Hatcher, Abigail; de Wet, Jacques; Bonell, Christopher Philip; Strange, Vicki; Phetla, Godfrey; Proynk, Paul M; Kim, Julia C; Morison, Linda; Porter, John D H; Busza, Joanna; Watts, Charlotte; Hargreaves, James R
The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants.
Gibbs, Andrew; Campbell, Catherine; Maimane, Sbongile
Globally, there is a renewed interest in building the local sustainability of HIV/AIDS programmes to ensure that once funders withdraw, local communities can sustain programmes. While the 'local sustainability assumption' is widespread, little research has assessed this. In this article, we assess the sustainability of the Entabeni Project, a community-based intervention that sought to build women's local leadership and capacity to respond to HIV/AIDS through a group of volunteer carers, 3 years after external support was withdrawn. Overall, the sustainability of the Entabeni Project was limited. The wider social and political context undermined volunteer carers' sense that they could affect change, with little external support for them from government and NGOs, who struggled to engage with local community organizations. At the community level, some church leaders and community members recognized the important role of health volunteers, many continued to devalue the work of the carers, especially once there was no external organization to support and validate their work. Within the health volunteer group, despite extensive efforts to change dynamics, it remained dominated by a local male leader who denied others active participation while lacking the skills to meaningfully lead the project. Our case study suggests that the local-sustainability assumption is wishful thinking. Small-scale local projects are unlikely to be able to challenge the broader social and political dynamics hindering their sustainability without meaningful external support.
Sanjobo, Nawa; Lukwesa, Matilda; Kaziya, Charity; Tepa, Cornwell; Puta, Bernard
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
Sorvillo, F.; Smith, L.; Kerndt, P.; Ash, L.
Trichomonas vaginalis may be emerging as one of the most important cofactors in amplifying HIV transmission, particularly in African-American communities of the United States. In a person co-infected with HIV, the pathology induced by T. vaginalis infection can increase HIV shedding. Trichomonas infection may also act to expand the portal of entry for HIV in an HIV-negative person. Studies from Africa have suggested that T. vaginalis infection may increase the rate of HIV transmission by approximately twofold. Available data indicate that T. vaginalis is highly prevalent among African-Americans in major urban centers of the United States and is often the most common sexually transmitted infection in black women. Even if T. vaginalis increases the risk of HIV transmission by a small amount, this could translate into an important amplifying effect since Trichomonas is so common. Substantial HIV transmission may be attributable to T. vaginalis in African-American communities of the United States. PMID:11747718
Roos, Ronel; Myezwa, Hellen; van Aswegen, Helena
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.
... person’s chance of getting or transmitting HIV. The poverty rate is higher among African Americans than other racial/ethnic groups. The socioeconomic issues associated with poverty—including limited access to high-quality health care, ...
Wagemakers, Annemarie; van Husen, Gwen; Barrett, Jennifer B.; Koelen, Maria A.
Objective: The STI/HIV prevention programme in Amsterdam aims to improve the sexual health of Amsterdam residents of African, Antillean, Aruban and Surinamese origins. The programme strategy is to achieve and enhance the participation of migrant community-based organisations (CBOs) in sexual health promotion through a grant scheme and by providing…
Background In the current context of diversity and coexistence of HIV testing approaches, limited information exists on test recipient’s views of HIV testing services and programme attributes that could ease the testing process and make it more appealing for at risk individuals who don’t know their HIV status. This study analyzed ratings given to different testing sites and programme characteristics that might facilitate testing. Methods We analyzed data from 3120 persons attending a mobile HIV testing programme located on a central street in the gay district of Madrid. Results 64% were men (of which, 55% had had sex with other men), 59.5% were <30 years, 35.4% foreigners, 50.6% had a university degree,71.7% a regular employment, 59.3% reported multiple partners and inconsistent condom use and 56.5% had been tested for HIV. Non Governmental Organizations and specific HIV/STI centres received the maximum rating from over 60% of participants, followed by self-testing (38.9%). Pharmacies (20.8%) and hospital emergency departments (14.2%) were the worst valued testing sites. Over 80% gave the highest rating to having immediate test results, not needing a previous appointment, and free testing, while less than 50% gave the maximum rating to privacy and anonymity. Conclusions HIV testing services that don’t require an appointment, based on free tests with rapid results are most valued by a young, not socially marginalized but high risk sexual exposure population. On the contrary, issues traditionally highly valued by health care providers or AIDS social organizations (privacy and anonymity) are much less valued. PMID:23987230
Nunn, Amy; Cornwall, Alexandra; Thomas, Gladys; Callahan, Pastor Leslie; Waller, Pastor Alyn; Friend, Rafiyq; Broadnax, Pastor Jay; Flanigan, Timothy
African-Americans are disproportionately infected and affected by HIV/AIDS. Although faith-based institutions play critical leadership roles in the African-American community, the faith-based response to HIV/AIDS has historically been lacking. We explore recent successful strategies of a citywide HIV/AIDS awareness and testing campaign developed in partnership with 40 African-American faith-based institutions in Philadelphia, Pennsylvania, a city with some of the USA's highest HIV infection rates. Drawing on important lessons from the campaign and subsequent efforts to sustain the campaign's momentum with a citywide HIV testing, treatment and awareness programme, we provide a road map for engaging African-American faith communities in HIV prevention that includes partnering with faith leaders, engaging the media to raise awareness, destigmatising HIV/AIDS and encouraging HIV testing, and conducting educational and HIV testing events at houses of worship. African-American faith-based institutions have a critical role to play in raising awareness about the HIV/AIDS epidemic and reducing racial disparities in HIV infection.
It remains unclear why there is such marked variation in the severity of the human immunodeficiency virus (HIV) epidemic between African countries. The prevalence of HIV infection has reached high levels in many parts of southern Africa but in most countries of West Africa the levels are much lower. Although there is good evidence that sexually transmitted infections (STIs) and genital ulcers in particular facilitate heterosexual transmission of HIV, there is little comparative STI data from the African countries worst affected by HIV infection. A MEDLINE search covering the period 1966 to August 2000 using the keywords "sexually transmitted diseases", "genital ulcers" and "Africa" was performed to identify factors that might be relevant to the spread of HIV infection in countries with the highest prevalences of the virus. In the countries worst affected by HIV infection, the proportions of men and women with STI who had genital ulcers lay in the ranges 45-68% and 13-68%, respectively. The proportions were much lower in countries of West Africa than in those of southern Africa. The African countries worst affected by HIV infection should adopt a more specialized approach to STI control than hitherto and specifically target the high incidence of genital ulceration. Locally, technical STI committees should draw up country-specific guidelines taking into account the prevalence of the various causes of genital ulceration. In these countries, national AIDS control programmes and donor agencies should develop a specific focus for decreasing the incidence of genital ulcer disease. PMID:11436480
Cooper, Hannah L. F.; Osborne, Andrew H.
HIV continues to be transmitted at unacceptably high rates among African Americans, and most HIV-prevention interventions have focused on behavioral change. To theorize additional approaches to HIV prevention among African Americans, we discuss how sexual networks and drug-injection networks are as important as behavior for HIV transmission. We also describe how higher-order social structures and processes, such as residential racial segregation and racialized policing, may help shape risk networks and behaviors. We then discuss 3 themes in African American culture—survival, propriety, and struggle—that also help shape networks and behaviors. Finally, we conclude with a discussion of how these perspectives might help reduce HIV transmission among African Americans. PMID:19372519
Background In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting all components of human development. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners. Methods In our search strategy, we relied on secondary information, mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. We restricted ourselves to reports dealing explicitly with the impact of HIV/AIDS on human development in African countries. Results and discussion HIV/AIDS is affecting the global human development of African countries through its devastating impact on health and demographic indicators such as life expectancy at birth, healthcare assistance, age and sex distribution, economic indicators like income, work force, and economic growth, education and knowledge acquisition and other indicators like governance, gender inequality and human rights. Conclusion On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. Consequently, HIV/AIDS is a development question and should be viewed as such. The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security
McCord, Laneshia R
Understanding sexual-risk behaviours as defined by a culture presents new challenges for human service professionals. Older African American women constitute the fastest growing group of new cases of HIV in the USA. With heterosexual sex as the primary mode of transmission among this group, there exist minimal programmes that are culture and age-specific in terms of primary and secondary prevention. In an attempt to address this gap in knowledge, this study examined how a group of older African American women defined sexual-risk behaviour. A focus group was conducted with seven women age 45 and older, who were recruited from a community centre. This paper examines the way that sexual-risk behaviour was defined through thematic analysis and conceptualises the locus of sexual risk behaviour as defined by the participants. The major theme of the study was social prescription, how to behave sexually as an ageing adult. Underlying ideas that arose were that unprotected sex occurred out of habit, that impulsivity was associated with risky sex and that older women needed to be aware of warning signs and behaviours of potential mates. Micro- and macro-level implications for human service professionals are discussed.
Jensen, Kipton; Gaie, Joseph Br
This article explores the possible relevance of African communalism to HIV/AIDS policies in Botswana and other parts of sub-Saharan Africa. We examine various interpretations of African communalism, which many consider to be the cardinal insight of African thought. We suggest several applications of this indigenous notion of personhood to HIV prevention in general and to routine HIV-testing policies in particular. This analysis demonstrates some of the ethical dilemmas and cultural complexities inherent in designing as well as implementing effective HIV-prevention programmes that strike a conscientious balance between protecting individual freedoms and securing public health. Recovering past traditions (such as African conceptions of personal identity) is valuable not only for the purpose of self-identification but also for helping us meet the challenges and problems of today in Africa. We also suggest that the human-rights-based approach to HIV prevention, which strives to protect individuals, is possibly incompatible with the socio-ethical ideals espoused by African communalism. We conclude that public health programmes in Botswana and other parts of sub-Saharan Africa would be more effective if those who designed and implemented them possessed a better understanding of indigenous conceptions of personhood or human agency as well as existing ethno-medical beliefs and cultural practices.
Uhrig, Jennifer D.; Davis, Kevin C.; Rupert, Doug; Fraze, Jami
Objective: To examine whether there is an association between knowledge, attitudes and beliefs, reported intentions to get an HIV test, and reported HIV testing behaviour at a later date among a sample of African American women. Design: Secondary analysis of data collected from October 2007 through March 2008 for a randomized controlled experiment…
Dickinson, D; Stevens, M
This paper provides a framework analysing the response of South African companies to HIV/AIDS. Drawing on three case studies of companies, each with over 20,000 South African-based employees, we identify six 'drivers' that influence corporate behaviour regarding HIV/AIDS: legal requirements, voluntary regulation, business costs, social pressures, visibility of the disease, and individuals within companies. We suggest that costs calculations, while possibly underestimating indirect and macro-implications, are not key in driving company responses to HIV/AIDS. The law and voluntary regulation have influenced, but not determined, the response of companies to HIV/AIDS. Social pressures on companies are of importance, but the scale and complexity of need in South Africa has seen the deflecting of this driver. Of greater reference in determining responses has been the social pressure of other companies' responses. The general visibility of the AIDS epidemic is also a significant factor in explaining companies' responses to HIV/AIDS. Moreover, the visibility of HIV/AIDS within companies has influenced the responses of often relatively weak, internal agents who have been attempting to drive companies' HIV/AIDS programmes. We conclude that external drivers--legal requirements, economic performance, and social pressures--have framed corporate responses to HIV/AIDS to a degree, but have generally been weak. Moreover, there has been relatively little synergy between these external drivers and the internal drivers--voluntary regulation, visibility, and company HIV/AIDS 'champions'--that could propel companies into pro-active, bold responses to HIV/AIDS.
Seheri, L Mapaseka; Page, Nicola A; Mawela, Mothahadini P B; Mphahlele, M Jeffrey; Steele, A Duncan
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.
Rao, Deepa; Molina, Yamile; Lambert, Nina; Cohn, Susan E.
