interventions seeking to promote gender equity and reduce HIV/STI may be more effective when the socioeconomic context of gender ideologies is assessed and addressed. Programs and policies to increase educational and professional opportunity structures, particularly among marginalized communities, should be actively integrated into HIV/STI prevention planning.

Romantic Relationships: An Important Context for HIV/STI and Pregnancy Prevention Programmes with Young People

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Coyle, Karin K.; Anderson, Pamela M.; Franks, Heather M.; Glassman, Jill; Walker, James D.; Charles, Vignetta Eugenia

2014-01-01

Romantic relationships are central in the lives of young people. This paper uses data on romantic relationships from urban youth in the USA to illustrate how using a relationships perspective in HIV/STI and pregnancy prevention programmes broadens the skills and content covered, and contextualises the learning to enhance relevance and use.…

Developing a mHealth intervention to promote uptake of HIV testing among African communities in the UK: a qualitative study.

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Evans, C; Turner, K; Suggs, L S; Occa, A; Juma, A; Blake, H

2016-07-28

HIV-related mHealth interventions have demonstrable efficacy in supporting treatment adherence, although the evidence base for promoting HIV testing is inconclusive. Progress is constrained by a limited understanding of processes used to develop interventions and weak theoretical underpinnings. This paper describes a research project that informed the development of a theory-based mHealth intervention to promote HIV testing amongst city-dwelling African communities in the conditions. A community-based participatory social marketing design was adopted. Six focus groups (48 participants in total) were undertaken and analysed using a thematic framework approach, guided by constructs from the Health Belief Model. Key themes were incorporated into a set of text messages, which were pre-tested and refined. The focus groups identified a relatively low perception of HIV risk, especially amongst men, and a range of social and structural barriers to HIV testing. In terms of self-efficacy around HIV testing, respondents highlighted a need for communities and professionals to work together to build a context of trust through co-location in, and co-involvement of, local communities which would in turn enhance confidence in, and support for, HIV testing activities of health professionals. Findings suggested that messages should: avoid an exclusive focus on HIV, be tailored and personalised, come from a trusted source, allay fears and focus on support and health benefits. HIV remains a stigmatized and de-prioritized issue within African migrant communities in the UK, posing barriers to HIV testing initiatives. A community-based participatory social marketing design can be successfully used to develop a culturally appropriate text messaging HIV intervention. Key challenges involved turning community research recommendations into brief text messages of only 160 characters. The intervention needs to be evaluated in a randomized control trial. Future research should explore the

Does marital status matter in an HIV hyperendemic country? Findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey.

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Shisana, Olive; Risher, Kathryn; Celentano, David D; Zungu, Nompumelelo; Rehle, Thomas; Ngcaweni, Busani; Evans, Meredith G B

2016-01-01

South Africa has experienced declining marriage rates and the increasing practice of cohabitation without marriage. This study aims to improve the understanding of the relationship between marital status and HIV in South Africa, an HIV hyperendemic country, through an analysis of findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The nationally representative population-based cross-sectional survey collected data on HIV and socio-demographic and behavioural determinants in South Africa. This analysis considered respondents aged 16 years and older who consented to participate in the survey and provided dried blood spot specimens for HIV testing (N = 17,356). After controlling for age, race, having multiple sexual partners, condom use at last sex, urban/rural dwelling and level of household income, those who were married living with their spouse had significantly reduced odds of being HIV-positive compared to all other marital spouses groups. HIV incidence was 0.27% among respondents who were married living with their spouses; the highest HIV incidence was found in the cohabiting group (2.91%). Later marriage (after age 24) was associated with increased odds of HIV prevalence. Our analysis suggests an association between marital status and HIV prevalence and incidence in contemporary South Africa, where odds of being HIV-positive were found to be lower among married individuals who lived with their spouses compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socio-economic status, low social cohesion and the resulting destabilization of sexual relationships may explain the increased risk of HIV among unmarried populations, it is necessary to address structural issues including poverty that create an environment unfavourable to stable sexual relationships.

Impact of National HIV and AIDS Communication Campaigns in South Africa to Reduce HIV Risk Behaviour

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Karl Peltzer

2012-01-01

Full Text Available In South Africa social and behavioural communication interventions are a critical component of HIV/AIDS prevention, and numerous communication campaigns have been implemented intensively across the country through government initiatives and nongovernmental organisations over the past decade. The aim of this paper is to assess the reach of HIV and AIDS communication campaigns in conjunction with contributions to knowledge, attitudes, and HIV risk behaviours in the general population in South Africa. The sample included in this nationally representative cross-sectional survey was 13234 people aged 15–55 years. Overall, the study found that there was high exposure to 18 different HIV communication programmes (median 6 programmes and 14 programmes more than 30% across different age groups. Most programmes were more often seen or heard by young people aged between 15 and 24 years. In multivariate analysis, greater exposure to HIV mass communication programmes was associated with greater HIV knowledge, condom use at last sex, having tested for HIV in the past 12 months, and less stigmatizing attitude toward PLWHA.

The role of South African traditional health practitioners in the treatment of HIV/AIDS; A study of their practices and use of herbal medicines

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David R Walwyn

2010-11-01

Full Text Available Background A large proportion of HIV positive South Africans regularly consult Traditional Health Practitioners (THPs for their healthcare needs, despite some evidence of negative interactions with antiretrovirals (ARVs and no published peer-reviewed clinical evidence for the efficacy of traditional medicines in the treatment of HIV. In this study, we investigated the dominant practices of THPs towards HIV positive patients and whether these practices have changed following widespread public awareness campaigns covering HIV and its treatment. Method The study used a semi-structured interviewer-administered questionnaire in the home language of the interviewee. A total of 52 THPs from four provinces (Gauteng, Limpopo, Kwazulu Natal and Eastern Cape were interviewed. 38% of the respondents were based in the rural areas, and 69% classified themselves as inyangas, with the remainder being sangomas. Findings All of the THPs in the survey offered treatment for HIV, although only 20% claimed to be able to cure the disease. 88% prepared their own medication, mostly from plant material, and sold their products as aqueous extracts in labelled bottles. None of these products had been systematically evaluated, and there was mostly no record keeping, either of the patient, or of the medicine itself. Quality control practices such as expiry dates, controlled storage conditions and batch records were totally unknown in our sample. Only 38% of the THPs had received training on HIV/AIDS although 75% believed that they were well informed about the disease. Our own assessment was that only 50% had a working knowledge of HIV; more disturbingly 37% believe that only traditional medicines should be used for the treatment of HIV and a further 50% believe that both traditional medicines and ARVs can be taken simultaneously. Interpretation Despite ongoing public educational campaigns on HIV, some of which have specifically targeted THPs, the care of HIV positive

"It's my secret": fear of disclosure among sub-Saharan African migrant women living with HIV/AIDS in Belgium.

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Agnes Ebotabe Arrey

Full Text Available Patients with HIV not only have to deal with the challenges of living with an incurable disease but also with the dilemma of whether or not to disclose their status to their partners, families and friends. This study explores the extent to which sub-Saharan African (SSA migrant women in Belgium disclose their HIV positive status, reasons for disclosure/non-disclosure and how they deal with HIV disclosure. A qualitative study consisting of interviews with twenty-eight SSA women with HIV/AIDS was conducted. Thematic content analysis was employed to identify themes as they emerged. Our study reveals that these women usually only disclose their status to healthcare professionals because of the treatment and care they need. This selective disclosure is mainly due to the taboo of HIV disease in SSA culture. Stigma, notably self-stigma, greatly impedes HIV disclosure. Techniques to systematically incorporate HIV disclosure into post-test counseling and primary care services are highly recommended.

Psychosocial and behavioural correlates of attitudes towards antiretroviral therapy (ART) in a sample of South African mineworkers.

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Govender, Kaymarlin; Akintola, Olagoke; George, Gavin; Petersen, Inge; Bhagwanjee, Anil; Reardon, Candice

2011-01-01

Despite being one of the worst affected sectors in South Africa, the mining sector has proven to be one of the most active in intervention efforts in the fight against HIV and AIDS (Ellis, 2007). Owing to low uptake rates of antiretroviral therapy (ART) in mining companies in recent years (Connelly & Rosen, 2006) and the positive relationship between attitudes towards ART and ART uptake (Cooper et al., 2002; Horne, Cooper, Gellaitry, Leake, & Fisher, 2007), this study sought to describe and investigate the psychosocial and behavioural correlates of attitudes towards ART in a sample of South African mineworkers. A total of 806 mineworkers from a large South African mine participated in this quantitative study. Despite a high rate of HIV testing behaviour (83.0%) as well as favourable attitudes towards ART, analysis indicated that temporary employees and contractors were more vulnerable in terms of HIV risk, HIV testing behaviours and ART knowledge and attitudes. Employees who had more positive attitudes towards ART were more knowledgeable of ART and, importantly, had a more favourable attitude towards the mine's HIV/AIDS treatment programme. These findings are discussed in relation to the low ART uptake rates in this context and recommendations for the improvement of ART uptake amongst employees at this mining site.

African American adolescents and new media: associations with HIV/STI risk behavior and psychosocial variables.