Purpose In the present study, we validated a culturally adapted stigma scale designed to assess stigma among African Americans living with HIV. Methods We collected data on the scale using an audio computer assisted self-interview (ACASI) format. We validated the scale with a sample of 62 African American participants living with HIV. Results Findings demonstrated that stigma can be measured succinctly and effectively in a 14-item scale with two subscales measuring enacted and internalized stigma. Discussion We identified many advantages to using the scale, which demonstrated good psychometric properties when used with an audio computer assisted self-interview format and with an African American sample. We recommend this scale’s use in both clinical practice and research study of HIV-stigma reduction interventions with African American populations. PMID:27761520
Matebeni, Zethu; Reddy, Vasu; Sandfort, Theo; Southey-Swartz, Ian
HIV-prevention and service programmes have long either ignored or overlooked lesbians. The experiences of lesbians with HIV have similarly been unrecognised and unreported. This erasure has contributed to the invisibility of lesbians in relation to HIV and related health risks. This community participatory study, based on in-depth interviews with 24 self-identifying African lesbians living with HIV in South Africa, Zimbabwe and Namibia, focuses on their personal experiences and circumstances. Women's experiences shed light and challenge popular notions around lesbian risk. In particular among this group are lesbians who self-report exclusive sexual relationships with women. For these women, experiences of living with HIV are challenging as they struggle to understand the possibility of female-to-female transmission. While battling with their own perceptions of invulnerability and accepting their HIV-positive status, they have to deal also with wide-ranging misconceptions about risk. The paper argues that within the context of HIV, lesbians cannot be regarded as a 'no-risk' group. Health services and health providers are encouraged to respond to the health needs of lesbians living with HIV.
Polzer Casarez, Rebecca L; Miles, Margaret Shandor
The purpose of this study was to describe how spirituality affected the lives of African American mothers with Human Immunodeficiency Virus (HIV) in the context of coping. This qualitative descriptive study used secondary data of interviews from a larger longitudinal study of parental caregiving of infants seropositive for HIV. Participants were 38 African American mothers with HIV. Data from longitudinal semi-structured interviews were analyzed using content analysis. The women dealt with the stresses of HIV through a relationship with God. Two domains explain this relationship: God in control and God requires participation. The benefits of their relationship with God were a decrease in stress and worry about their own health and that of their infants. It is important for nurses working with mothers with HIV to acknowledge their spirituality and assess how spirituality helps them cope with and manage their illness.
VanTyler, Samaya; Sheilds, Laurene
In this study researchers explored the daily experiences of HIV+ women living in Kibera, Kenya. Using a convergence of narrative, feminist, and indigenous approaches, we engaged in individual in-depth interviews with nine HIV+ women. Interpretive storylines include the following: Being an African woman; If I sit there, that 10 bob won't come; If I die, who will take care of my children?; I am stigma; They just come to you; Being up, feeling down, and stress-up; and Living with HIV is a challenge. We present our findings to provide evidence-based insights to better support HIV+ women living in poverty.
Celum, Connie L; Delany-Moretlwe, Sinead; McConnell, Margaret; van Rooyen, Heidi; Bekker, Linda-Gail; Kurth, Ann; Bukusi, Elizabeth; Desmond, Chris; Morton, Jennifer; Baeten, Jared M
EP, a first-generation biomedical HIV prevention product, will inform development of new and less user-dependent PrEP formulations and delivery of an expanding choice of prevention options in HIV prevention programmes for young African women. PMID:26198350
Mamary, Edward M; Toevs, Kim; Burnworth, Karla B; Becker, Lin
Abstract Objectives 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. Design 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. Setting and participants 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. Variables studied Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment. Results 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. Conclusions 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. PMID:15117390
Davidson, Tatiana M; Lopez, Cristina M; Saulson, Raelle; Borkman, April L; Soltis, Kathryn; Ruggiero, Kenneth J; de Arellano, Michael; Wingood, Gina M; Diclemente, Ralph J; Danielson, Carla Kmett
National data suggests that teenage girls of Latino descent in the USA are disproportionately affected by HIV, with the US Centers for Disease Control and Prevention reporting the rate of new infections being approximately four times higher compared to White women of comparable age . This paper highlights the need for an effective single-sex HIV-prevention programme for teenage girls of Latino descent and describes the development and preliminary evaluation of Chicas Healing, Informing, Living and Empowering (CHILE), a culturally-tailored, HIV-prevention programme exclusively for teenage girls of Latino descent that was adapted from Sisters Informing, Healing, Living and Empowering (SiHLE), an evidence-based HIV- prevention program that is culturally tailored for African American young women. Theatre testing, a pre-testing methodology to assess consumer response to a demonstration of a product, was utilised to evaluate the relevance and utility of the HIV programme as well as opportunities for the integration of cultural constructs. Future directions for the evaluation of CHILE are discussed.
Njie-Carr, Veronica; Sharps, Phyllis; Campbell, Doris; Callwood, Gloria
This qualitative study examined the experiences of HIV-positive African-American and African Caribbean childbearing women related to decisions about HIV testing, status disclosure, adhering to treatment, decisions about childbearing, and experiences in violent intimate relationships. Twenty-three women completed a 60-minute in-depth interview. Six themes emerged: perceived vulnerability to HIV infection; feelings about getting tested for HIV; knowledge, attitudes, and behaviors after HIV diagnosis; disclosure of HIV status; living with HIV (positivity, strength, and prayer); and, experiences with physical and sexual violence. Three women (13%) reported perinatal abuse and 10 women (n = 23, 43.4%) reported lifetime abuse. Positive experiences and resilience were gained from faith and prayer. Most important to the women were the perceived benefits of protecting the health of their baby. Findings suggest that policies supporting early identification of HIV-positive childbearing women are critical in order to provide counseling and education in forming their decisions for safety precautions in violent intimate partner relationships. PMID:23061166
Cronje, Johan Herman; Williams, Margaret; Steenkamp, Liana; Venter, Danie; Elkonin, Diane
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
KELLY, J. A.; SOMLAI, A. M.; BENOTSCH, E. G.; AMIRKHANIAN, Y. A.; FERNANDEZ, M. I.; STEVENSON, L. Y.; SITZLER, C. A.; MCAULIFFE, T. L.; BROWN, K. D.; OPGENORTH, K. M.
This study assessed the programmes, resources, and needs of HIV-prevention nongovernmental organizations (NGOs) in 75 countries in Africa, Central/Eastern Europe and Central Asia, Latin America and the Caribbean. Multiple databases and expert recommendations were used to identify one major HIV-prevention NGO in the capital or a large city in each country, and in-depth interviews were conducted with each NGO Director. Most NGOs are carrying out their programmes with minimal funding and few regularly employed personnel. Most are highly dependent on international donors, but reliance on small grants with short funding periods limits programme development capacity. HIV-prevention activities varied by region, with African NGOs most likely to use peer education and community awareness events; Eastern European NGOs most likely to offer needle exchange; Latin American NGOs to have resource centres and offer risk reduction programmes; and Caribbean organizations to use mass education approaches. Across regions, NGOs most often targeted the general public and youth, although specialized at-risk groups were the additional focus of attention in some regions. Limited funding, governmental indifference or opposition, AIDS stigma, and social discomfort discussing sex were often cited as barriers to new HIV-prevention programmes. NGOs are critical service providers. However, their funding, programmes, and resource capacities must be strengthened if NGOs are to realize their full potential in HIV prevention. PMID:16282071
Frye, Victoria; Bonner, Sebastian; Williams, Kim; Henny, Kirk; Bond, Keosha; Lucy, Debbie; Cupid, Malik; Smith, Stephen; Koblin, Beryl A.
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…
Breast-feeding is a route of HIV transmission from an HIV infected mother to her infant. However, breast-feeding is an important pillar of child survival and part of a mother's womanhood. This paper highlights the dilemma created by the risks and the benefits of breast-feeding and will discuss the implementation in South Africa, of the Safer Breastfeeding Programme, to reduce some of the known risk factors associated with HIV transmission. Operations research was carried out, including infant HIV testing at 6 wk, and 9, 12, and 15 mo. Among 188 breast-fed infants enrolled in the program who were HIV negative at 6 wk, 4 became infected by 9 mo of age (2.6%). Infants enrolled in the Safer Breastfeeding Programme had less breast pathology than is usually reported for HIV infected women. Limited success was attained in promoting heat treatment of expressed breast milk; however, it does appear to be a feasible option after 6 mo of age, and it is believed that mothers would practice it more widely if sufficient promotion and support was given to it. Mothers found it difficult to stop breast-feeding earlier than the norm, and it therefore is important that mothers considering early cessation of breast-feeding be given sufficient preparation and support.
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.
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
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
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.
Vaas, Jocelyn R
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.
Kerr, Jelani C.; Valois, Robert F.; Diclemente, Ralph J.; Fletcher, Faith; Carey, Michael P.; Romer, Daniel; Vanable, Peter A.; Farber, Naomi
HIV-related stigma inhibits optimal HIV prevention and treatment among African-Americans. Regional differences in HIV/AIDS prevalence may be related to stigma among young African-Americans. Baseline data (N=1,606) from an HIV prevention intervention were used to investigate regional differences in HIV-related stigma and knowledge among African-American adolescents in four midsized cities in the Northeastern and Southeastern US. Analyses indicated greater HIV-related stigma among adolescents from the southeast relative to adolescents from the northeast (F=22.23;p<0.0001). Linear regression indicated a negative relationship between HIV stigma and HIV knowledge (b=−0.65;p<0.0001). Addressing HIV/AIDS in high prevalence locales should include efforts to reduce HIV-related stigma. PMID:24402690
Kelso, Gwendolyn A; Cohen, Mardge H; Weber, Kathleen M; Dale, Sannisha K; Cruise, Ruth C; Brody, Leslie R
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.
Kelso, Gwendolyn A.; Cohen, Mardge H.; Weber, Kathleen M.; Dale, Sannisha K.; Cruise, Ruth C.; Brody, Leslie R.
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. PMID:24077930
Maleka, Elma Nelisiwe
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
Kerrigan, Deanna; Kennedy, Caitlin E; Cheng, Alison Surdo; Sandison, Sarah J; Fonner, Virginia A; Holtgrave, David R; Brahmbhatt, Heena
In the field of HIV prevention, there is renewed interest in operations research (OR) within an implementation science framework. The ultimate goal of such studies is to generate new knowledge that can inform local programmes and policies, thus improving access, quality, efficiency and effectiveness. Using four case studies from the USAID-funded Research to Prevention (R2P) project, we highlight the strategic use of OR and the impact it can have on shaping the focus and content of HIV prevention programming across geographic and epidemic settings and populations. These case studies, which include experiences from several sub-Saharan African countries and the Caribbean, emphasize four unique ways that R2P projects utilized OR to stimulate change in a given context, including: (1) translating findings from clinical trials to real-world settings; (2) adapting promising structural interventions to a new context; (3) tailoring effective interventions to underserved populations; and (4) prioritizing key populations within a national response to HIV. Carefully crafted OR can bridge the common gap that exists between research-generated knowledge and field-based practice, lead to substantial, real-world changes in national policies and programmes, and strengthen local organizations and the use of data to be more responsive to a given topic or population, ultimately supporting a locally tailored HIV response. PMID:26290331
Kerrigan, Deanna; Kennedy, Caitlin E; Cheng, Alison Surdo; Sandison, Sarah J; Fonner, Virginia A; Holtgrave, David R; Brahmbhatt, Heena
In the field of HIV prevention, there is renewed interest in operations research (OR) within an implementation science framework. The ultimate goal of such studies is to generate new knowledge that can inform local programmes and policies, thus improving access, quality, efficiency and effectiveness. Using four case studies from the USAID-funded Research to Prevention (R2P) project, we highlight the strategic use of OR and the impact it can have on shaping the focus and content of HIV prevention programming across geographic and epidemic settings and populations. These case studies, which include experiences from several sub-Saharan African countries and the Caribbean, emphasize four unique ways that R2P projects utilized OR to stimulate change in a given context, including: (1) translating findings from clinical trials to real-world settings; (2) adapting promising structural interventions to a new context; (3) tailoring effective interventions to underserved populations; and (4) prioritizing key populations within a national response to HIV. Carefully crafted OR can bridge the common gap that exists between research-generated knowledge and field-based practice, lead to substantial, real-world changes in national policies and programmes, and strengthen local organizations and the use of data to be more responsive to a given topic or population, ultimately supporting a locally tailored HIV response.
Peterson, John L; Miner, Michael H; Brennan, David J; Rosser, B R Simon
The association between HIV treatment optimism--beliefs about susceptibility to transmit HIV, motivation to use condoms, and severity of HIV--and sexual risk behavior was examined among HIV-positive African American men who have sex with men (MSM). Participants were 174 men recruited in four major metropolitan areas of the United States to participate in a weekend HIV risk reduction intervention. Baseline results revealed that beliefs in less susceptibility to transmit HIV and less motivation to use condoms were significantly associated with more unprotected anal intercourse among serodiscordant casual partners. Less motivation to use condoms also predicted more unprotected insertive and receptive anal sex and was more important than susceptibility beliefs in predicting these behaviors. Suggestions are offered of ways to better inform HIV-positive African American MSM about their misperceptions about HIV treatment and how their level of optimism about HIV treatment may diminish or encourage condom use.