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Whiteley, Laura B; Brown, Larry K; Swenson, Rebecca R; Romer, Daniel; DiClemente, Ralph J P; Salazar, Laura E; Vanable, Peter A; Carey, Michael P; Valois, Robert F

2011-01-01

Cell phones and online media are used frequently but we know little about their use among African American adolescents. This study examines the frequency of such use and its relationship to psychosocial variables and STI/HIV risk behavior. 1,518 African American, aged 13-18 years, from 2 Northeast US cities (Providence, RI; Syracuse, NY) and 2 Southeast US cities (Columbia, SC; Macon, GA), were assessed from 2008-2009. Participants were assessed on frequency of cell phone and Internet use, psychological constructs (ie, depression, life satisfaction, impulsivity) and HIV/STI risk behaviors (ie, history of intercourse, sexual sensation seeking attitudes, peer sexual risks norms) with reliable scales and measures using an audio computer-assisted self-interview. Over 90% of African American adolescents used cell phones every day or most days and 60% used social networking sites every day or most days (96% used Myspace). Greater frequency of cell phone use was associated with sexual sensation seeking (P = .000), riskier peer sexual norms (P = .000), and impulsivity (P = .016). Greater frequency of Internet use was associated with a history of oral/vaginal/anal sex (OR = 1.03, CI = 1.0-1.05) and sexual sensation seeking (P = .000). These findings suggest that riskier youth are online and using cell phones frequently. The Internet and cell phones may be useful platforms for targeted health promotion and prevention efforts with AA adolescents.

HIV epidemic appraisals for assisting in the design of effective prevention programmes: shifting the paradigm back to basics.

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Sharmistha Mishra

Full Text Available To design HIV prevention programmes, it is critical to understand the temporal and geographic aspects of the local epidemic and to address the key behaviours that drive HIV transmission. Two methods have been developed to appraise HIV epidemics and guide prevention strategies. The numerical proxy method classifies epidemics based on current HIV prevalence thresholds. The Modes of Transmission (MOT model estimates the distribution of incidence over one year among risk-groups. Both methods focus on the current state of an epidemic and provide short-term metrics which may not capture the epidemiologic drivers. Through a detailed analysis of country and sub-national data, we explore the limitations of the two traditional methods and propose an alternative approach.We compared outputs of the traditional methods in five countries for which results were published, and applied the numeric and MOT model to India and six districts within India. We discovered three limitations of the current methods for epidemic appraisal: (1 their results failed to identify the key behaviours that drive the epidemic; (2 they were difficult to apply to local epidemics with heterogeneity across district-level administrative units; and (3 the MOT model was highly sensitive to input parameters, many of which required extraction from non-regional sources. We developed an alternative decision-tree framework for HIV epidemic appraisals, based on a qualitative understanding of epidemiologic drivers, and demonstrated its applicability in India. The alternative framework offered a logical algorithm to characterize epidemics; it required minimal but key data.Traditional appraisals that utilize the distribution of prevalent and incident HIV infections in the short-term could misguide prevention priorities and potentially impede efforts to halt the trajectory of the HIV epidemic. An approach that characterizes local transmission dynamics provides a potentially more effective tool with

Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

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Lisa Visagie

2015-07-01

Objectives: The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments. Method: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9–13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- postand follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants’ symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale. Conclusion: If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African anxiety intervention programmes can be built.

"Getting tested is almost like going to the Salem witch trials": discordant discourses between Western public health messages and sociocultural expectations surrounding HIV testing among East African immigrant women.

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De Jesus, Maria; Carrete, Claudia; Maine, Cathleen; Nalls, Patricia

2015-01-01

Washington, DC, has the highest AIDS diagnosis rate in the USA, and Black women are disproportionately affected. Although HIV testing is the first entryway into vital treatment services, evidence reveals that foreign-born blacks have a lower rate of recent HIV testing than US-born blacks. To date, however, there are no studies that examine the culture-specific perceptions of HIV testing among East African immigrant women (who comprise a large share of Black Africans in DC) to better understand their potential barriers to testing. Adopting the PEN-3 cultural model as our theoretical framework, the main objective of this study was to examine East African women's HIV testing perceptions and partner communication norms. Between October 2012 and March 2013, trained interviewers conducted a total of 25 interviews with East African women in the Washington, DC, metropolitan area. For triangulation purposes, data collection consisted of both in-depth, semi-structured interviews and cognitive interviews, in which participants were administered a quantitative survey and assessed on how they interpreted items. Qualitative thematic analysis revealed a systematic pattern of discordant responses across participants. While they were aware of messages related to Western public health discourse surrounding HIV testing (e.g., Everyone should get tested for HIV; One should talk to one's spouse about HIV testing), divergent sociocultural expectations rooted in cultural and religious beliefs prevailed (e.g., Getting an HIV test brings shame to the person who got tested and to one's family; it implies one is engaging in immoral behavior; One should not talk with one's spouse about HIV testing; doing so breaks cultural norms). Implications of using a culture-centered model to examine the role of sociocultural expectations in HIV prevention research and to develop culturally responsive prevention strategies are discussed.

"It pains me because as a woman you have to breastfeed your baby": decision-making about infant feeding among African women living with HIV in the UK.

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Tariq, Shema; Elford, Jonathan; Tookey, Pat; Anderson, Jane; de Ruiter, Annemiek; O'Connell, Rebecca; Pillen, Alexandra

2016-08-01

UK guidance advises HIV-positive women to abstain from breast feeding. Although this eliminates the risk of postnatal vertical transmission of HIV, the impact of replacement feeding on mothers is often overlooked. This qualitative study examines, for the first time in the UK, decision-making about infant feeding among African women living with HIV. Between 2010 and 2011, we conducted semistructured interviews with 23 HIV-positive African women who were pregnant or had recently given birth. We recruited participants from three HIV antenatal clinics in London. Women highlighted the cultural importance of breast feeding in African communities and the social pressure to breast feed, also describing fears that replacement feeding would signify their HIV status. Participants had significant concerns about physical and psychological effects of replacement feeding on their child and felt their identity as good mothers was compromised by not breast feeding. However, almost all chose to refrain from breast feeding, driven by the desire to minimise vertical transmission risk. Participants' resilience was strengthened by financial assistance with replacement feeding, examples of healthy formula-fed children and support from partners, family, peers and professionals. The decision to avoid breast feeding came at considerable emotional cost to participants. Professionals should be aware of the difficulties encountered by HIV-positive women in refraining from breast feeding, especially those from migrant African communities where breast feeding is culturally normative. Appropriate financial and emotional support increases women's capacity to adhere to their infant-feeding decisions and may reduce the emotional impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Spirituality/Religiosity: A Cultural and Psychological Resource among Sub-Saharan African Migrant Women with HIV/AIDS in Belgium.

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Agnes Ebotabe Arrey

Full Text Available Spirituality/religion serves important roles in coping, survival and maintaining overall wellbeing within African cultures and communities, especially when diagnosed with a chronic disease like HIV/AIDS that can have a profound effect on physical and mental health. However, spirituality/religion can be problematic to some patients and cause caregiving difficulties. The objective of this paper was to examine the role of spirituality/religion as a source of strength, resilience and wellbeing among sub-Saharan African (SSA migrant women with HIV/AIDS. A qualitative study of SSA migrant women was conducted between April 2013 and December 2014. Participants were recruited through purposive sampling and snowball techniques from AIDS Reference Centres and AIDS workshops in Belgium, if they were 18 years and older, French or English speaking, and diagnosed HIV positive more than 3 months beforehand. We conducted semi-structured interviews with patients and did observations during consultations and support groups attendances. Thematic analysis was used to analyse the data. 44 women were interviewed, of whom 42 were Christians and 2 Muslims. None reported religious/spiritual alienation, though at some point in time many had felt the need to question their relationship with God by asking "why me?" A majority reported being more spiritual/religious since being diagnosed HIV positive. Participants believed that prayer, meditation, regular church services and religious activities were the main spiritual/religious resources for achieving connectedness with God. They strongly believed in the power of God in their HIV/AIDS treatment and wellbeing. Spiritual/religious resources including prayer, meditation, church services, religious activities and believing in the power of God helped them cope with HIV/AIDS. These findings highlight the importance of spirituality in physical and mental health and wellbeing among SSA women with HIV/AIDS that should be taken into

Project GRACE: a staged approach to development of a community-academic partnership to address HIV in rural African American communities.

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Corbie-Smith, Giselle; Adimora, Adaora A; Youmans, Selena; Muhammad, Melvin; Blumenthal, Connie; Ellison, Arlinda; Akers, Aletha; Council, Barbara; Thigpen, Yolanda; Wynn, Mysha; Lloyd, Stacey W

2011-03-01

The HIV epidemic is a health crisis in rural African American communities in the Southeast United States; however, to date little attention has been paid to community-academic collaborations to address HIV in these communities. Interventions that use a community-based participatory research (CBPR) approach to address individual, social, and physical environmental factors have great potential for improving community health. Project GRACE (Growing, Reaching, Advocating for Change and Empowerment) uses a CBPR approach to develop culturally sensitive, feasible, and sustainable interventions to prevent the spread of HIV in rural African American communities. This article describes a staged approach to community-academic partnership: initial mobilization, establishment of organizational structure, capacity building for action, and planning for action. Strategies for engaging rural community members at each stage are discussed; challenges faced and lessons learned are also described. Careful attention to partnership development has resulted in a collaborative approach that has mutually benefited both the academic and community partners.

Interleukin-10 (IL-10) pathway: genetic variants and outcomes of HIV-1 infection in African American adolescents.

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Shrestha, Sadeep; Wiener, Howard W; Aissani, Brahim; Song, Wei; Shendre, Aditi; Wilson, Craig M; Kaslow, Richard A; Tang, Jianming

2010-10-14

Immunological and clinical outcomes can vary considerably at the individual and population levels during both treated and untreated HIV-1 infection. Cytokines encoded by the interleukin-10 gene (IL10) family have broad immunomodulatory function in viral persistence, and several SNPs in the IL10 promoter sequence have been reported to influence pathogenesis or acquisition of HIV-1 infection. We examined 104 informative SNPs in IL10, IL19, IL20, IL24, IL10RA and IL10RB among 250 HIV-1 seropositive and 106 high-risk seronegative African American adolescents in the REACH cohort. In subsequent evaluation of five different immunological and virological outcomes related to HIV-1 infection, 25 SNPs were associated with a single outcome and three were associated with two different outcomes. One SNP, rs2243191 in the IL19 open reading frame (Ser to Phe substitution) was associated with CD4(+) T-cell increase during treatment. Another SNP rs2244305 in IL10RB (in strong linkage disequilibrium with rs443498) was associated with an initial decrease in CD4(+) T-cell by 23 ± 9% and 29 ± 9% every 3 months (for AA and AG genotypes, respectively, compared with GG) during ART-free period. These associations were reversed during treatment, as CD4(+) T-cell increased by 31 ± 0.9% and 17 ± 8% every 3 months for AA and AG genotype, respectively. In African Americans, variants in IL10 and related genes might influence multiple outcomes of HIV-1 infection, especially immunological response to HAART. Fine mapping coupled with analysis of gene expression and function should help reveal the immunological importance of the IL10 gene family to HIV-1/AIDS.

African Journals Online (AJOL)

African Journals Online (AJOL)

reviewed, African-published scholarly journals. Historically ... It has also been difficult for African researchers to access the work of other African academics. In partnership with ... Vol 15, No 1 (2018). SAHARA-J: Journal of Social Aspects of HIV/AIDS.

Factors related to risky sexual behaviors and effective STI/HIV and pregnancy intervention programs for African American adolescents.

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Lee, Young Me; Cintron, Adanisse; Kocher, Surinder

2014-01-01

The purpose of this integrative literature review study was to investigate factors related to risky sexual behaviors among African American adolescents, to evaluate which of the factors are common across successful and effective STI/HIV and pregnancy intervention programs, and finally, to propose suggestions for future intervention programs for African American adolescents in West Englewood, Chicago. An integrative literature review was conducted. Using CINAHL, PubMed, and ProQuest database, the following terms were searched: African American, Black, adolescents, teenagers, sexual behavior, cultural factors, pregnancy, STIs/HIV/AIDS, and intervention programs. A total of 18 articles were reviewed, findings indicated there were five major contributing factors related to risky sexual behaviors: substance use, gender roles, peer influences, parental involvement, and level of knowledge and information on sex and STIs. Six successful STI/HIV and pregnancy programs that incorporated those factors to effectively reduce risky sexual behaviors were identified. After analyzing six national intervention programs proven to be effective, the findings suggest that future prevention programs should be designed with more emphasis on avoidance or limited substance use, increased parental involvement, integration of cultural teaching components such as storytelling and history as suggested from the Aban Aya Youth Project. This study also concluded that future prevention programs should consider the length of programs be longer than 1 year, as it has been shown to be more effective than shorter programs. © 2014 Wiley Periodicals, Inc.

Gender differences in use of prayer as a self-care strategy for managing symptoms in African Americans living with HIV/AIDS.

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Coleman, Christopher Lance; Holzemer, William L; Eller, Lucille Sanzero; Corless, Inge; Reynolds, Nancy; Nokes, Kathleen M; Kemppainen, Jeanne K; Dole, Pam; Kirksey, Kenn; Seficik, Liz; Nicholas, Patrice; Hamilton, Mary Jane

2006-01-01

The objective of this study was to explore the association of gender to use of prayer as a self-care strategy for managing the HIV-related symptoms of fatigue, nausea, depression, and anxiety among African American men and women who are HIV-seropositive. To accomplish this, data were determined using convenience sampling from a sample of 448 African American men and women from the United States who were participants in a national study on self-care symptom management of HIV/AIDS. Chi-square analyses were used to examine the potential relationships between gender and the use of prayer for managing the four symptoms. The mean age of the sample was 42.69 +/- 7.93 years (range, 20-66). Results showed the following gender differences in the use of prayer as a self-care strategy: fatigue-men 46% (n = 62), women 54% (n = 74); nausea-men 52% (n = 33), women 48% (n = 30); depression-men 55% (n = 90), women 45% (n = 73); and anxiety-men 77% (n = 83), women 87% (n = 73). Chi-square analyses determined that significant differences exist between African American men and women in the frequency of the use of prayer for managing HIV-related fatigue (chi(2) = 14.81, 1 df, p = .000), nausea (chi(2) = 4.10, 1 df, p =.043), and depression (chi(2) = 5.21, 1 df, p = .022). There was no gender difference in the use of prayer to manage anxiety. Prayer was reported as a self-care strategy by over 50% of the respondents for three of the four symptoms and was rated highly efficacious. The authors conclude that the African American men and women differed in their selection of prayer as a self-care strategy for managing HIV-related depression, fatigue, and nausea. A higher proportion of women than men used prayer to manage fatigue, and more men than women reported using prayer to manage nausea and depression.

HIV prevalence and risk among people who inject drugs in five South African cities.

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Scheibe, Andrew; Makapela, David; Brown, Ben; dos Santos, Monika; Hariga, Fabienne; Virk, Harsheth; Bekker, Linda-Gail; Lyan, Olga; Fee, Nancy; Molnar, Margarete; Bocai, Alina; Eligh, Jason; Lehtovuori, Riku

2016-04-01

Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data. We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants' saliva and assessed drug-using and sexual practices by means of a questionnaire. We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0-4.6, p=0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9-9.4, p<0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1-5.5, p=0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7-7.2, p=0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1-4.4, p=0.019). This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities. Copyright © 2016 Elsevier B.V. All rights reserved.

Factors influencing retention in care after starting antiretroviral therapy in a rural South African programme.

Directory of Open Access Journals (Sweden)

Tom H Boyles

2011-05-01

Full Text Available The prognosis of patients with HIV in Africa has improved with the widespread use of antiretroviral therapy (ART but these successes are threatened by low rates of long-term retention in care. There are limited data on predictors of retention in care, particularly from rural sites.Prospective cohort analysis of outcome measures in adults from a rural HIV care programme in Madwaleni, Eastern Cape, South Africa. The ART programme operates from Madwaleni hospital and seven primary care feeder clinics with full integration between inpatient and outpatient services. Outreach workers conducted home visits for defaulters.1803 adults initiated ART from June 2005 to May 2009. At the end of the study period 82.4% were in active care or had transferred elsewhere, 11.1% had died and 6.5% were lost to follow-up (LTFU. Independent predictors associated with an increased risk of LTFU were CD4 nadir >200, initiating ART as an inpatient or while pregnant, and younger age, while being in care for >6 months before initiating ART was associated with a reduced risk. Independent factors associated with an increased risk of mortality were baseline CD4 count 6 months before initiating ART and initiating ART while pregnant were associated with a reduced risk.Serving a socioeconomically deprived rural population is not a barrier to successful ART delivery. Patients initiating ART while pregnant and inpatients may require additional counselling and support to reduce LTFU. Providing HIV care for patients not yet eligible for ART may be protective against being LTFU and dying after ART initiation.

A model for the roll-out of comprehensive adult male circumcision services in African low-income settings of high HIV incidence: the ANRS 12126 Bophelo Pele Project.

Science.gov (United States)

Lissouba, Pascale; Taljaard, Dirk; Rech, Dino; Doyle, Sean; Shabangu, Daniel; Nhlapo, Cynthia; Otchere-Darko, Josephine; Mashigo, Thabo; Matson, Caitlin; Lewis, David; Billy, Scott; Auvert, Bertran

2010-07-20

World Health Organization (WHO)/Joint United Nations Programme on AIDS (UNAIDS) has recommended adult male circumcision (AMC) for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyperendemic and AMC prevalence is low. The objective of this study was to investigate the feasibility of the roll-out of medicalized AMC according to UNAIDS/WHO operational guidelines in a targeted African setting. The ANRS 12126 "Bophelo Pele" project was implemented in 2008 in the township of Orange Farm (South Africa). It became functional in 5 mo once local and ethical authorizations were obtained. Project activities involved community mobilization and outreach, as well as communication approaches aimed at both men and women incorporating broader HIV prevention strategies and promoting sexual health. Free medicalized AMC was offered to male residents aged 15 y and over at the project's main center, which had been designed for low-income settings. Through the establishment of an innovative surgical organization, up to 150 AMCs under local anesthesia, with sterilized circumcision disposable kits and electrocautery, could be performed per day by three task-sharing teams of one medical circumciser and five nurses. Community support for the project was high. As of November 2009, 14,011 men had been circumcised, averaging 740 per month in the past 12 mo, and 27.5% of project participants agreed to be tested for HIV. The rate of adverse events, none of which resulted in permanent damage or death, was 1.8%. Most of the men surveyed (92%) rated the services provided positively. An estimated 39.1% of adult uncircumcised male residents have undergone surgery and uptake is steadily increasing. This study demonstrates that a quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines. The project can be a model for the scale-up of comprehensive AMC services, which

A model for the roll-out of comprehensive adult male circumcision services in African low-income settings of high HIV incidence: the ANRS 12126 Bophelo Pele Project.