Zwemstra, Pedro; Loxton, Helene
Although fears are part of normal development, the living environment of HIV/AIDS affected children is conducive to the development of particular fears. This study examined the fears of 39 South African children (7-13 years) living in a low socioeconomic community with a high prevalence of HIV/AIDS. The aim was to consider if these children were a special population with regard to their fears. The Free Option Method was used to identify the children's fears. Data were analyzed by means of a priori thematic analysis, followed by a qualitative analysis. The expressed fears could be described with fear categories previously reported by normative samples. The wild animal category and specifically snake fears were reported most. The second analysis revealed a substantial minority of fears reflecting life in the South African HIV/AIDS affected context. It was concluded that the children represented a normative population who experienced particular fears due to their special circumstances. Further investigation of HIV/AIDS affected children's fears and related psychological issues is recommended.
Berkley-Patton, Jannette; Moore, Erin W.; Hawes, Starlyn M.; Thompson, Carole Bowe; Bohn, Alexandria
HIV continues to disproportionately impact communities of color, and more calls are being extended to African American churches to assist in HIV education and screening efforts. However, no studies have reported on the HIV testing practices of African American church-affiliated persons. This study examines demographic, social, and behavioral factors associated with ever receiving an HIV test and last 12-month HIV testing. Findings indicated not having insurance and condom use were predictors of ever receiving an HIV test. Predictors of HIV testing in the last 12 months included marital status (i.e., single, divorced, separated, or widowed) and intentions to get tested for HIV in the near future. These predictors should be considered when designing HIV education and screening interventions for African American church settings. PMID:22468975
Campbell, C; Williams, B
While migrant labour is believed to play an important role in the dynamics of HIV-transmission in many of the countries of southern Africa, little has been written about the way in which HIV/AIDS has been dealt with in the industrial settings in which many migrant workers are employed. This paper takes the gold mining industry in the countries of the Southern African Development Community (SADC) as a case study. While many mines made substantial efforts to establish HIV-prevention programmes relatively early on in the epidemic, these appear to have had little impact. The paper analyses the response of key players in the mining industry, in the interests of highlighting the limitations of the way in which both managements and trade unions have responded to HIV. It will be argued that the energy that has been devoted either to biomedical or behavioural prevention programmes or to human rights issues has served to obscure the social and developmental dimensions of HIV-transmission. This argument is supported by means of a case study which seeks to highlight the complexity of the dynamics of disease transmission in this context, a complexity which is not reflected in individualistic responses. An account is given of a new intervention which seeks to develop a more integrated approach to HIV management in an industrial setting.
Schneider, H; Lehmann, U
One of the consequences of massive investment in antiretroviral access and other AIDS programmes has been the rapid emergence of large numbers of lay workers in the health systems of developing countries. In South Africa, government estimates are 65,000, mostly HIV/TB care-related lay workers contribute their labour in the public health sector, outnumbering the main front-line primary health care providers and professional nurses. The phenomenon has grown organically and incrementally, playing a wide variety of care-giving, support and advocacy roles. Using South Africa as a case, this paper discusses the different forms, traditions and contradictory orientations taken by lay health work and the system-wide effects of a large lay worker presence. As pressures to regularise and formalize the status of lay health workers grow, important questions are raised as to their place in health systems, and more broadly what they represent as a new intermediary layer between state and citizen. It argues for a research agenda that seeks to better characterise types of lay involvement in the health system, particularly in an era of antiretroviral therapy, and which takes a wider perspective on the meanings of this recent re-emergence of an old concept in health systems heavily affected by HIV/AIDS.
Kumar, SG Prem; Dandona, Rakhi; Schneider, John A; Ramesh, YK; Dandona, Lalit
Background HIV prevention programmes for truck drivers form part of the HIV control efforts, but systematic data on the outputs and cost of providing such services in India are not readily available for further planning and use of resources. Methods Detailed cost and output data were collected from written records and interviews for 2005–2006 fiscal year using standardized methods at six sampled HIV prevention programmes for truck drivers in the Indian state of Andhra Pradesh. The total economic cost for these programmes was computed and the relation of unit cost of services per truck driver with programme scale was assessed using regression analysis. Results A total of 120,436 truck drivers were provided services by the six programmes of which 55.9% were long distance truck drivers. The annual economic cost of providing services to a truck driver varied between programmes from US$ 1.52 to 4.56 (mean US$ 2.49). There was an inverse relation between unit economic cost of serving a truck driver and scale of the programme (R2 = 0.63; p = 0.061). The variation between programmes in the average number of contacts made by the programme staff with truck drivers was 1.3 times versus 5.8 times for contacts by peer educators. Only 1.7% of the truck drivers were referred by the programmes for counseling and HIV testing. Conclusion These data provide information for further planning of HIV prevention programmes for truck drivers and estimating the resources needed for such programmes. The findings suggest the need to strengthen the role of peer educators and increase referral of truck drivers for HIV testing. PMID:19457269
Mkwanazi, Ntombizodumo B.; Rochat, Tamsen J.; Bland, Ruth M.
Prevention of mother-to-child Transmission and HIV Treatment programmes were scaled-up in resource-constrained settings over a decade ago, but there is still much to be understood about women's experiences of living with HIV and their HIV disclosure patterns. This qualitative study explored women's experiences of living with HIV, 6–10 years after being diagnosed during pregnancy. The area has high HIV prevalence, and an established HIV treatment programme. Participants were enrolled in a larger intervention, “Amagugu”, that supported women (n = 281) to disclose their HIV status to their children. Post-intervention we conducted individual in-depth interviews with 20 randomly selected women, stratified by clinic catchment area, from the total sample. Interviews were entered into ATLAS.ti computer software for coding. Most women were living with their current sexual partner and half were still in a relationship with the child's biological father. Household exposure to HIV was high with the majority of women knowing at least one other HIV-infected adult in their household. Eighteen women had disclosed their HIV status to another person; nine had disclosed to their current partner first. Two main themes were identified in the analyses: living with HIV and the normalisation of HIV treatment at a family level; and the complexity of love relationships, in particular in long-term partnerships. A decade on, most women were living positively with HIV, accessing care, and reported experiencing little stigma. However, as HIV became normalised new challenges arose including concerns about access to quality care, and the need for family-centred care. Women's sexual choices and relationships were intertwined with feelings of love, loyalty and trust and the important supportive role played by partners and families was acknowledged, however, some aspects of living with HIV presented challenges including continuing to practise safe sex several years after HIV diagnosis. PMID
Corneille, Maya A.; Zyzniewski, Linda E.; Belgrave, Faye Z.
Though HIV prevention efforts have focused on young adult women, women of all ages may engage in HIV risk behaviors and experience barriers to condom use. This article examines the effect of age on sexual risk and protective attitudes and behaviors among African American women. Unmarried heterosexual African American women between the ages of 18…
Jipguep, Marie-Claude; Sanders-Phillips, Kathy; Cotton, Lisa
This study tested a conceptual model that integrates structural and psychological determinants of HIV prevention for African American women. The sample consisted of African American mothers (N = 129) of children in Head Start programs. Higher levels of perceived stress were associated with higher levels of HIV risk; higher levels of perceived…
Asander, Ann-Sofie; Bjorkman, Anders; Belfrage, Erik; Faxelid, Elisabeth
In Sweden, most HIV-infected parents are of African origin. The present study explored the frequency of HIV-infected African parents' disclosure of their status to their children and custody planning for their children's future to identify support needs among these families. Semistructured interviews were conducted with 47 parents (41 families).…
Harris, Gregory E.; Corcoran, Valerie; Myles, Adam; Lundrigan, Philip; White, Robert; Greidanus, Elaine; Savage, Stephanie L.; Pope, Leslie; McDonald, James; Yetman, Gerard
Background: Online peer support can be a valuable approach to helping people living with HIV, especially in regions with large rural populations and relatively centralised HIV services. Design: This paper focuses on a community-university partnership aimed at developing an online peer support programme in the Canadian province of Newfoundland and…
Annang, Lucy; Spencer, S. Melinda; Jackson, Dawnyéa; Rosemond, Tiara N.; Best, Alicia L.; Williams, Leah R.; Carlos, Bethany
Objective: To describe how nominal group technique was used to inform the development of a breast and cervical cancer awareness programme for African-American adult daughters and mothers. Design: A qualitative approach using nominal group technique. Setting: A mid-sized city in the Southern USA. Method: Nominal group technique was used with 30…
This article explores the ability of the training and work experience offered under public works programmes to promote employment in South Africa. Public works are a key component of South African labour market policy and are ascribed considerable potential in terms of addressing the core challenge of unemployment. However, despite this policy…
Harvey, Stephen; Peacock, Alan
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…
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…
Mason, Sally; Berger, Barbara; Ferrans, Carol Estwing; Sultzman, Vickey; Fendrich, Michael
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…
Edwards, Lorece V.; Irving, Shalon M.; Hawkins, Anita S.
HIV/AIDS disease continues to be an escalating health problem, particularly among women. However, African American women are among the leading demographic groups for HIV prevalence in the United States. The typical woman with HIV/AIDS is young, in her late twenties, economically challenged, and of childbearing age. Participants were recruited from…
Maticka-Tyndale, E.; Mungwete, R.; Jayeoba, O.
School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term when delivered on a small scale. The question addressed here is whether results obtained with small-scale delivery are replicable in large-scale roll-out. Primary School Action for Better Health (PSABH), a programme to train teachers to…
Rabin, D L
Sexually acquired human immunodeficiency virus (HIV) infection continues to be the major source of HIV infection in the USA. Preventing sexual transmission of HIV can be accomplished through patient behaviour change. Such behaviour change can also decrease risk of other sexually transmitted diseases (STDs) and unwanted pregnancies, both far more common problems than HIV infection. Primary care physicians and other providers can increase patients' safe sex practices by conducting effective sexual risk assessment (RA) and risk reduction (RR) counselling, but physicians both infrequently and incompletely do sexual RA and RR. A programme was developed to improve primary care physicians' prevention practice using Simulated Patient Instructors (SPIs) and mailed educational materials. Programme evaluations showed improved sexual RA and RR practice both by self-report as well as by observation by Simulated Patient Evaluators (SPEs). This paper briefly reviews these findings and then presents adaptations made to improve the programme's content, decrease its cost and increase its availability for training many other care providers. Evaluation of the adapted programme indicates that content and training methods are highly regarded by a diverse array of trainees. To disseminate the modified programme beyond the local area, a Train-the-Trainer programme and manual have been developed, including discussion of recruiting, training and using SPIs for sexual risk reduction. Wider use of this training, as well as more effective and more readily available STD/HIV prevention training, are needed to attain national goals of provider clinical prevention practice.
Voisin, Dexter R.; Bird, Jason D. P.
This study explored the beliefs of African American male adolescents concerning the high rates of HIV infection among their peers and their reasons for those beliefs. In-depth interviews were conducted with a sample of 16 male African Americans, and a thematic analysis of the data was conducted. Half of the participants believed that peers were…
Newsome, Valerie; Airhihenbuwa, Collins O.
Although literature suggests that African American women are no more likely to engage in risky sex than their White counterparts, they are more likely to have sex partners with higher HIV risk. Thus, it is not solely an individual’s behavior that determines their risk, but also the behavior of their partner and their position within a sexual network. For this reason, it is important to consider the dynamics of heterosexual relationships in the African American community. An important area of concern regarding African American heterosexual relationships is that of partner availability. A shortage of available African American men for potential partnerships exists and is reportedly due to poorer health and higher mortality rates. Some have argued that gender-ratio imbalance may be responsible for increased HIV vulnerability for African American women. This article reviews the literature on gender ratio imbalance and HIV risk in the African American community, and presents implications and suggestions for future research and intervention. PMID:23041754
Johnson, Eboneé T.; Yaghmaian, Rana A.; Best, Andrew; Chan, Fong; Burrell, Reginald, Jr.