Directory of Open Access Journals (Sweden)

Pascale Lissouba

2010-07-01

Full Text Available BACKGROUND: World Health Organization (WHO/Joint United Nations Programme on AIDS (UNAIDS has recommended adult male circumcision (AMC for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyperendemic and AMC prevalence is low. The objective of this study was to investigate the feasibility of the roll-out of medicalized AMC according to UNAIDS/WHO operational guidelines in a targeted African setting. METHODS AND FINDINGS: The ANRS 12126 "Bophelo Pele" project was implemented in 2008 in the township of Orange Farm (South Africa. It became functional in 5 mo once local and ethical authorizations were obtained. Project activities involved community mobilization and outreach, as well as communication approaches aimed at both men and women incorporating broader HIV prevention strategies and promoting sexual health. Free medicalized AMC was offered to male residents aged 15 y and over at the project's main center, which had been designed for low-income settings. Through the establishment of an innovative surgical organization, up to 150 AMCs under local anesthesia, with sterilized circumcision disposable kits and electrocautery, could be performed per day by three task-sharing teams of one medical circumciser and five nurses. Community support for the project was high. As of November 2009, 14,011 men had been circumcised, averaging 740 per month in the past 12 mo, and 27.5% of project participants agreed to be tested for HIV. The rate of adverse events, none of which resulted in permanent damage or death, was 1.8%. Most of the men surveyed (92% rated the services provided positively. An estimated 39.1% of adult uncircumcised male residents have undergone surgery and uptake is steadily increasing. CONCLUSION: This study demonstrates that a quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines. The project can be

HIV testing practices of South African township MSM in the era of expanded access to ART.

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Sandfort, Theo G M; Knox, Justin; Collier, Kate L; Lane, Tim; Reddy, Vasu

2015-03-01

While men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those already infected know their status. Effectively promoting frequent HIV testing-of increasing importance with the expanding accessibility of antiretroviral treatment-requires an understanding of the testing practices in this population. To understand men's HIV testing practices, including their behavior, experiences, and perceptions, we conducted in-depth interviews with 81 black South African MSM (ages 20-39), purposively recruited from four townships. Many men in the sample had tested for HIV. While ever having tested seemed to facilitate repeat testing, men still expressed a high level of discomfort with testing. It was common to test after having engaged in risky behavior, thus increasing anxiety about testing that was already present. Fear that they might test HIV positive caused some men to avoid testing until they were clearly sick, and others to avoid testing completely. HIV testing may increase in this population if it becomes a routine practice, instead of being driven by anxiety-inducing incidents. Mobilization through social support might facilitate frequent testing while education about current treatment options is needed.

‘Getting tested is almost like going to the Salem witch trials’: Discordant discourses between western public health messages and sociocultural expectations surrounding HIV testing among East African immigrant women

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DE JESUS, Maria; CARRETE, Claudia; MAINE, Cathleen; NALLS, Patricia

2015-01-01

Washington, DC has the highest AIDS diagnosis rate in the United States and Black women are disproportionately affected. Although HIV testing is the first entryway into vital treatment services, evidence reveals that foreign-born blacks have a lower rate of recent HIV testing than U.S.-born blacks. To date, however, there are no studies that examine the culture-specific perceptions of HIV testing among East African immigrant women (who comprise a large share of Black Africans in DC) to better understand their potential barriers to testing. Adopting the PEN-3 cultural model as our theoretical framework, the main objective of this study was to examine East African women’s HIV testing perceptions and partner communication norms. Between October 2012 and March 2013, trained interviewers conducted a total of 25 interviews with East African women in the Washington DC Metropolitan area. For triangulation purposes, data collection consisted of both in-depth, semi-structured interviews and cognitive interviews, in which participants were administered a quantitative survey and assessed on how they interpreted items. Qualitative thematic analysis revealed a systematic pattern of discordant responses across participants. While they were aware of messages related to western public health discourse surrounding HIV testing (e.g., Everyone should get tested for HIV; One should talk to one’s spouse about HIV testing), divergent sociocultural expectations rooted in cultural and religious beliefs prevailed (e.g., Getting an HIV test brings shame to the person who got tested and to one’s family; it implies one is engaging in immoral behavior; One should not talk with one’s spouse about HIV testing; doing so breaks cultural norms). Implications of using a culture-centered model to examine the role of sociocultural expectations in HIV prevention research and to develop culturally responsive prevention strategies are discussed. PMID:25616443

Impact of comorbidities and drug therapy on development of renal impairment in a predominantly African American and Hispanic HIV clinic population

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M Keith Rawlings

2011-01-01

Full Text Available M Keith Rawlings1, Jennifer Klein1, Edna P Toubes Klingler1, Ejeanée Queen1, Lauren Rogers1, Linda H Yau2, Keith A Pappa2, Gary E Pakes21AIDS Arms Peabody Health Clinic, Dallas, Texas; 2GlaxoSmithKline, Research Triangle Park, North Carolina, USAPurpose: Renal impairment in human immunodeficiency virus (HIV-infected patients could potentially be caused by many factors. HIV-related renal impairment risks have been little studied in African Americans and Hispanics. We investigated the impact of HIV itself, highly active antiretroviral therapy (HAART, comorbidities, and non-HIV-related drug treatment on glomerular filtration rate in a predominantly African American/Hispanic HIV-infected population who had received HAART for at least one year. This study was a retrospective electronic medical record database evaluation of renal impairment risks in a largely African American/Hispanic HIV population obtaining medical care at an HIV clinic in Dallas, Texas.Methods: Proportional hazards models were used to investigate an association between an estimated glomerular filtration rate decrease >25% from baseline (ie, renal impairment and demographics, antiretroviral/nonantiretroviral medications, comorbidities (hypertension, diabetes mellitus, hepatitis C virus [HCV] infection, hepatitis B virus [HBV] infection, CD4+ counts, viral load, and duration patients were monitored at the clinic (time on study.Results: In total, 323 patients were evaluated: 82% males; 61% African American/12% Hispanic/19% Caucasian; mean age 37.9 years (standard deviation [SD] 8.5; 6% HBV-positive; 34% HCV-positive; 29% hypertensive; 3% diabetic; 52% tenofovir-treated; mean weight 75.4 kg (SD, 15.4; mean estimated glomerular filtration 114.5 mL/min/1.73 m2 (SD, 36.7 using the Modification of Diet in Renal Disease (MDRD calculation method; mean creatinine clearance (from which estimated glomerular filtration was extrapolated by the Cockcroft-Gault calculation method 120.6 mL/min/1

How does mother-to-child transmission of HIV differ among African populations? Lessons from MBL2 genetic variation in Zimbabweans.

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Mhandire, Kudakwashe; Pharo, Gavin; Kandawasvika, Gwendolene Q; Duri, Kerina; Swart, Marelize; Stray-Pedersen, Babill; Dandara, Collet

2014-07-01

Mannose binding lectin (MBL) is a pathogen pattern recognition protein involved in antimicrobial activities. Variation in MBL2 gene has been extensively implicated in differential outcomes of infectious diseases in studies conducted outside Africa, but virtually very little is known on the role of this candidate gene in the African continent. We investigated human genetic variations in MBL2 in a Zimbabwean pediatric population and their putative associations with HIV infection in perinatally exposed children. One hundred and four children aged 7 to 9 years comprising 68 perinatally exposed to HIV (32 who were born infected and 36 who were uninfected) and 36 unexposed controls were recruited. DNA samples were genotyped for MBL2 polymorphisms using PCR-RFLP and sequencing. HIV infected children had markedly variable and significantly lower mean height (p=0.03) and weight (p=0.005) when compared to the uninfected children. Using all samples, frequencies for MBL2 genetic variants for the Zimbabwean population were calculated. Twelve single nucleotide polymorphisms were observed and minor alleles occurred with the following frequencies: -550C>G (G: 0.02), -435G>A (A: 0.08), -428A>C (C: 0.39), -394A>G (A: 0.39), -328AGAGAA ins/del (AGAGAA ins: 0.44), -245G>A (A: 0.05), -221C>G (C: 0.12), -111A>T (T: 0.10), -70C>T (C: 0.46), +4C>T (C: 0.45), novel -595G>A (A: 0.02), and 170G>A (0.24). We found that the MBL2 +4T variant displayed a trend for association with reduced risk of HIV transmission from mother-to-child but the remaining vast majority of the genetic markers did not show a significant association. We conclude (1) the MBL2 gene is highly polymorphic in the Zimbabwean population, and (2) MBL2 genetic variation does not appear to play a major role in influencing the risk of mother-to-child HIV transmission in our study sample. These observations contest the hitherto significant role of this candidate gene for HIV transmission from mother-to-child in non-African

How Peer Conversations About HIV/AIDS Media Messages Affect Comprehension and Beliefs of Young South African Women.