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…
Gardezi, F; Calzavara, L; Husbands, W; Tharao, W; Lawson, E; Myers, T; Pancham, A; George, C; Remis, R; Willms, D; McGee, F; Adebajo, S
African and Caribbean communities in Canada and other developed countries are disproportionately affected by HIV/AIDS. This qualitative study of African and Caribbean communities in Toronto sought to understand HIV-related stigma, discrimination, denial and fear, and the effects of multiple intersecting factors that influence responses to the disease, prevention practices and access to treatment and support services. Semi-structured interviews were conducted with 30 HIV-positive men and women and focus groups were conducted with 74 men and women whose HIV status was negative or unknown. We identified a range of issues faced by African and Caribbean people that may increase the risk for HIV infection, create obstacles to testing and treatment and lead to isolation of HIV-positive people. Our findings suggest the need for greater sensitivity and knowledge on the part of healthcare providers; more culturally specific support services; community development; greater community awareness; and expanded efforts to tackle housing, poverty, racism and settlement issues.
Soofie, Nasiha; Nunes, Marta C.; Kgagudi, Prudence; van Niekerk, Nadia; Makgobo, Tselane; Agosti, Yasmeen; Hwinya, Cleopas; Pathirana, Jayani; Madhi, Shabir A.
Background. There are limited data on pertussis in African children, including among human immunodeficiency virus (HIV)–exposed infants. We conducted population-based hospital surveillance to determine the incidence and clinical presentation of Bordetella pertussis–associated hospitalization in perinatal HIV-exposed and -unexposed infants. Methods. Children <12 months of age hospitalized with any sign or symptom of respiratory illness (including suspected sepsis or apnea in neonates) were enrolled from 1 January 2015 to 31 December 2015. Detailed clinical and demographic information was recorded and respiratory samples were tested by polymerase chain reaction (PCR). Results. The overall B. pertussis PCR positivity was 2.3% (42/1839), of which 86% (n = 36) occurred in infants <3 months of age. Bordetella pertussis was detected in 2.1% (n = 26/1257) of HIV-unexposed and 2.7% (n = 16/599) of HIV-exposed infants. The incidence (per 1000) of B. pertussis–associated hospitalization was 2.9 (95% confidence interval [CI], 1.8–4.5) and 1.9 (95% CI, 1.3–2.6) in HIV-exposed and HIV-unexposed infants, respectively (P = .09). The overall in-hospital case fatality ratio among the cases was 4.8% (2/42), both deaths of which occurred in HIV-exposed infants <3 months of age. Among cases, presence of cough ≥14 days (20.5%) and paroxysmal coughing spells (33.3%) at diagnosis were uncommon. Only 16 (38%) B. pertussis–associated hospitalizations fulfilled the Centers for Diseases Control and Prevention case definition of “definite” pertussis. Conclusions. Bordetella pertussis contributed to a modest proportion of all-cause respiratory illness hospitalization among black-African children, with a trend for higher incidence among HIV-exposed than HIV-unexposed infants. Maternal vaccination of pregnant women should be considered to reduce the burden of pertussis hospitalization in this population. PMID:27838669
Williams, Jason; Umaru, Farouk; Edgil, Dianna; Kuritsky, Joel
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
Brawner, Bridgette M.
Disproportionate HIV/AIDS rates among African American women have been examined extensively—primarily from an individually-centered focus. Beyond individual behaviors, factors such as the hyper-incarceration of African American men and geographically concentrated disadvantage may better explain inequitable disease burden. This paper proposes 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. PMID:25139057
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
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.
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
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
Berkley-Patton, Jannette; Thompson, Carole Bowe; Moore, Erin; Hawes, Starlyn; Simon, Stephen; Goggin, Kathy; Martinez, David; Berman, Marcie; Booker, Alexandria
Background African Americans are disproportionately burdened by HIV. The African American church is an influential institution with potential to increase reach of HIV prevention interventions in Black communities. Purpose This study examined HIV testing rates in African American churches in the Taking It to the Pews pilot project. Using a community-engaged approach, church leaders delivered religiously-tailored HIV education and testing materials/activities (e.g., sermons, brochures/bulletins, testimonials) to church and community members. Methods Four African American churches (N=543 participants) located in the Kansas City metropolitan area were randomized to intervention and comparison groups. Receipt of an HIV test was assessed at baseline and 6 months. Results Findings indicated intervention participants were 2.2 times more likely to receive an HIV test than comparisons at 6 months. Church leaders delivered about 2 tools per month. Conclusions Church-based HIV testing interventions are feasible and have potential to increase HIV testing rates in African American communities. PMID:26821712
Stewart, Jennifer M.; Dancy, Barbara L.
Having an HIV ministry within a church depends on the religious culture of that church. However, little is known about how a church’s religious culture influences an HIV ministry. This study’s purpose was to examine how an African American church’s religious culture supported the development, implementation, and maintenance of an HIV ministry within the church. An ethnographic case study research design was used. Data were collected through interviews, non-participant and participant observations, review of pertinent documents, and survey of congregants. Results revealed the following as important for an HIV ministry: (a) a belief in helping others and treating everyone with respect and dignity, (b) feelings of compassion toward individuals infected with HIV, and (c) HIV education. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries. PMID:22212914
Kwakwa, Helena A; Wahome, Rahab; Goines, Djalika S; Jabateh, Voffee; Green, Arraina; Bessias, Sophia; Flanigan, Timothy P
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.
Singh, Elvira; Ruff, Paul; Babb, Chantal; Sengayi, Mazvita; Beery, Moira; Khoali, Lerato; Kellett, Patricia; Underwood, J Michael
Cancer is projected to become a leading cause of morbidity and mortality in low-income and middle-income countries in the future. However, cancer incidence in South Africa is largely under-reported because of a lack of nationwide cancer surveillance networks. We describe present cancer surveillance activities in South Africa, and use the International Agency for Research on Cancer framework to propose the development of four population-based cancer registries in South Africa. These registries will represent the ethnic and geographical diversity of the country. We also provide an update on a cancer surveillance pilot programme in the Ekurhuleni Metropolitan District, and the successes and challenges in the implementation of the IARC framework in a local context. We examine the development of a comprehensive cancer surveillance system in a middle-income country, which might serve to assist other countries in establishing population-based cancer registries in a resource-constrained environment. PMID:26248849
Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine
Introduction 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. Methods 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. Results Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social 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, p<0.002 between structural deprivation and psychosocial problems, and B=−0.07, p<0.001 between psychosocial problems and HIV risk behaviour). Conclusions Adolescents with the greatest structural
Mihan, Robert; Kerr, Jelani; Maticka-Tyndale, Eleanor
HIV-related stigma has been shown to undermine prevention, care, treatment, and the well-being of people living with HIV. A disproportion burden of HIV infection, as well as elevated levels of HIV-related stigma, is evidenced in sub-Saharan African (SSA) and African-diasporic populations. This study explores factors that influence HIV-related stigma among 16- to 25-year-old youth residing in a Canadian city who identify as African, Caribbean, or Black. Stigma, as rooted in cultural norms and beliefs and related social institutions, combined with insights from research on stigma in SSA and African-diasporic populations, guided the development of a path analytic structural equation model predicting levels of HIV-related stigmatizing attitudes. The model was tested using survey responses of 510 youth to estimate the direct and indirect influences of ethno-religious identity, religious service attendance, time in Canada, HIV/AIDS knowledge, HIV-testing history, sexual health service contact, and gender on HIV-related stigma. Statistically significant negative associations were found between levels of stigma and knowledge and HIV-testing history. Ethno-religious identity and gender had both direct and indirect effects on stigma. African-Muslim participants had higher levels of stigma, lower knowledge, and were less likely to have been tested for HIV infection than other ethno-religious groups. Male participants had higher levels of stigma and lower knowledge than women. Time in Canada had only indirect effects on stigma, with participants in Canada for longer periods having higher knowledge and less likely to have been tested than more recent arrivals. While the strength of the effect of knowledge on stigmatizing attitudes in this research is consistent with other research on stigma and evaluations of stigma-reduction programs, the path analytic results provide additional information about how knowledge and HIV-testing function as mediators of non
McNamara, Lynne; Takuva, Simbarashe; Chirwa, Tobias; MacPhail, Patrick
Background: Host genetic factors may a play role in susceptibility to infection. Vitamin-D is an immunomodulator that may play a role in HIV infection. Vitamin-D action is mediated by the vitamin-D receptor. We establish prevalence of ApaI, BsmI, FokI and TaqI polymorphisms (VDRPs) amongst a black southern African HIV+ve population and investigate polymorphic differences between HIV+ve and -ve people. Methods: Seventy-nine sex and age-group matched HIV+ve patients of African origin initiating antiretroviral therapy (ART) and 79 HIV-ve participants, also of African origin, were recruited from a public sector HIV testing and treatment clinic and investigated for the 4 polymorphisms. The genotype frequencies were compared, odds ratios and 95% confidence intervals of the association of HIV status and each genotype were calculated. Both dominant, co-dominant, recessive and allele models were tested. Results: We found no evidence of difference in distribution and association between HIV infection and the genotypes of the BsmI, FokI and TaqI VDR polymorphisms. The genotype distributions were consistent with Hardy-Weinberg equilibrium for these genotypes. The ApaI genotype showed differences in distribution by HIV status in the dominant and co-dominant models. However this finding is cautiously stated as the ApaI genotype violated the Hardy-Weinberg equilibrium and frequency of the minor variant was unexpectedly low in this population. Conclusion: We do not show convincing differences in distribution of the VDR genotypes among HIV+ve and HIV-ve black southern African persons. Future studies need to be replicated in larger study populations as understanding polymorphic differences and similarities may offer insights into the different susceptibility and progression of HIV in southern African populations. PMID:27186331
Portas, M.; Boinas, F. S.; Oliveira E Sousa, J.; Rawlings, P.
African horse sickness (AHS) was diagnosed for the first time in southern Portugal in autumn 1989, following outbreaks in Spain. AHS virus presence was confirmed by virus isolation and serotyping. An eradication campaign with four sanitary zones was set up by Central Veterinary Services in close collaboration with private organizations. Vaccination began on 6 October. In February 1990, vaccination was extended to all Portuguese equines (170000 animals). There were 137 outbreaks on 104 farms: 206 of the equidae present died (16%) or were slaughtered (14%); 81.5% were horses, 10.7% were donkeys and 7.8% were mules. Clinical AHS occurred more frequently in horses than donkeys and mules. In the vaccinated population, 82 animals (62.2% horses and 37.8% mules and donkeys), died or were slaughtered due to suspected or confirmed AHS. One year after ending vaccination, December 1991, Portugal was declared free of AHS. Cost of eradication was US$1955513 (US$11.5/Portuguese equine). PMID:10579455
Sulzbach, Sara; De, Susna; Wang, Wenjuan
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
Kellett, Nicole Coffey; Gnauck, Katherine
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.
Lippman, Sheri A.; Maman, Suzanne; MacPhail, Catherine; Twine, Rhian; Peacock, Dean; Kahn, Kathleen; Pettifor, Audrey
Introduction 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. Objectives 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. Method 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. Results 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. Conclusions 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
Butcher, Richard O.; Hood, Rodney G.; Jordan, Wilbert C.
HIV/AIDS is a disease that has a disproportionate negative impact on the African-American and Latino communities when compared with the general population. African Americans account for more than 50% of new AIDS cases, though they comprise only 12% of the general population. More than one-third of AIDS-related deaths in the United States have been among African Americans. Many factors contribute to the HIV/AIDS healthcare disparities seen in the African-American and Latino communities. These factors include medical issues (such as resistance to antiretroviral therapy, toxicities of medications and hepatitis-C coinfection) and social factors (such as a lack of faith in the healthcare system, cultural circumstances and poor access to healthcare services). Healthcare providers can take steps to improve HIV care for African Americans and Latinos. Distrust of the medical establishment can be addressed by increasing the number of culturally sensitive healthcare providers. Communication is the first step toward establishing the trust of patients and minimizing the devastating effects of perceived institutional bias that may lead many HIV patients to be diagnosed late in the course of the disease. Medical and cultural issues faced by African Americans and Latinos should also be addressed in treatment guidelines. When healthcare providers take steps to overcome the medical and cultural issues facing African Americans and Latinos, HIV patients will have access to more effective disease management. PMID:16173324
Ferguson, Y Owens; Quinn, S Crouse; Eng, E; Sandelowski, M
African American women are at increased risk of HIV transmission through heterosexual contact. HIV/AIDS is the leading cause of death among African American women between 25 to 34 years of age, and many of these women were likely infected while in college. Four focus groups were conducted with African American students attending Historically Black Colleges and Universities (HBCUs) in order to learn about the college dating environment and how it influenced women's risk of HIV infection. We used constant comparison techniques and visual display matrixes to analyse the data. Students identified the gender ratio imbalance of more women to men on campus as a key element of the campus dating environment and described how it places women at an increased risk for HIV infection. Primary consequences of this gender ratio imbalance were men having multiple female sexual partners during the same time period and women complying with men's condom use preferences. HIV preventive intervention programmes at HBCUs must address the gender ratio imbalance and its consequences to reduce women's risk of contracting the infection.