NARCIS (Netherlands)

Lubinga, Elizabeth; Maes, A.; Jansen, C. J. M.

2016-01-01

Most existent research on the effects of interpersonal discussions about health campaign messages is based on surveys. In this study, we analysed actual conversations about an HIV/AIDS poster to find out possible effects. Young South African women in 59 dyads (n = 118) participated in conversations

Four African Nations Agree to Water Management Programme

International Nuclear Information System (INIS)

2013-01-01

Full text: Seeking to improve their management of water resources, four northeast African nations today agreed at the International Atomic Energy Agency (IAEA) to establish a long-term framework for utlizing a key underground water system. Chad, Egypt, Libya and Sudan signed a Strategic Action Programme (SAP) that aims to optimize the equitable use of the Nubian Sandstone Aquifer System, a huge water resource that lies beneath the four nations. The SAP also commits the countries to strengthen and build upon a previously existing regional coordination mechanism, in part by establishing a new Joint Authority for the Nubian Aquifer System. The Programme lays the groundwork for improving cooperation among the four arid nations and for strengthening their capacity to monitor and manage the aquifer effectively. With growing populations and decreasing water availability from other sources in the region, the aquifer is under mounting pressure. Removing water without a clear understanding of transboundary and other implications threatens water quality and has the potential to harm biodiversity and accelerate land degradation. The agreement resulted from a joint Technical Cooperation project of the United Nations Development Programme (UNDP) and the Global Environment Facility (GEF), the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the IAEA. ''I congratulate all involved on this significant achievement,'' said IAEA Director General Yukiya Amano. ''Water is a key resource, and effective management and use of such water resources is essential for the future. The agreement of the Strategic Action Programme is the result of real cooperation between the four States, the Agency and UNDP-GEF. I am confident that this Programme will be a success and will benefit the people of the region. This positive project experience benefits strengthened and expanded cooperation between the IAEA and the UNDP-GEF.'' ''UNDP would like to congratulate the

Epidemiological and demographic HIV/AIDS projections: South Africa

African Journals Online (AJOL)

Epidemiological and demographic HIV/AIDS projections: South Africa. ... African Journal of AIDS Research ... Projections and the Spectrum model program developed by the Futures Group were used to model the South African HIV epidemic, project future trends in HIV/AIDS and estimate the demographic impact of AIDS.

Breaking the Silence: The Black Church Addresses HIV.

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Swartz, Aimee

2002-01-01

AIDS is the leading cause of death among African Americans age 25-44 years. About half of all new U.S. HIV cases are African Americans, though African Americans make up only 13 percent of the population. Most U.S. children living with HIV are African American. There exists a strong pattern of resistance and denial of the disease in the African…

Intervention Induced Changes on Parenting Practices, Youth Self-Pride and Sexual Norms to Reduce HIV-Related Behaviors among Rural African American Youths

Science.gov (United States)

Murry, Velma McBride; Berkel, Cady; Chen, Yi-fu; Brody, Gene H.; Gibbons, Frederick X.; Gerrard, Meg

2011-01-01

AIDS is the leading killer of African Americans between the ages of 25 and 44, many of whom became infected when they were teenagers or young adults. The disparity in HIV infection rate among African Americans youth residing in rural Southern regions of the United States suggests that there is an urgent need to identify ways to promote early…

Human papillomavirus infection in Rwanda at the moment of implementation of a national HPV vaccination programme.

Science.gov (United States)

Ngabo, Fidele; Franceschi, Silvia; Baussano, Iacopo; Umulisa, M Chantal; Snijders, Peter J F; Uyterlinde, Anne M; Lazzarato, Fulvio; Tenet, Vanessa; Gatera, Maurice; Binagwaho, Agnes; Clifford, Gary M

2016-05-24

Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV). To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2508 women aged 18-69 years from the general population in Kigali, Rwanda, during 2013/14. 20 % of women were HIV-positive. Samples were used for liquid-based cytology and HPV testing (44 types) with GP5+/6+ PCR. HPV prevalence was 34 %, being highest (54 %) in women ≤19 years and decreasing to 20 % at age ≥50. Prevalence of high risk (HR) HPV and cytological abnormalities was 22 and 11 % respectively (including 2 % with high-grade squamous intraepithelial lesions, HSIL) decreasing with age. Age-standardised prevalence of HR HPV was 22 % (or 19 % among HIV-negative women), and HPV16 was the most common type. Prevalence of HPV and cytological abnormalities were significantly higher in HIV-positive than HIV-negative women, and the difference increased with age. Other significant risk factors for HPV positivity in multivariate analyses were high lifetime number of sexual partners, receiving cash for sex, and being a farmer. 40 % of women with HSIL were infected with HPV16/18 and there was no significant difference between HIV-positive and HIV-negative women. This study confirms Rwanda to be a setting of high prevalence of HPV and cervical disease that is worsened by HIV. These data will serve as a robust baseline for future evaluations of HPV vaccine programme effectiveness.

An extended model of reasoned action to understand the influence of individual- and network-level factors on African Americans' participation in HIV vaccine research.

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Frew, Paula M; Archibald, Matthew; Diallo, Dazon Dixon; Hou, Su-I; Horton, Takeia; Chan, Kayshin; Mulligan, Mark J; del Rio, Carlos

2010-06-01

In the United States, the number and proportion of HIV/AIDS cases among black/African Americans continue to highlight the need for new biomedical prevention interventions, including an HIV vaccine, microbicide, or new antiretroviral (ARV) prevention strategies such as pre-exposure prophylaxis (PrEP) to complement existing condom usage, harm reduction methods, and behavioral change strategies to stem the HIV epidemic. Although black/African Americans are disproportionately impacted by HIV/AIDS, their participation in HIV clinical research continues to have unique challenges. We theorize that interaction among multilevel factors creates ideal alignment for minority participation in HIV clinical studies. Thus, we initially set out to test an extended model of reasoned action with 362 participants to understand the interplay of sociopsychological and network-level considerations influencing minority participation in HIV prevention research efforts. In this study, we linked the intrapersonal dimensions of attitudes, beliefs, and normative concerns to community-level components, appraisal of involvement with the clinical research organization, an entity which operates within a networked structure of community partner agencies, and identification with coalition advocacy aims. Various participatory outcomes were explored including involvement in future HIV vaccine community functions, participation in community promotion of HIV vaccine research, and community mobilization. Three-stage least squares estimates indicated similar findings across three models. Significant effects demonstrate the importance of positive attitudes toward HIV vaccine research, favorable health research beliefs, perceived social support for participation, HIV/AIDS issue engagement, and perceived relevance of the clinical research site's mission and values. Identification of these nuanced pathway effects provides implications for tailored community program development.

Social-Ecological, Motivational and Volitional Factors for Initiating and Maintaining Physical Activity in the Context of HIV.

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Ley, Clemens; Barrio, María Rato; Leach, Lloyd

2015-01-01

Sport and exercise can have several health benefits for people living with HIV. These benefits can be achieved through different types of physical activity, adapting to disease progression, motivation and social-ecological options. However, physical activity levels and adherence to exercise are generally low in people living with HIV. At the same time, high drop-out rates in intervention studies are prevalent; even though they often entail more favourable conditions than interventions in the natural settings. Thus, in the framework of an intervention study, the present study aims to explore social-ecological, motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme. The qualitative data was produced in the framework of a non-randomised pre-post intervention study that evaluated structure, processes and outcomes of a 10-week sport and exercise programme. All 25 participants of the programme were included in this analysis, independent of compliance. Data was produced through questionnaires, participatory group discussions, body image pictures, research diaries and individual semi-structured interviews. All participants lived in a low socioeconomic, disadvantaged setting. Hence, the psychological correlates are contextualised and social-ecological influences on perception and behaviour are discussed. The results show the importance of considering social-cultural and environmental influences on individual motives, perceptions and expectancies, the fear of disclosure and stigmatisation, sport and exercise-specific group dynamics and self-supporting processes. Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed.

Mobilising indigenous resources for anthropologically designed HIV-prevention and behaviour-change interventions in southern Africa.