Lépine, Aurélia; Chandrashekar, Sudhashree; Shetty, Govindraj; Vickerman, Peter; Bradley, Janet; Alary, Michel; Moses, Stephen; Vassall, Anna
Expanding essential health services through non-government organisations (NGOs) is a central strategy for achieving universal health coverage in many low-income and middle-income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost-effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed-effect panel estimator and a random-intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant-based payment setting.
Chandrashekar, Sudhashree; Shetty, Govindraj; Vickerman, Peter; Bradley, Janet; Alary, Michel; Moses, Stephen; Vassall, Anna
Abstract Expanding essential health services through non‐government organisations (NGOs) is a central strategy for achieving universal health coverage in many low‐income and middle‐income countries. Human immunodeficiency virus (HIV) prevention services for key populations are commonly delivered through NGOs and have been demonstrated to be cost‐effective and of substantial global public health importance. However, funding for HIV prevention remains scarce, and there are growing calls internationally to improve the efficiency of HIV prevention programmes as a key strategy to reach global HIV targets. To date, there is limited evidence on the determinants of costs of HIV prevention delivered through NGOs; and thus, policymakers have little guidance in how best to design programmes that are both effective and efficient. We collected economic costs from the Indian Avahan initiative, the largest HIV prevention project conducted globally, during the first 4 years of its implementation. We use a fixed‐effect panel estimator and a random‐intercept model to investigate the determinants of average cost. We find that programme design choices such as NGO scale, the extent of community involvement, the way in which support is offered to NGOs and how clinical services are organised substantially impact average cost in a grant‐based payment setting. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd. PMID:26763652
Okigbo, Charles; Okigbo, Carol A.; Hall, William B., Jr.; Ziegler, Dhyana
Both African states and African American communities can benefit from a new communication framework that the United Nations Global AIDS Program and the Pennsylvania State University developed to combat the HIV/AIDS pandemic. The framework contains five universal values recommended for AIDS intervention programs worldwide (government policies,…
Lloyd, Stacey W.; Ferguson, Yvonne Owens; Corbie-Smith, Giselle; Ellison, Arlinda; Blumenthal, Connie; Council, Barbara J.; Youmans, Selena; Muhammad, Melvin R.; Wynn, Mysha; Adimora, Adaora; Akers, Aletha
Though African-American youth in the South are at high risk for HIV infection, abstinence until marriage education continues to be the only option in some public schools. Using community-based participatory research methods, we conducted 11 focus groups with African-American adults and youth in a rural community in North Carolina with high rates…
Taylor, Sandra E.; Jones, Tara
This paper investigated African American college students' responses to a set of interview questions selected from a larger survey instrument in an exploratory study of basic attitudes about HIV/AIDS. Forty-two participants responded to an interview schedule in an investigation of student attitudinal domains regarding the HIV/AIDS epidemic.…
Presents findings from interviews conducted with 18 African American women living with HIV/AIDS. Presents their perceptions of ways in which their families function as a source of support and as a source of stress in their dealings with HIV/AIDS issues. Provides information on supportive aspects provided by family in emotional, concrete, and…
Helleve, Arnfinn; Flisher, Alan J.; Onya, Hans; Mukoma, Wanjiru; Klepp, Knut-Inge
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…
Lloyd, Stacey W; Ferguson, Yvonne Owens; Corbie-Smith, Giselle; Ellison, Arlinda; Blumenthal, Connie; Council, Barbara J; Youmans, Selena; Muhammad, Melvin R; Wynn, Mysha; Adimora, Adaora; Akers, Aletha
Though African-American youth in the South are at high risk for HIV infection, abstinence until marriage education continues to be the only option in some public schools. Using community-based participatory research methods, we conducted 11 focus groups with African-American adults and youth in a rural community in North Carolina with high rates of HIV infection with marked racial disparities. Focus group discussions explored participant views on contributors to the elevated rates of HIV and resources available to reduce transmission. Participants consistently identified the public schools' sex education policies and practices as major barriers toward preventing HIV infection among youth in their community. Ideas for decreasing youth's risk of HIV included public schools providing access to health services and sex education. Policymakers, school administrators, and other stakeholders should consider the public school setting as a place to provide HIV prevention education for youth in rural areas.
Derose, Kathryn Pitkin; Kanouse, David E.; Bogart, Laura M.; Griffin, Beth Ann; Haas, Ann; Stucky, Brian D.; Williams, Malcolm V.; Flórez, Karen R.
Objectives Inform church-based stigma interventions by exploring dimensions of HIV stigma among African American and Latino religious congregants and how these are related to drug addiction and homosexuality stigmas and knowing someone HIV-positive. Methods In-person, self-administered surveys of congregants 18+ years old across two African American and three Latino churches (n=1235, response rate 73%) in a western US city with high HIV prevalence. Measures included 12 items that captured dimensions of HIV stigma, a 5-item scale that assessed attitudes towards people who are addicted to drugs, a 7-item scale assessing attitudes towards homosexuality, and questions regarding socio-demographics and previous communication about HIV. Results 63.8% of survey participants were women, mean age was 40.2 years, and 34.4% were African American, 16.8% were U.S.-born Latinos, 16.0% were foreign-born, English-speaking Latinos, and 32.9% were foreign-born, Spanish-speaking Latinos. Exploratory and confirmatory factor analyses identified four dimensions of HIV stigma – discomfort interacting with people with HIV (4 items, α=0.86), feelings of shame “if you had HIV” (3 items, α=0.78), fears of rejection “if you had HIV” (3 items, α=0.71) and feelings of blame towards people with HIV (2 items, α=0.65). Across all dimensions, after controlling for socio-demographic characteristics and previous communication about HIV, knowing someone with HIV was associated with lower HIV stigma, and greater stigma concerning drug addiction and homosexuality were associated with higher HIV stigma. Conclusions Congregation-based HIV stigma reduction interventions should consider incorporating contact with HIV-affected people. It may also be helpful to address attitudes toward drug addiction and sexual orientation. PMID:26213890
Hanson, Brent W; Wodak, Alex; Fiamma, Agnès; Coates, Thomas J
Conflict and post-conflict settings pose specific challenges to HIV prevention and care efforts. Whereas armed conflicts have decreased very considerably in number, the interactions between HIV epidemiology and conflict remain problematic. This review describes factors that affect HIV in conflict and post-conflict settings, identifies challenges to addressing HIV, and presents actionable and measurable programming and funding recommendations that can be implemented immediately. Funding priorities include prevention and care efforts such as the provision and monitoring of universal precautions for HIV infection, health services for sexual violence and antiretroviral therapy. Policy efforts should prioritize enforcing appropriate conduct by peacekeepers and aid workers, interventions targeted at specific phases and contexts of conflicts, supporting the continuity of programmes from emergency to post emergency and reconstruction efforts and simplifying and accelerating funding mechanisms.
Stewart, Jennifer M; Thompson, Keitra; Rogers, Christopher
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.
Ehsanzadeh-Cheemeh, Parvaneh; Sadeque, Abul; Grimes, Richard M; Essien, E James
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.
Fletcher, Faith; Ingram, Lucy Annang; Kerr, Jelani; Buchberg, Meredith; Bogdan-Lovis, Libby; Philpott-Jones, Sean
African American women bear a disproportionate burden of HIV/AIDS in the United States. Although they constitute only 13% of the US population, African Americans account for nearly 65% of all new HIV infections among American women. In addition, this population suffers comparatively greater adverse health outcomes related to HIV status. African American women living with HIV in the South may be further burdened by HIV/AIDS stigma, which is comparatively more pronounced in this region. To further explore this burden, we used narrative data and the Social Ecological Model to explore how African American women living with HIV in the US South recount, conceptualize, and cope with HIV/AIDS stigma at interpersonal, community, and institutional levels. Our narrative analysis suggests that HIV-positive African American women living in the South are vulnerable to experiences of multilevel HIV stigma in various settings and contexts across multiple domains of life. Stigma subsequently complicated disclosure decisions and made it difficult for women to feel supported in particular social, professional and medical settings that are generally regarded as safe spaces for noninfected individuals. Findings suggest that the debilitating and compounded effect of multilevel HIV/AIDS stigma on HIV-positive African American women in the South warrants closer examination to tailor approaches that effectively address the unique needs of this population.
Coyle, Karin K.; Anderson, Pamela M.; Franks, Heather M.; Glassman, Jill; Walker, James D.; Charles, Vignetta Eugenia
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.…
Kelly, Sherrie L; Shattock, Andrew J; Kerr, Cliff C; Stuart, Robyn M; Papoyan, Arshak; Grigoryan, Trdat; Hovhannisyan, Ruben; Grigoryan, Samvel; Benedikt, Clemens; Wilson, David P
Introduction HIV prevalence is declining in key populations in Armenia including in people who inject drugs (PWID), men who have sex with men, prison inmates, and female sex workers (FSWs); however, prevalence is increasing among Armenians who seasonally migrate to work in countries with higher HIV prevalence, primarily to the Russian Federation. Methods We conducted a modelling study using the Optima model to assess the optimal resource allocation to meet targets from the 2013 to 2016 national strategic plan to minimize HIV incidence and AIDS-related deaths by 2020. Demographic, epidemiological, behavioural, and programme cost data from 2000 through 2014 were used to inform the model. The levels of coverage that could be attained among targeted populations with different investments, as well as their expected outcomes, were determined. In the absence of evidence of the efficacy of HIV programmes targeted at seasonal labour migrants, we conducted a sensitivity analysis to determine the cost-effective funding threshold for the seasonal labour migrant programme. Results The optimization analysis revealed that shifts in funding allocations could further minimize incidence and deaths by 2020 within the available resource envelope. The largest emphasis should be on antiretroviral therapy (ART), with the optimal investment to increase treatment coverage by 40%. Optimal investments also involve increases in opiate substitution therapy and FSW programmes, as well as maintenance of other prevention programmes for PWID and prevention of mother-to-child transmission. Additional funding for these increases should come from budgets for general population programmes. This is projected to avert 17% of new infections and 29% of AIDS-related deaths by 2020 compared to a baseline scenario of maintaining 2013 spending. Our sensitivity analysis demonstrated that, at current spending, coverage of annual testing among migrants of at least 43% should be achieved to warrant continuation
Kalichman, Seth C; Simbayi, Leickness C; Jooste, Sean; Cherry, Chauncey; Cain, Demetria
Community stress associated with poverty is related to health risks and poor health outcomes. Perceived community stress is specifically related to HIV transmission risk behaviors in the United States, but research has not examined these relationships in southern Africa, the region of the world with the highest rates of HIV infection and among the greatest poverty. Men (N=464) and women (N=531) living in impoverished adjacent communities distinguished by race (e.g., indigenous African and Coloured) completed anonymous surveys of perceptions of 10 poverty-related community stressors and measures of HIV risk-related behaviors. Indigenous African and Coloured communities differed in their perceptions of stressors, with Africans consistently viewing the 10 community stressors as more serious problems. In addition, perceived seriousness of lacking basic living resources was related to higher risk for HIV among Africans. Perceived community stress was also related to alcohol and drug use, but substance use did not mediate the association between perceived community stress and HIV risks. In the Coloured community, perceived community stressors were related to drug use, but perceived community stressors were not associated with HIV risks. These findings extend the findings of previous research to show that poverty-related stressors are associated with HIV transmission risks in some poverty-stricken communities and that these associations are not mediated by substance use.
Goparaju, Lakshmi; Warren-Jeanpiere, Lari
African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women contribute to women's HIV risk. Popular media discourse tends to refer to these men as 'down low' or 'DL'. Six focus groups were conducted with 36 African American women in Washington, DC, to examine their knowledge, attitudes, beliefs and behaviours regarding DL men. Three of the focus groups were composed of HIV-positive women and three groups were composed of HIV-negative women. Data analysis reveals six central subcategories related to women's perspectives on the DL: awareness, suspicion, coping with partner infidelity (male versus female), sexual health communication, empathy and religion. No major differences were identified between the HIV-positive and HIV-negative focus groups. Findings from this study provide insight into African American women's perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women's exposure to HIV risk.
Mason-Jones, Amanda J.; Flisher, Alan J.; Mathews, Catherine
Characteristics of learners who become peer educators are rarely explored despite the potential relevance to the success of peer education programmes. Fifteen high schools selected to implement peer education HIV prevention programmes in South Africa were recruited. A total of 2339 Grade 10 learners were surveyed and comparisons were made between…
Beres, Laura K; Winskell, Kate; Neri, Elizabeth M; Mbakwem, Benjamin; Obyerodhyambo, Oby
HIV testing and counselling are a critical intervention to support treatment access and prevent new infections. Despite high rates of infection, few young Africans know their HIV status. With the aim of informing initiatives that encourage HIV testing and access to testing benefits, this study seeks to understand how young Africans make sense of HIV testing. We conducted thematic narrative-based analysis of a stratified random sample (n = 586, ≈ 5%) from 11,354 narratives written in 2005 by males and females aged 10-24 from six sub-Saharan African countries for the 'Scenarios from Africa' scriptwriting contest which invites young people to contribute ideas for short films about HIV. The factors represented by the young authors as influencing testing behaviour and outcomes are complex and interactive, indicating that interventions that are not contextually appropriate are unlikely to affect a shift towards increased testing or improved post-testing outcomes. The narratives point to opportunities to increase HIV testing in this demographic.
Kennedy, Bernice Roberts; Jenkins, Chalice C
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.
The design of effective behavioral interventions to prevent HIV infection among African American women requires a more complete understanding of the context and circumstances that precipitate infection with the virus. A descriptive study was designed to explore African American women's experiences of infection with HIV in the rural southeastern United States. Ten women living with HIV participated in interviews. All were infected through sex with a man or men; three had engaged in high-risk activities associated with HIV infection including sex trading; seven described themselves as at low risk for infection related to serial monogamy, no injection drug use, and no history of addiction. Participants reported that desire for intimacy coupled with inaccurate risk appraisal of sex partners contributed to their infection. These results provide insight into the role of intimacy in sexual risk taking. Inquiry into how women can be assisted to protect themselves in the context of intimate relationships may improve interventions to prevent HIV.
Stewart, Jennifer M.
Objective 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. Design Mixed methods cross-sectional design. Setting African American churches in Philadelphia, PA. Participants 142 African American pastors, church leaders, and young adult women ages 18 to 25. Methods Mixed methods convergent parallel design. Results 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. Conclusion 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. PMID:25139612
Anema, Aranka; Zhang, Wendy; Wu, Yingfeng; Elul, Batya; Weiser, Sheri D; Hogg, Robert S; Montaner, Julio SG; El Sadr, Wafaa; Nash, Denis
Objective To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa. Design In 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods. Setting President’s Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries. Subjects A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients. Results Of the sites under study, 303 (90%) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98%, 64%, 36% and 31% of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2·2, 95% CI 1·1, 4·5). Rural sites (AOR: 2·3, 95% CI 1·4, 3·8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2·4, 95% CI 1·4, 4·1). Sites providing ART for >2 years (AOR: 1·6, 95% CI 1·3, 1·9) and rural sites (AOR: 2·4, 95% CI 1·4, 4·4) had greater odds of food ration availability. Conclusions Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes. PMID:21806867
Klein, H; Sterk, CE; Elifson, KW
Purpose Race and HIV are intertwined in complex ways. African Americans, particularly those residing in the southern United States, are at great risk for contracting and subsequently transmitting HIV. Research on the extent to which members of this population understand the risks associated with engaging in specific behaviors is limited. This paper examines HIV knowledge among at-risk adult African American men and women and the factors associated with levels of HIV knowledge. Methods Based on a conceptual model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2011. Questionnaire-based interviews were conducted with 1,864 respondents from 80 strategically-chosen census block groups in Atlanta, Georgia. An innovative approach to assessing amount of HIV knowledge was implemented, to derive better estimates of the extent of knowledge. Results Overall, HIV knowledge was low (average=43.5% correct answers). Seven factors were identified as contributing uniquely to having higher levels of knowledge about HIV transmission: (1) younger age, (2) being educated beyond the high school level, (3) being gay, lesbian or bisexual, (4) experiencing sexual abuse during childhood and/or adolescence, (5) drinking alcohol less frequently, (6) knowing a larger number of HIV-infected persons and (7) knowing anyone currently living with “full blown” AIDS. Conclusion HIV educational and intervention programs targeting at-risk African American adults need to develop effective ways of bolstering a solid understanding of how HIV is/not transmitted. In particular, efforts need to be targeted toward older adults, those with lower levels of educational attainment and persons who are not acquainted with anyone who is HIV-infected. PMID:27891291
Maticka-Tyndale, E; Mungwete, R; Jayeoba, O
School-based programmes to combat the spread of HIV have been demonstrated to be effective over the short-term when delivered on a small scale. The question addressed here is whether results obtained with small-scale delivery are replicable in large-scale roll-out. Primary School Action for Better Health (PSABH), a programme to train teachers to deliver HIV-prevention education in upper primary-school grades in Kenya demonstrated positive impact when tested in Nyanza Province. This article reports pre-, 10-month post- and 22-month post-training results as PSABH was delivered in five additional regions of the country. A total of 26 461 students from 110 primary schools in urban and rural, middle- and low-income settings participated in this repeated cross-sectional study. Students ranged in age from 11 to 16 years, were predominantly Christian (10% Muslim), and the majority were from five different ethnic groups. Results demonstrated positive gains in knowledge, self-efficacy related to changes in sexual behaviours and condom use, acceptance of HIV+ students, endorsement of HIV-testing and behaviours to post-pone sexual debut or decrease sexual activity. These results are as strong as or stronger than those demonstrated in the original impact evaluation conducted in Nyanza Province. They support the roll-out of the programme across Kenyan primary schools.
Wallace, Scyatta A.; McLellan-Lemal, Eleanor; Harris, Muriel J.; Townsend, Tiffany G.; Miller, Kim S.
A qualitative study examined perceptions of HIV testing and strategies to enhance HIV testing among HIV-negative African American heterosexual young adults (ages 18-25 years). Twenty-six focus groups (13 male groups, 13 female groups) were conducted in two low-income communities (urban and rural). All sessions were audio-recorded and transcribed.…
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.
Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi
HIV chronicity has resulted in increased life expectancy for many African American women who acquired the disease during the epidemic’s peak years. As these women live longer and age, their social support needs may increase. Five focus groups were conducted in Washington, DC with 23 HIV-positive African American women aged 52–65 to explore women’s perceptions about how aging and HIV chronicity affects their social support needs. Participants were recruited from the longitudinal Women’s Interagency HIV Study (WIHS) participant pool. A constant comparison approach was applied during data analysis. Participants reported needing increased social support, especially emotional support from health care providers, family, and HIV-positive peers. The importance of providers and HIV-positive peers was discussed most frequently relative to meeting these needs. Health care providers in particular may need to increase their provision of emotional support when devising treatment plans to meet the social support needs of older HIV-positive African American women. PMID:28239009
Gannett, Katherine; Merrill, Jamison; Kaufman, Braunschweig Elise; Barkley, Chris; DeCelles, Jeff; Harrison, Abigail
HIV prevalence is eight times higher in young South African women compared to men. Grassroot Soccer (GRS) developed SKILLZ Street (SS), a single-sex intervention using soccer to improve self-efficacy, HIV-related knowledge, and HIV counselling and testing (HCT) uptake among girls ages 12–16. Female community leaders—“coaches”—deliver ten 2-hour sessions bi-weekly. Attendance and HCT data were collected at 38 programmes across 5 GRS sites during 24 months in 2011–2012. 514 participants completed a 16-item pre/post questionnaire. Focus group discussions (FGDs) were conducted with participants (n=11 groups) and coaches (n=5 groups), and coded for analysis using NVivo. Of 1,953 participants offered HCT, 68.5% tested. Overall, significant pre/post improvement was observed (p<0.001). FGDs suggest participants: valued coach-participant relationship; improved self-efficacy, HIV-related knowledge, communication, and changed perception of soccer as a male-only sport; and increased awareness of testing’s importance. Results suggest SS helps at-risk girls access HCT and HIV-related knowledge while promoting self-confidence. PMID:26997967
Hershow, Rebecca; Gannett, Katherine; Merrill, Jamison; Kaufman, Braunschweig Elise; Barkley, Chris; DeCelles, Jeff; Harrison, Abigail
HIV prevalence is eight times higher in young South African women compared to men. Grassroot Soccer (GRS) developed SKILLZ Street (SS), a single-sex intervention using soccer to improve self-efficacy, HIV-related knowledge, and HIV counselling and testing (HCT) uptake among girls ages 12-16. Female community leaders-"coaches"-deliver ten 2-hour sessions bi-weekly. Attendance and HCT data were collected at 38 programmes across 5 GRS sites during 24 months in 2011-2012. 514 participants completed a 16-item pre/post questionnaire. Focus group discussions (FGDs) were conducted with participants (n=11 groups) and coaches (n=5 groups), and coded for analysis using NVivo. Of 1,953 participants offered HCT, 68.5% tested. Overall, significant pre/post improvement was observed (p<0.001). FGDs suggest participants: valued coach-participant relationship; improved self-efficacy, HIV-related knowledge, communication, and changed perception of soccer as a male-only sport; and increased awareness of testing's importance. Results suggest SS helps at-risk girls access HCT and HIV-related knowledge while promoting self-confidence.
Bhattacharjee, Parinita; McClarty, Leigh M; Musyoki, Helgar; Anthony, John; Kioko, Japheth; Kaosa, Shem; Ogwang, Bernard E; Githuka, George; Sirengo, Martin; Birir, Sarah; Blanchard, James F; Muraguri, Nicholas; Isac, Shajy; Moses, Stephen
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.
This paper reports baseline behavioral and biological data collected from a cohort of 535 African American HIV serodiscordant couples enrolled in the Eban study across four urban metro areas. Data were collected on (1) the prevalence of risky sexual behaviors that occur within a couple and with concurrent sexual partners, (2) the STD prevalence for each member of the couple and (3) the correlates of STDs in the male partner as well as in the female partner. Presentation of the sociodemographic characterization and HIV risk behavior profiles of African American HIV serodiscordant couples represents an important initial description of a hidden, vulnerable population. Future research should be conducted with diverse samples of African American couples (i.e., younger couples, non-stable couples) to explore other potential correlates of STD prevalence. PMID:20499152
This paper reports baseline behavioral and biological data collected from a cohort of 535 African American HIV serodiscordant couples enrolled in the Eban study across four urban metro areas. Data were collected on (1) the prevalence of risky sexual behaviors that occur within a couple and with concurrent sexual partners, (2) the STD prevalence for each member of the couple and (3) the correlates of STDs in the male partner as well as in the female partner. Presentation of the sociodemographic characterization and HIV risk behavior profiles of African American HIV serodiscordant couples represents an important initial description of a hidden, vulnerable population. Future research should be conducted with diverse samples of African American couples (i.e., younger couples, non-stable couples) to explore other potential correlates of STD prevalence.
De Jesus, Maria; Taylor, Juanita; Maine, Cathleen; Nalls, Patricia
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
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
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.
Rose, Michelle A; Sharpe, Tanya Telfair; Raliegh, Kathleen; Reid, Laurie; Foley, Megan; Cleveland, Janet
The meeting, HIV/AIDS and African American Women: A Consultation Supporting CDC's Heightened National Response to the HIV/AIDS Crisis among African Americans, provided a forum to address gaps in prevention and HIV/AIDS infection for African American women. Health researchers, community-based organization leaders, and representatives from both healthcare and non-healthcare sectors took this opportunity to discuss and develop a variety of priorities and suggestions for HIV/AIDS prevention. Four focus areas were provided for meeting attendees to promote discussion and strategy development. The resulting list of priorities and suggestions for HIV/AIDS prevention may provide future steps for researchers, communities, and physicians to increase prevention and decrease infection rates. Novel, innovative, and participatory approaches are needed within and outside the public arena to decrease the gaps in HIV/AIDS prevention for African American women.
Paruk, Z; Mohamed, S D; Patel, C; Ramgoon, S
Given the dearth of literature on the influence of religiosity on attitudes toward people with HIV/AIDS, the present study surveyed these variables in a sample of South African Muslim university students using the Religious Orientation Scale (ROS) and an attitude to people with HIV scale. Gender differences in attitudes towards people with HIV were also examined. The sample comprised 90 male and female undergraduate and postgraduate Muslim students. While both males and females displayed high religiosity scores, male students were found to be significantly more religious than female students. No gender differences were found on the attitude to people with HIV scale, with students indicating positive attitudes to people with HIV. Higher religiosity was significantly correlated with a more positive attitude to people with HIV. The implications of the findings are discussed.