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Green, Edward C; Dlamini, Cedza; D'Errico, Nicole C; Ruark, Allison; Duby, Zoe

2009-12-01

HIV prevention is often implemented as if African culture were either nonexistent or a series of obstacles to overcome in order to achieve an effective, gender-equitable, human rights-based set of interventions. Similarly, traditional or indigenous leaders, such as chiefs and members of royal families, have been largely excluded from HIV/AIDS responses in Africa. This qualitative study used focus group discussions and in-depth interviews with traditional leaders and 'ritual specialists' to better understand cultural patterns and ways of working with, rather than against, culture and traditional leaders in HIV-prevention efforts. The research was carried out in four southern African countries (Botswana, Lesotho, South Africa and Swaziland). The purpose was to discover what aspects of indigenous leadership and cultural resources might be accessed and developed to influence individual behaviour as well as the prevailing community norms, values, sanctions and social controls that are related to sexual behaviour. The indigenous leaders participating in the research largely felt bypassed and marginalised by organised efforts to prevent HIV infections and also believed that HIV-prevention programmes typically confronted, circumvented, criticised or condemned traditional culture. However, indigenous leaders may possess innovative ideas about ways to change individuals' sexual behaviour in general. The participants discussed ways to revive traditional social structures and cultural mechanisms as a means to incorporate HIV-prevention and gender-sensitivity training into existing cultural platforms, such as rites of passage, chiefs' councils and traditional courts.

Premarital HIV screening in Johor--(2002-2004).

Science.gov (United States)

Khebir, B V; Adam, M A; Daud, A R; Shahrom, C M D

2007-03-01

A descriptive study was conducted on premarital HIV screening programme in Johor over a three year period. HIV screenings were done at government clinics and confirmed by accredited laboratories. As a result, 123 new HIV cases were detected (0.17%) from 74,210 respondents. In 2004, 24 cases (64.9%) advanced to marriage (n = 37) after they underwent counselling and six of them married among themselves. Positivity rate from this programme (0.17%) is higher than antenatal screening (0.05%). Despite the implementation of the premarital HIV screening programme, marriage application in Johor rose 2.8% in 2004 compared with 2002. This programme had partly contributed to public awareness against HIV and provides another option in early detection of the disease.

Determinants of HIV sero-conversion among male injection drug users enrolled in a needle exchange programme at Karachi, Pakistan

International Nuclear Information System (INIS)

Samo, R. N.; Altaf, A.

2013-01-01

Objective: To assess the determinants of HIV sero-conversion among male injection drug users enrolled in needle exchange programme at Karachi. Methods: An unmatched retrospective case control study was conducted among male injection drug users receiving needle exchange services in Karachi. The cases and controls were identified from one drop in center providing needle exchange services. The data for the study participants was collected retrospectively from the programme. Descriptive statistics, univariate analysis, and multivariate regression analysis for determinants of HIV sero-conversion and Hosmer and Lameshow goodness of fit test for model adequacy were performed. Results: Mean age of the study participants was 34.17 +- 10.74 years. Average monthly income of the participants was US$ 125.15+-76.32. In unconditional multivariate regression analysis being unmarried (AOR: 3.0 95% CI 1.14-7.9, p=0.02), not living with family (AOR: 2.8 95% CI 1.18-6.79 p=0.02), family history of addiction (AOR: 2.5, 95% CI 1.01-6.49, p=0.04), injecting drugs in groups (AOR: 2.8, 95% CI 1.12 7.02 p=0.02), not obtaining syringes from the programme (AOR: 26.45, 95% CI 2.47-282.8 p=0.007), and history of blood transfusion (AOR: 52.9, 95% CI 1.32-2118.41 p=0.03) were significantly associated with HIV positive sero-status. Model adequacy was assessed by Hosmer and Lameshow goodness of (J: 4.95, p=0.7) indicating that the model was accurate. Conclusion: Social and drug related risky behaviours are important determinants of HIV among male IDUs in Karachi. The situation calls for programmatic initiatives for addressing the risky behaviours among IDUs for effective control of epidemic in the country. (author)

Traditional Healing, Biomedicine and the Treatment of HIV/AIDS: Contrasting South African and Native American Experiences

Science.gov (United States)

Flint, Adrian

2015-01-01

Traditional healing remains an important aspect of many people’s engagement with healthcare and, in this, responses to the treatment of HIV/AIDS are no different. However, given the gravity of the global HIV/AIDS pandemic, there has been much debate as to the value of traditional healing in this respect. Accordingly, this paper explores the extent to which meaningful accommodation between the biomedical and traditional sectors is possible (and/or even desirable). It does this through a consideration of Native American and South African experiences, looking at how the respective groups, in which medical pluralism is common, have addressed the issue of HIV/AIDS. The paper points to the importance of developing “culturally appropriate” forms of treatment that emphasise complementary rather than adversarial engagement between the traditional and biomedical systems and how policymakers can best facilitate this. PMID:25903057

Traditional Healing, Biomedicine and the Treatment of HIV/AIDS: Contrasting South African and Native American Experiences

Directory of Open Access Journals (Sweden)

Adrian Flint

2015-04-01

Full Text Available Traditional healing remains an important aspect of many people’s engagement with healthcare and, in this, responses to the treatment of HIV/AIDS are no different. However, given the gravity of the global HIV/AIDS pandemic, there has been much debate as to the value of traditional healing in this respect. Accordingly, this paper explores the extent to which meaningful accommodation between the biomedical and traditional sectors is possible (and/or even desirable. It does this through a consideration of Native American and South African experiences, looking at how the respective groups, in which medical pluralism is common, have addressed the issue of HIV/AIDS. The paper points to the importance of developing “culturally appropriate” forms of treatment that emphasise complementary rather than adversarial engagement between the traditional and biomedical systems and how policymakers can best facilitate this.

Ethical, legal and social issues in the context of the planning stages of the Southern African Human Genome Programme.

Science.gov (United States)

de Vries, Jantina; Slabbert, Melodie; Pepper, Michael S

2012-03-01

As the focus on the origin of modern man appears to be moving from eastern to southern Africa, it is recognised that indigenous populations in southern Africa may be the most genetically diverse on the planet and hence a valuable resource for human genetic diversity studies. In order to build regional capacity for the generation, analysis and application of genomic data, the Southern African Human Genome Programme was recently launched with the aid of seed funding from the national Department of Science and Technology in South Africa. The purpose of the article is to investigate pertinent ethical, legal and social issues that have emerged during the planning stages of the Southern African Human Genome Programme. A careful consideration of key issues such as public perception of genomic research, issues relating to genetic and genomic discrimination and stigmatisation, informed consent, privacy and data protection, and the concept of genomic sovereignty, is of paramount importance in the early stages of the Programme. This article will also consider the present legal framework governing genomic research in South Africa and will conclude with proposals regarding such a framework for the future.

HIV and tuberculosis in prisons in sub-Saharan Africa.

Science.gov (United States)

Telisinghe, Lilanganee; Charalambous, Salome; Topp, Stephanie M; Herce, Michael E; Hoffmann, Christopher J; Barron, Peter; Schouten, Erik J; Jahn, Andreas; Zachariah, Rony; Harries, Anthony D; Beyrer, Chris; Amon, Joseph J

2016-09-17

Given the dual epidemics of HIV and tuberculosis in sub-Saharan Africa and evidence suggesting a disproportionate burden of these diseases among detainees in the region, we aimed to investigate the epidemiology of HIV and tuberculosis in prison populations, describe services available and challenges to service delivery, and identify priority areas for programmatically relevant research in sub-Saharan African prisons. To this end, we reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country. We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are

Association between injectable progestin-only contraceptives and HIV acquisition and HIV target cell frequency in the female genital tract in South African women: a prospective cohort study.

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Byrne, Elizabeth H; Anahtar, Melis N; Cohen, Kathleen E; Moodley, Amber; Padavattan, Nikita; Ismail, Nasreen; Bowman, Brittany A; Olson, Gregory S; Mabhula, Amanda; Leslie, Alasdair; Ndung'u, Thumbi; Walker, Bruce D; Ghebremichael, Musie S; Dong, Krista L; Kwon, Douglas S

2016-04-01

The use of injectable progestin-only contraceptives has been associated with increased risk of HIV acquisition in observational studies, but the biological mechanisms of this risk remain poorly understood. We aimed to assess the effects of progestins on HIV acquisition risk and the immune environment in the female genital tract. In this prospective cohort, we enrolled HIV-negative South African women aged 18-23 years who were not pregnant and were living in Umlazi, South Africa from the Females Rising through Education, Support, and Health (FRESH) study. We tested for HIV-1 twice per week to monitor incident infection. Every 3 months, we collected demographic and behavioural data in addition to blood and cervical samples. The study objective was to characterise host immune determinants of HIV acquisition risk, including those associated with injectable progestin-only contraceptive use. Hazard ratios (HRs) were estimated using Cox proportional hazards methods. Between Nov 19, 2012, and May 31, 2015, we characterised 432 HIV-uninfected South African women from the FRESH study. In this cohort, 152 women used injectable progestin-only contraceptives, 43 used other forms of contraception, and 222 women used no method of long-term contraception. Women using injectable progestin-only contraceptives were at substantially higher risk of acquiring HIV (12·06 per 100 person-years, 95% CI 6·41-20·63) than women using no long-term contraception (3·71 per 100 person-years, 1·36-8·07; adjusted hazard ratio [aHR] 2·93, 95% CI 1·09-7·868, p=0·0326). HIV-negative injectable progestin-only contraceptive users had 3·92 times the frequency of cervical HIV target cells (CCR5+ CD4 T cells) compared with women using no long-term contraceptive (p=0·0241). Women using no long-term contraceptive in the luteal phase of the menstrual cycle also had a 3·25 times higher frequency of cervical target cells compared with those in the follicular phase (p=0·0488), suggesting that a

A critical historical analysis of the South African Catholic Church's HIV/AIDS response between 2000 and 2005.