Stewart, Jennifer M.; Rogers, Christopher K.; Bellinger, Dawn; Thompson, Keitra
HIV/AIDS has a devastating impact on African Americans (AA), particularly women and young adults. We sought to characterize risks, barriers, content and delivery needs for a faith-based intervention to reduce HIV risk among AA women ages 18–25. In a convergent parallel mixed methods study we conducted four focus groups (n=38) and surveyed 71 young adult women. Data were collected across 4 AA churches for a total of 109 participants. We found the majority of women in this sample were engaged in behaviors that put them at risk for contracting HIV, struggled with religiously based barriers and matters of sexuality, and had a desire to incorporate their intimate relationships, parenting and financial burdens into faith-based HIV risk reduction interventions (RRIs). Incorporating additional social context related factors into HIV RRIs for young AA women is critical to adapting and developing HIV interventions to reduce risk among young adult women in faith settings. PMID:26879828
le Roex, N; Cooper, D; van Helden, P D; Hoal, E G; Jolles, A E
Providing an evidence base for wildlife population management is difficult, due to limited opportunities for experimentation and study replication at the population level. We utilized an opportunity to assess the outcome of a test and cull programme aimed at limiting the spread of Mycobacterium bovis in African buffalo. Buffalo act as reservoirs of M. bovis, the causative agent of bovine tuberculosis (BTB), which can have major economic, ecological and public health impacts through the risk of infection to other wildlife species, livestock and surrounding communities. BTB prevalence data were collected in conjunction with disease control operations in Hluhluwe-iMfolozi Park, South Africa, from 1999 to 2006. A total of 4733 buffalo (250-950 per year) were tested for BTB using the single comparative intradermal tuberculin (SCIT) test, with BTB-positive animals culled, and negative animals released. BTB prevalence was spatially and temporally variable, ranging from 2.3% to 54.7%. Geographic area was a strong predictor of BTB transmission in HiP, owing to relatively stable herds and home ranges. Herds experiencing more intensive and frequent captures showed reduced per capita disease transmission risk and less increase in herd prevalence over time. Disease hot spots did not expand spatially over time, and BTB prevalence in all but the hot spot areas was maintained between 10% and 15% throughout the study period. Our data suggest that HiP's test and cull programme was effective at reducing BTB transmission in buffalo, with capture effort and interval found to be the crucial components of the programme. The programme was thus successful with respect to the original goals; however, there are additional factors that should be considered in future cost/benefit analyses and decision-making. These findings may be utilized and expanded in future collaborative work between wildlife managers, veterinarians and scientists, to optimize wildlife disease control programmes and
Objective To describe the Eban HIV/STD Risk Reduction Intervention being evaluated in the NIMH Multisite HIV/STD Prevention trial for heterosexual African American couples, including the integrated theoretical framework, the structure, core elements and procedures of the intervention and how the content was shaped by culturally congruent concepts to address the needs of the study target population. Design The Eban HIV/STD Risk Reduction Intervention is designed to address multilevel individual, interpersonal and community level factors that contribute to HIV/STD transmission risk behaviors among heterosexual African American couples who are HIV serodiscordant. Methods The Eban HIV/STD Risk Reduction Intervention employs a mixed modality, couples-based approach that is based on an integrated ecological framework incorporating social cognitive theory and uses an Afro-centric paradigm that is informed by previous evidence-based couples HIV prevention interventions. For this randomized controlled trial, African American serodiscordant couples were recruited from four urban sites (Atlanta, Los Angeles, New York and Philadelphia) and were randomized to either the Eban HIV/STD Risk Reduction Intervention (treatment condition) or a Health Promotion Intervention that served as an attentional control condition. Both interventions had 4 individual couple sessions and 4 group sessions, but only the treatment condition was focused on reducing HIV/STD risk behaviors. Behavioral and biological data were collected at baseline, immediately after the intervention, and at 6 and 12 months. The theoretical framework, core elements and content of each session are described and lessons learned from this intervention trial are discussed. Results An HIV prevention intervention combining couple and group sessions can be feasibly implemented with African American HIV serodiscordant couples who remain at high risk of HIV/STD transmission. The lessons learned from the trial suggest that the
Bogart, Laura M; Skinner, Donald; Weinhardt, Lance S; Glasman, Laura; Sitzler, Cheryl; Toefy, Yoesrie; Kalichman, Seth C
In South Africa, approximately 20% of 15–49-year-olds are infected with HIV. Among black South Africans, high levels of HIV/AIDS misconceptions (e.g. HIV is manufactured by whites to reduce the black African population; AIDS is caused by supernatural forces or witchcraft) may be barriers to HIV prevention. We conducted a cross-sectional study of 150 young, black adults (aged 18–26; 56% males) visiting a public clinic for sexually transmitted infections, to investigate whether HIV/AIDS misconceptions were related to low condom use in main partner relationships. We assessed agreement with HIV/AIDS misconceptions relating to the supernatural (e.g. witchcraft as a cause of HIV) and to genocide (e.g. the withholding of a cure). In multivariate models, agreement that ‘Witchcraft plays a role in HIV transmission’ was significantly related to less positive attitudes about condoms, less belief in condom effectiveness for HIV prevention, and lower intentions to use condoms among men. The belief that ‘Vitamins and fresh fruits and vegetables can cure AIDS’ was associated with lower intentions among men to use condoms. Women who endorsed the belief linking HIV to witchcraft had a higher likelihood of unprotected sex with a main partner, whereas women who endorsed the belief that a cure for AIDS was being withheld had a lower likelihood of having had unprotected sex. Knowledge about distinct types of HIV/AIDS misconceptions and their correlates can help in the design of culturally appropriate HIV-prevention messages that address such beliefs. PMID:21804784
Singleton, Judith L; Raunig, Manuela; Brunsteter, Halley; Desmond, Michelle; Rao, Deepa
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.
Singleton, Judith L.; Raunig, Manuela; Brunsteter, Halley; Desmond, Michelle; Rao, Deepa
African American men have the highest rates of HIV in the United States, and research has shown that stigma, mistrust of healthcare, 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 United States: 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 their HIV-linked identities remain invisible and anonymous, associated with perceived and created isolation from physical community spaces. This article suggests that our healthcare 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. PMID:26863561
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
De Jesus, Maria; Carrete, Claudia; Maine, Cathleen; Nalls, Patricia
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
Amutah, Ndidiamaka N.
In 2007, the estimated HIV and AIDS case rates among adult and adolescent African-American females in the United States was 60.6 per 100,000, as compared to 3.3 per 100,000 for adult and adolescent white American females. Women living with HIV or AIDS often face complex social problems that may inhibit them from accessing resources and healthcare…
Doty, Nathan; Hawkins, Linda A.; Gaskins, Clare S.; Beidas, Rinad; Rudy, Bret J.
Abstract Understanding the multiple forms of stigma experienced by young HIV-positive African American men who have sex with men and how they relate to sexual risk behaviors is essential to design effective HIV prevention programs. This study of 40 African American young MSM found that 90% of those surveyed experienced sexual minority stigma, 88% experienced HIV stigma, and 78% experienced dual stigma. Sexual minority stigma was characterized by experiences of social avoidance, and HIV stigma, by shame. Individuals with high HIV stigma were significantly more likely to engage in unprotected sex while high or intoxicated. Associations between stigma and sexual practices were examined; youth endorsing higher levels of sexual minority stigma engaged in less insertive anal intercourse. Individuals endorsing more HIV stigma reported more receptive anal intercourse. These findings support the development of stigma-informed secondary prevention interventions for African American HIV-positive young MSM. PMID:20673080
Essien, E James; Meshack, Angela F; Peters, Ronald J; Ogungbade, GO; Osemene, Nora I
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 personal experience with
Belgrave, Faye Z.; Corneille, Maya; Hood, Kristina; Foster-Woodson, Julia; Fitzgerald, Angela
The enormous HIV/AIDS disparity among African American women and women in other ethnic groups dictates the need to implement the most effective HIV prevention interventions. This study examined the impact of perceived group support on HIV protective behaviors (i.e., attitudes and behaviors related to condom use, alcohol, and drugs) of African…
Dolcini, M. Margaret; Harper, Gary W.; Boyer, Cherrie B.; Pollack, Lance M.
There is an urgent need for continued innovation in the design of HIV/STI prevention interventions for African American females, a group at high risk for STIs and HIV. In particular, attention to social development and to culture is needed. The present study reports on a group randomized controlled trial of a friendship-based HIV/STI prevention…
Harawa, Nina T.; Ramamurthi, Hema Codathi; Bingham, Trista A.
Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested. PMID:16736115
Nunn, Amy; Cornwall, Alexandra; Chute, Nora; Sanders, Julia; Thomas, Gladys; James, George; Lally, Michelle; Trooskin, Stacey; Flanigan, Timothy
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
Nunn, Amy; Cornwall, Alexandra; Chute, Nora; Sanders, Julia; Thomas, Gladys; James, George; Lally, Michelle; Trooskin, Stacey; Flanigan, Timothy
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
Holzemer, William L; Makoae, Lucy N; Greeff, Minrie; Dlamini, Priscilla S; Kohi, Thecla W; Chirwa, Maureen L; Naidoo, Joanne R; Durrheim, Kevin; Cuca, Yvette; Uys, Yvette R
The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a 1-year period. HIV stigma has been shown to negatively affect the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardised scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a 1-year period in a three-wave longitudinal design. The average age of people living with HIV/AIDS (PLHAs) (N=948) was 36.15 years (SD=8.69), and 67.1% (N=617) were female. The average age of nurses (N=887) was 38.44 years (SD=9.63), and 88.6% (N=784) were females. Eighty-four per cent of all PLHAs reported one or more HIV-stigma events at baseline. This declined, but was still significant 1 year later, when 64.9% reported experiencing at least one HIV-stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV-stigma events and this increased to 83.7% 1 year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association.
Potterton, Joanne; Stewart, Aimee; Cooper, Peter; Becker, Pieter
Aims: The human immunodeficiency virus (HIV) potentially causes a significant encephalopathy and resultant developmental delay in infected children. The aim of this study was to determine whether a home-based intervention programme could have an impact on the neurodevelopmental status of children infected with HIV. Method: A longitudinal,…
Zumla, A; Huggett, J; Dheda, K; Green, C; Kapata, N; Mwaba, P
We describe the initiation and establishment of The University of Zambia - University College London Medical School (UNZA-UCLMS) Research and Training Project, an entirely African scientist-led, south-north partnership. In its 16 year existence, the project, by successfully obtaining competitive grant funding, has transformed itself into one of Africa's most productive African-led R&D programmes with training and visible research outputs. The project serves as a role model and now networks R&D and training activities with six southern African (10 institutions) and six European countries. This project case study illustrates that deep commitment is essential for success and that the factors which facilitate success in R&D in Africa need to be evaluated. The long-term prospects for sustaining the UNZA-UCLMS Project appear bright and are dependent on several factors: the ability to retain trained African scientists; obtaining continued competitive or donor grant funding support; and serious investment by the African governments involved. The recent 255 million Euros EDCTP investment in sub-Saharan Africa through south-north partnerships is expected to enhance existing African-led R&D programmes. African governments and scientists must rise to the challenge.
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.
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 <0.001) and decreased by 19% among HIV-infected persons from 178.2 to 144.7 (p <0.001). Tuberculous meningitis decreased by 40% from 11.3 in 2009 to 6.8 in 2012 (p <0.001) and decreased by 36% among HIV-infected persons from 54.4 to 34.9 (p <0.001). Pneumococcal meningitis decreased by 41% from 4.2 in 2009 to 2.5 in 2012 (p <0.001) and decreased by 38% among HIV-infected persons from 28.0 to 17.5 (p <0.001). Among cases of other bacterial 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
Gruskin, Sofia; Safreed-Harmon, Kelly; Moore, Chelsea L; Steiner, Riley J; Dworkin, Shari L
The global HIV policy arena has seen a surge of interest in gender-related dimensions of vulnerability to HIV and violence. UNAIDS and other prominent actors have named gender-based violence a key priority, and there seems to be genuine understanding and commitment to addressing gender inequalities as they impact key populations in the AIDS response. In the quest for evidence-informed interventions, there is usually a strong connection between the research conducted and the policies and programmes that follow. Regarding gender, HIV and violence, is this the case? This discussion paper asks whether the relevant peer-reviewed literature is suitably representative of all affected populations--including heterosexual men, transgender men and women, women who have sex with women, and men who have sex with men--as well as whether the literature sufficiently considers gender norms and dynamics in how research is framed. Conclusions about violence in the context of heterosexual relationships, and with specific attention to heterosexual women, should not be presented as insights about gender-based violence more generally, with little attention to gender dynamics. Research framed by a more comprehensive understanding of what is meant by gender-based violence as it relates to all of the diverse populations affected by HIV would potentially guide policies and programmes more effectively.