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Joshua, Stephen Muoki

2010-12-01

The South African HIV and AIDS experience is unique in many ways considering the country's delayed and robust epidemic, the apartheid context, and successive HIV-denialist government regimes. While the struggle for democracy may have overshadowed the enormity of the unfolding HIV epidemic, there was also a delay in constructive religious responses to it early on. In 1990, HIV/AIDS was declared a Catholic institutional focus, and by 2000 the Church had established the largest system of care and treatment in the country besides that of the government. However, the Catholic Church suffered severe criticism on account of its anti-condom policy to HIV prevention. As a result, the institutional Church underwent both organisational and ideological changes in an attempt to adapt to the contextual challenges brought about by HIV and AIDS. Informed by archival collections and oral sources, this article endeavours to critically analyse the HIV/AIDS-related care and treatment activities of the Catholic Church in South Africa between 2000 and 2005. It argues that the complex interplay between HIV and AIDS, the controversy about condom use, and the availability of antiretroviral therapy, accompanied by church activists' multiple engagements with these issues, changed the Church's institutional HIV/AIDS response at that time, in effect transforming the Catholic Church in South Africa into a substantial health asset and agent. However, its stance against the use of condoms for HIV prevention, informed by a larger religious tradition on sexuality, proved to be a health liability.

Southern African HIV Clinicians Society adult antiretroviral therapy guidelines: Update on when to initiate antiretroviral therapy

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Graeme Meintjes

2015-12-01

Full Text Available The most recent version of the Southern African HIV Clinicians Society’s adult antiretroviral therapy (ART guidelines was published in December 2014. In the 27 August 2015 edition of the New England Journal of Medicine, two seminal randomised controlled trials that addressed the optimal timing of ART in HIV-infected patients with high CD4 counts were published: Strategic timing of antiretroviral therapy (START and TEMPRANO ANRS 12136 (Early antiretroviral treatment and/or early isoniazid prophylaxis against tuberculosis in HIV-infected adults. The findings of these two trials were consistent: there was significant individual clinical benefit from starting ART immediately in patients with CD4 counts higher than 500 cells/μL rather than deferring until a certain lower CD4 threshold or clinical indication was met. The findings add to prior evidence showing that ART reduces the risk of onward HIV transmission. Therefore, early ART initiation has the public health benefits of potentially reducing both HIV incidence and morbidity. Given this new and important evidence, the Society took the decision to provide a specific update on the section of the adult ART guidelines relating to when ART should be initiated.

Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy

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Ekouevi, Didier K; Balestre, Eric; Coffie, Patrick A

2013-01-01

HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework o...... of the International epidemiological Databases to Evaluate AIDS (IeDEA)....

The interactive effects of social support and physical functioning on HIV medical outcomes among African Americans whom inject drugs.

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Maragh-Bass, Allysha C; Denison, Julie A; Thorpe, Roland J; Knowlton, Amy R

2017-02-15

Research suggests a syndemic of substance use, mental illness, and familial conflict is associated with poor HIV medical outcomes among African American persons living with HIV (PLHIV). Social support may facilitate positive health outcomes. This study explores psychosocial correlates of HIV medical outcomes, defined as undetectable viral load (UVL) and acute care minimization. Data were from baseline of the BEACON study (N = 351). UVL was ≤40 copies/mL. Acute care minimization was defined as no ER visits and/or hospitalizations in 6 months. Descriptive statistics and Poisson regression were implemented (N = 351). Moderate syndemic burden was associated with viral suppression. Individuals with main partner caregivers had 35% higher likelihood of viral suppression than individuals whose main supporters were neither kin nor main partners (adjusted point-prevalence rate ratio [APR] = 1.35; 95% CI [1.05, 1.74]). Surprisingly, individuals with more health-related support were more likely to use acute care than individuals with less health-related support (pInteraction analyses showed that physical function modified the relationship between main supporter type and acute care minimization. Results suggest that social support receipt was not consistently associated with HIV medical outcomes. Conversely, higher syndemic burden may have facilitated positive outcomes through necessitating increased rates of health care engagement. Health care professionals should elicit discussion of social support to strengthen PLHIVs' and their supporters' relationships to improve their health. Results highlight the need for culturally tailored interventions to improve HIV medical outcomes among African American PLHIV substance users.

Associations between mode of HIV testing and consent, confidentiality, and referral : a comparative analysis in four African countries

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Obermeyer, C. M.; Neuman, M.; Desclaux, Alice; Wanyenze, R.; Ky-Zerbo, O.; Cherutich, P.; Namakhoma, I.; Hardon, A.

2012-01-01

Editors' Summary Background In 2007, World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued a joint guidance document on “provider-initiated” HIV testing and counseling. They noted that previous testing strategies that relied on “client-initiated” testing (also referred to as VCT, for voluntary counseling and testing) had failed to reach enough people, both in high-income and resource-constrained countries—in Africa, for example, at that time, just ...

Changes in Bone Mineral Density, Body Composition, Vitamin D Status, and Mineral Metabolism in Urban HIV-Positive South African Women Over 12 Months.

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Hamill, Matthew M; Pettifor, John M; Ward, Kate A; Norris, Shane A; Prentice, Ann

2017-08-01

Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are associated with bone loss and poor vitamin D status in white populations, though their relative roles are not known. No previous studies have examined longitudinal changes in areal bone mineral density (aBMD), measured by dual-energy X-ray absorptiometry (DXA), or in vitamin D status in HIV-positive African women. Of 247 premenopausal, urban, black African women from Soweto, South Africa, initially recruited, 187 underwent anthropometry, DXA scanning and blood and urine collections at both baseline and 12 months. Of these, 67 were HIV-negative throughout (Nref), 60 were HIV-positive with preserved CD4 counts at baseline (Ppres), and 60 were HIV-positive with low CD4 counts at baseline, eligible for ART by South African standards of care at the time (Plow). No participant had been exposed to ART at baseline. By 12 months, 51 Plow women had initiated ART, >85% of whom took combined tenofovir disoproxil fumarate (TDF), lamivudine, and efavirenz. By 12 months, Plow and Nref, but not Ppres, increased in body weight and fat mass (group-by-timepoint p ≤ 0.001, p = 0.002, respectively). Plow had significant decreases in aBMD of 2% to 3%, before and after size adjustment, at the femoral neck (p ≤ 0.002) and lumbar spine (p ≤ 0.001), despite significant weight gain. These decreases were associated with increased bone turnover but there were no significant differences or changes over time in vitamin D status, serum phosphate concentrations, or renal phosphate handling. Excluding data from nine Plow women unexposed to ART and 11 Ppres women who had initiated ART accentuated these findings, suggesting the bone loss in Plow was related to ART exposure. This is the first study describing DXA-defined bone loss in HIV-positive Sub-Saharan African women in association with ART. Further work is required to establish if bone loss continues with ongoing ART and, if so, whether this

A study of HIV positive undocumented African migrants' access to health services in the UK.

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Whyte, James; Whyte, Maria D; Hires, Kimberly

2015-01-01

Newly immigrated persons, whatever their origin, tend to fall in the lower socioeconomic levels. In fact, failure of an asylum application renders one destitute in a large proportion of cases, often resulting in a profound lack of access to basic necessities. With over a third of HIV positive failed asylum seekers reporting no income, and the remainder reporting highly limited resources, poverty is a reality for the vast majority. The purpose of the study was to determine the basic social processes that guide HIV positive undocumented migrant's efforts to gain health services in the UK. The study used the Grounded Theory Approach. Theoretical saturation occurred after 16 participants were included in the study. The data included reflections of the prominent factors related to the establishment of a safe and productive life and the ability of individuals to remain within the UK. The data reflected heavily upon the ability of migrants to enter the medical care system during their asylum period, and on an emerging pattern of service denial after loss on immigration appeal. The findings of this study are notable in that they have demonstrated sequence of events along a timeline related to the interaction between the asylum process and access to health-related services. The results reflect that African migrants maintain a degree of formal access to health services during the period that they possess legal access to services and informal access after the failure of their asylum claim. The purpose of this paper is to examine the basic social processes that characterize efforts to gain access to health services among HIV positive undocumented African migrants to the UK. The most recent estimates indicate that there are a total of 618,000 migrants who lack legal status within the UK. Other studies have placed the number of undocumented migrants within the UK in the range of 525,000-950,000. More than 442,000 are thought to dwell in the London metropolitan area. Even in

Assessment of an outreach street-based HIV rapid testing programme as a strategy to promote early diagnosis: a comparison with two surveillance systems in Spain, 2008-2011.

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Belza, M J; Hoyos, J; Fernández-Balbuena, S; Diaz, A; Bravo, M J; de la Fuente, L

2015-04-09

We assess the added value of a multisite, street-based HIV rapid testing programme by comparing its results to pre-existing services and assessing its potential to reduce ongoing transmission. Between 2008 and 2011, 8,923 individuals underwent testing. We compare outcomes with those of a network of 20 sexually transmitted infections (STI)/HIV clinics (EPI-VIH) and the Spanish National HIV Surveillance System (SNHSS); evaluate whether good visibility prompts testing and assess whether it reaches under-tested populations. 89.2% of the new infections were in men who have sex with men (MSM) vs 78.0% in EPI-VIH and 56.0% in SNHSS. 83.6% of the MSM were linked to care and 20.9% had VIH. 56.5% of the HIV-positive MSM tested because they happened to see the programme, 18.4% were previously untested and 26.3% had their last test ≥2 years ago. The programme provided linkage to care and early diagnosis mainly to MSM but attendees presented a lower HIV prevalence than EPI-VIH. From a cost perspective it would benefit from being implemented in locations highly frequented by MSM. Conversely, its good visibility led to reduced periods of undiagnosed infection in a high proportion of MSM who were not testing with the recommended frequency.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012.

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Hamel, Donald J; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T; Okonkwo, Prosper; Kanki, Phyllis J

From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

The Happy Teen programme: a holistic outpatient clinic-based approach to prepare HIV-infected youth for the transition from paediatric to adult medical care services in Thailand.

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Lolekha, Rangsima; Boon-Yasidhi, Vitharon; Na-Nakorn, Yossawadee; Manaboriboon, Boonying; Vandepitte, Warunee Punpanich; Martin, Michael; Tarugsa, Jariya; Nuchanard, Wipada; Leowsrisook, Pimsiri; Lapphra, Ketwadee; Suntarattiwong, Piyarat; Thaineua, Vorapathu; Chokephaibulkit, Kulkanya

2017-05-16

We developed an 18-month Happy Teen 2 (HT2) programme comprised of a one-day workshop, two half-day sessions, and three individual sessions to prepare HIV-infected youth for the transition from paediatric to adult HIV care services. We describe the programme and evaluate the change in youth's knowledge scores. We implemented the HT2 programme among HIV-infected Thai youth aged 14-22 years who were aware of their HIV status and receiving care at two hospitals in Bangkok (Siriraj Hospital, Queen Sirikit National Institute of Child Health [QSNICH]). Staff interviewed youth using a standardized questionnaire to assess HIV and health-related knowledge at baseline and at 12 and 18 months while they participated in the programme. We examined factors associated with a composite knowledge score ≥95% at month 18 using logistic regression. During March 2014-July 2016, 192 of 245 (78%) eligible youth were interviewed at baseline. Of these, 161 (84%) returned for interviews at 12 and 18 months. Among the 161 youth, the median age was 17 years, 74 (46%) were female, and 99% were receiving antiretroviral treatment. The median composite score was 45% at baseline and increased to 82% at 12 months and 95% at 18 months ( P  95% was associated with education level >high school (aOR: 2.15, 95%CI, 1.03-4.48) and receipt care at QSNICH (aOR: 2.43, 95%CI, 1.18-4.98). Youth whose mother and father had died were less likely to have score ≥95% (aOR: 0.22, 95%CI, 0.07-0.67) than those with living parents. Knowledge useful for a successful transition from paediatric to adult HIV care increased among youth participating in the HT2 programme. Youth follow-up will continue to assess the impact of improved knowledge on outcomes following the transition to adult care services.

An Extended Model of Reasoned Action to Understand the Influence of Individual- and Network-Level Factors on African Americans’ Participation in HIV Vaccine Research

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Frew, Paula M.; Archibald, Matthew; Diallo, Dazon Dixon; Hou, Su-I; Horton, Takeia; Chan, Kayshin; Mulligan, Mark J.; del Rio, Carlos

2010-01-01

In the United States, the number and proportion of HIV/AIDS cases among black/African Americans continue to highlight the need for new biomedical prevention interventions, including an HIV vaccine, microbicide, or new antiretroviral (ARV) prevention strategies such as pre-exposure prophylaxis (PrEP) to complement existing condom usage, harm reduction methods, and behavioral change strategies to stem the HIV epidemic. Although black/African Americans are disproportionately impacted by HIV/AIDS, their participation in HIV clinical research continues to have unique challenges. We theorize that interaction among multilevel factors creates ideal alignment for minority participation in HIV clinical studies. Thus, we initially set out to test an extended model of reasoned action with 362 participants to understand the interplay of sociopsychological and network-level considerations influencing minority participation in HIV prevention research efforts. In this study, we linked the intrapersonal dimensions of attitudes, beliefs, and normative concerns to community-level components, appraisal of involvement with the clinical research organization, an entity which operates within a networked structure of community partner agencies, and identification with coalition advocacy aims. Various participatory outcomes were explored including involvement in future HIV vaccine community functions, participation in community promotion of HIV vaccine research, and community mobilization. Three-stage least squares estimates indicated similar findings across three models. Significant effects demonstrate the importance of positive attitudes toward HIV vaccine research, favorable health research beliefs, perceived social support for participation, HIV/AIDS issue engagement, and perceived relevance of the clinical research site’s mission and values. Identification of these nuanced pathway effects provides implications for tailored community program development. PMID:20012200

Executive summary and recommendations from WHO/UNAIDS and AAVP consultation on: 'The inclusion of adolescents in HIV vaccine trials', 16-18 March 2006 in Gaborone, Botswana.

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Osmanov, Saladin

2007-09-12

This report summarizes the discussions and recommendations from a consultation held in Gaborone, Botswana (16-19 March 2006), organized by the joint World Health Organization (WHO)/United Nations Programme on HIV/AIDS (UNAIDS) HIV Vaccine Initiative (HVI) and the African AIDS Vaccine Programme (AAVP). The consultation considered key challenges and strategies in enrolling adolescents into HIV vaccine clinical trials, relevant to developing countries, in particular in eastern and southern Africa. Approaches were identified that might address and resolve country-specific challenges related to scientific, legal, ethical, regulatory and community aspects of the involvement of adolescents in HIV vaccine trials. This executive summary is formulated for a broader dissemination of the outcomes of the meeting to the general clinical, scientific and regulatory community involved in the review, approval and monitoring of clinical trials and potential licensing of HIV vaccine candidates. Four major topics were discussed and recommendations developed with regard to: (i) criteria for products selection and clinical trial design; (ii) ethical and legal issues; (iii) community acceptance and participation; and (iv) regulatory considerations. The recommendations of this meeting were further discussed and endorsed by the WHO/UNAIDS HIV Vaccine Advisory Committee.

The value of confirmatory testing in early infant HIV diagnosis programmes in South Africa: A cost-effectiveness analysis.

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Lorna Dunning

2017-11-01

Full Text Available The specificity of nucleic acid amplification tests (NAATs used for early infant diagnosis (EID of HIV infection is <100%, leading some HIV-uninfected infants to be incorrectly identified as HIV-infected. The World Health Organization recommends that infants undergo a second NAAT to confirm any positive test result, but implementation is limited. Our objective was to determine the impact and cost-effectiveness of confirmatory HIV testing for EID programmes in South Africa.Using the Cost-effectiveness of Preventing AIDS Complications (CEPAC-Pediatric model, we simulated EID testing at age 6 weeks for HIV-exposed infants without and with confirmatory testing. We assumed a NAAT cost of US$25, NAAT specificity of 99.6%, NAAT sensitivity of 100% for infants infected in pregnancy or at least 4 weeks prior to testing, and a mother-to-child transmission (MTCT rate at 12 months of 4.9%; we simulated guideline-concordant rates of testing uptake, result return, and antiretroviral therapy (ART initiation (100%. After diagnosis, infants were linked to and retained in care for 10 years (false-positive or lifelong (true-positive. All parameters were varied widely in sensitivity analyses. Outcomes included number of infants with false-positive diagnoses linked to ART per 1,000 ART initiations, life expectancy (LE, in years and per-person lifetime HIV-related healthcare costs. Both without and with confirmatory testing, LE was 26.2 years for HIV-infected infants and 61.4 years for all HIV-exposed infants; clinical outcomes for truly infected infants did not differ by strategy. Without confirmatory testing, 128/1,000 ART initiations were false-positive diagnoses; with confirmatory testing, 1/1,000 ART initiations were false-positive diagnoses. Because confirmatory testing averted costly HIV care and ART in truly HIV-uninfected infants, it was cost-saving: total cost US$1,790/infant tested, compared to US$1,830/infant tested without confirmatory testing

The impact of human immunodeficiency virus (HIV) infection on quality of life in a multiracial South African population.

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O'Keefe, E A; Wood, R

1996-04-01

We set out to document quality of life in South African HIV subjects, using the Medical Outcomes Survey (MOS) SF-36 instrument, and to determine whether this was affected by race, gender or clinical stage of disease. A cross-sectional survey of 134 HIV outpatients (42 White, 49 Mixed race, 43 Black) and 114 healthy non-medical hospital personnel (36 White, 37 Mixed race, 42 Black) was carried out at a referral centre for HIV patients in the Western Cape region of South Africa. Scores on eight scales measuring different aspects of quality of life were calculated. Black female controls scored significantly lower on all scales (p impacts early on all aspects of quality of life and that this impact is largely independent of racial origin.

Adapting an Evidence-Based HIV Intervention for At-Risk African American College Women at Historically Black Colleges and Universities Who Use Alcohol and Drugs

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