Painter, Julia E; Wingood, Gina M; DiClemente, Ralph J; Depadilla, Lara M; Simpson-Robinson, Lashun
African-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic 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 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and 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 with 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.
Paxton, Keisha C.; Williams, John K.; Bolden, Sherica; Guzman, Yesenia; Harawa, Nina T.
Background HIV continues to impact African American women at alarming rates. Yet, few researchers have examined the relationship factors promoting unprotected sex within African American communities, especially instances in which women are aware that their male partners are engaging in high risk behaviors. This qualitative study explored the sexual behaviors, relationship characteristics, and HIV prevention strategies utilized by African American women in relationships with African American men at-risk for HIV. Method To understand the issues that should be addressed in a sexual risk-reduction intervention, data were collected from three, two-hour focus group discussions (n=24) comprised primarily of low-income African American women with histories of at-risk male sex partners. At-risk partners included specifically men who had sex with other men or with transgender individuals, used crack cocaine or injection drugs, had lengthy incarceration periods, or an unknown sexual history. Discussion questions examined external factors affecting sexual risk behaviors such as societal pressures, peer norms, and financial vulnerability. Discussions were audiotaped, transcribed, and analyzed using a consensual qualitative research approach. Results Five themes, including self-esteem, social influences on behavior, relationship fidelity, sexual risk behavior, and partners' sexual behaviors, were identified as placing women at increased risk for HIV. Reasons for inconsistent condom use included concern for maintaining the relationship and substance use before and during sex. African American women also believed that men who have sex with men and women (MSMW) were dishonest about their sexuality due to stigma towards homosexuality/bisexuality. Despite these challenges, participants indicated that African American women have a strong sense of pride that can positively impact behaviors in relationships. Conclusion The findings of this study support that social and contextual factor
Brooks, Ronald A.; Lee, Sung-Jae; Stover, Gabriel N.; Barkley, Thomas W.
SUMMARY This study examined HIV testing behaviors, perceived vulnerability to HIV, and correlates of sexual risk behaviors of young adult Latino and African American male gang members in Los Angeles, California. Data were collected from 249 gang members ages 18–26 years old. The majority (59%) of gang members reported unprotected vaginal intercourse (UVI) in the past 12 months. Only one-third (33.2%) of gang members had ever been tested for HIV. In our multivariate analysis, gang members who reported UVI were more likely to have engaged in the following behaviors: had sex with someone they just met (Adjusted Odds Ratio [AOR] = 4.51), had sex with someone they think or know had an STD (AOR = 4.67), or had sex while incarcerated (AOR = 8.92). In addition, gang members with a higher perceived vulnerability to HIV were less likely to report UVI in the previous 12 months (AOR= 0.75). These findings offer implications for development of an HIV prevention intervention for young Latino and African American male gang members. PMID:21364062
Brooks, R A; Lee, S-J; Stover, G N; Barkley, T W
This study examined HIV testing behaviours, perceived vulnerability to HIV and correlates of sexual risk behaviours of young adult Latino and African American male gang members in Los Angeles, California. Data were collected from 249 gang members aged 18-26 years. The majority (59%) of gang members reported unprotected vaginal intercourse (UVI) in the past 12 months. Only one-third (33.2%) of gang members had ever been tested for HIV. In our multivariate analysis, gang members who reported UVI were more likely to have engaged in the following behaviours: had sex with someone they just met (adjusted odds ratio [AOR] = 4.51), had sex with someone they think or know had a sexually transmitted infection (STI; AOR = 4.67) or had sex while incarcerated (AOR = 8.92). In addition, gang members with a higher perceived vulnerability to HIV were less likely to report UVI in the previous 12 months (AOR = 0.75). These findings offer implications for development of an HIV prevention intervention for young Latino and African American male gang members.
Marston, Milly; Zaba, Basia; Salomon, Joshua A; Brahmbhatt, Heena; Bagenda, Danstan
For a given prevalence, HIV has a relatively higher impact on child mortality when mortality from other causes is low. To project the effect of the epidemic on child mortality, it is necessary to estimate a realistic schedule of "net" age-specific mortality rates that would operate if HIV were the only cause of child death observable. We assume that this net pattern would be independent of mortality from other causes. We used African studies that measured the survival of HIV-infected children (direct data) or survival of children of HIV-infected mothers (indirect data). We developed a mathematic procedure to estimate the mortality of infected children from indirect data sources and obtained net HIV mortality patterns for each study population. The net age-specific HIV mortality pattern for infected children can be described by a double Weibull curve fitted to empiric data; this gives a functional representation of age-specific mortality rates that decline after infancy and rise in the preteens. The fitted curve that we would expect if HIV were the only effective cause of death shows 67% net survival at 1 year and 39% at 5 years. The curve also predicts 13% net survival at 10 years using constraints based on survival of infected adults.
Surratt, Hilary L; Kurtz, Steven P
Foster care has been associated with increased HIV risk behaviors among youth, yet long-term association with HIV infection has not been examined. This study explored the associations between foster placement, victimization, mental health, onset of sex work and HIV infection among highly vulnerable female sex workers. 562 drug-involved African American women were enrolled into an intervention study to increase health services utilization and reduce HIV risk. Seventeen percent reported a history of foster placement. Foster history was associated with significantly lower educational attainment, higher victimization, and more severe mental health problems. Women with foster histories reported significantly earlier entry into paid sex work, with some 62% active in the sex trade before age 18. Multivariate analyses found that foster care was independently associated with HIV seropositivity, and that early sex work partially mediated this association. The potential long-term health vulnerabilities associated with foster placement are understudied and warrant additional research.
Adedimeji, Adebola A; Asibon, Aba; O'Connor, Gerard; Carson, Richard; Cowan, Ethan; McKinley, Philip; Leider, Jason; Mallon, Patrick; Calderon, Yvette
In 2012, immigrants constitute 63% of new cases of heterosexually transmitted HIV among individuals born outside Ireland. Current strategies to encourage testing can be ineffective if immigrants perceive them as culturally insensitive. We obtained qualitative data to explore challenges to voluntary HIV-testing for immigrants in Ireland. Content analysis was undertaken to identify and describe pertinent themes. Widespread beliefs that HIV is primarily a disease of African immigrants were identified as challenges that constrain access to testing and care. The organization and location of testing services, attitude of health workers, and beliefs regarding mandatory HIV-testing for immigrants seeking access to welfare benefits were also identified. Immigrants in Ireland encounter a variety of structural, cultural and personal constraints to HIV testing. Opportunities exist in the Irish Health system to increase testing among immigrants through greater acknowledgement of cultural sensitivities of immigrant groups.
Oduaran, A. B.
This article reports on the relationship between seven factors that described dimensions of education service quality and overall service quality on one hand, and students' satisfaction with the professional teacher development programmes by distance mode in a South African University on the other. We sought to find out whether students enrolled…
Mavunga, George; Cachalia, Fahmida
This study compared how the cohort of extended diploma students enrolled at a comprehensive South African university in 2012 perceived the programmes for which they were enrolled at the beginning of their first year and towards the end of the year. Data were gathered using questionnaires and semi-structured interviews involving students enrolled…
Holzemer, William L.; Makoae, Lucy N.; Greeff, Minrie; Dlamini, Priscilla S.; Kohi, Thecla W.; Chirwa, Maureen L.; Naidoo, Joanne R.; Durrheim, Kevin; Cuca, Yvette; Uys, Leana R.
The aim of this article is to document the levels of HIV stigma reported by persons living with HIV infections and nurses in Lesotho, Malawi, South Africa, Swaziland and Tanzania over a one-year period. HIV stigma has been shown to affect negatively the quality of life for people living with HIV infection, their adherence to medication, and their access to care. Few studies have documented HIV stigma by association as experienced by nurses or other health care workers who care for people living with HIV infection. This study used standardized scales to measure the level of HIV stigma over time. A repeated measures cohort design was used to follow persons living with HIV infection and nurses involved in their care from five countries over a one-year period in a three-wave longitudinal design. The average age of PLHAs (n = 948) was 36.15 years (SD= 8.69), and 67.1% (n= 617) were female. The average age of nurses (n = 887) was 38.44 years (SD=9.63), and 88.6% (n=784) were females. Eighty-four percent of all PLHAs reported one or more HIV stigma event at baseline. This declined, but was still significant one year later when 64.9% reported experiencing at least one HIV stigma event. At baseline, 80.3% of the nurses reported experiencing one or more HIV stigma events and this increased to 83.7% one year later. The study documented high levels of HIV stigma as reported by both PLHAs and nurses in all five of these African countries. These results have implications for stigma reduction interventions, particularly focused at health care providers who experience HIV stigma by association. PMID:19936409
Pinto, R. M.; McKay, M. M.
Grounded in a model of service utilization, this study conceptualizes attendance of African-American women at an HIV prevention intervention as associated with influences across three ecological domains--individual, service (program), and social network. First, the texts of responses to semistructured, open-ended elicitation interviews were…
Bogart, Laura M; Mutchler, Matt G; McDavitt, Bryce; Mutepfa, Kieta D; Risley, Brian
Background HIV-positive African Americans have been shown to have lower adherence to antiretroviral therapy (ART) than those of other races/ethnicities, yet adherence interventions have rarely been tailored to the needs of this population. Objective We developed and will evaluate a treatment education adherence intervention (called Rise) that was culturally adapted to address the needs of African Americans living with HIV. Methods This randomized controlled trial will examine the effects of the Rise intervention on ART adherence and HIV viral load. African Americans on ART who report adherence problems will be recruited from the community and randomly assigned to receive the intervention or usual care for 6 months. The intervention consists of 6-10 individual counseling sessions, with more sessions provided to those who demonstrate lower adherence. Primary outcomes include adherence as monitored continuously with Medication Event Monitoring Systems (MEMS) caps, and viral load data received from the participant’s medical provider. Survey assessments will be administered at baseline and month 6. Results The trial is ongoing. Conclusions If effective, the Rise intervention will provide community-based organizations with an intervention tailored to address the needs of African Americans for promoting optimal ART adherence and HIV clinical outcomes. Trial Registration Clinicaltrials.gov NCT01350544; https://clinicaltrials.gov/ct2/show/NCT01350544 (Archived by WebCite at http://www.webcitation.org/6fjqqnmn0). PMID:27025399
Raijmakers, L. R.; Pretorius, J. D.
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…
Harper, Gary W.; Dolcini, M. Margaret; Benhorin, Shira; Watson, Susan E.; Boyer, Cherrie B.
This article presents findings from a qualitative evaluation of an HIV/STI (sexually transmitted infection) prevention intervention for urban African American youth (Project ÒRÉ), which was delivered to groups of 3 to 8 adolescents who were members of the same friendship network. Sixteen focus groups (N = 63) were conducted with youth following…
Kogan, Steven M.; Brody, Gene H.; Gibbons, Frederick X.; Chen, Yi-fu; Grange, Christina M.; Simons, Ronald L.; Gerrard, Meg; Cutrona, Carolyn E.
A longitudinal model that tested mediating pathways between protective family processes and HIV-related behavior was evaluated with 195 African American youth. Three waves of data were collected when the youth were 13, 15, and 19 years old. Evidence of mediation and temporal priority were assessed for 3 constructs: academic engagement, evaluations…
Miller, Kim S.; Boyer, Cherrie B.; Cotton, Garnette
Sexually transmitted infections, including human immunodeficiency virus (HIV), disproportionately affect African American adolescents and young adults. Many of our current strategies and approaches have been inadequate in the promotion of risk reduction among youth and need to be reconceptualized. This article identifies issues that may guide…
Milhausen, Robin R.; Crosby, Richard; Yarber, William L.; DiClemente, Ralph J.; Wingood, Gina M.; Ding, Kele
Objective: To determine differences between African American adolescents on STD/HIV sexual-risk behaviors and precursors to these risk behaviors. Methods: Six hundred sixty-three rural and 3313 nonrural adolescents who completed the 1999 YRBS Survey were selected. Results: Rural females and males were more likely to report ever having coitus and…
Melwa, Irene T.; Oduntan, Olalekan A.
Objective: To assess the basic knowledge about HIV and AIDS among young South Africans in the Capricorn District of Limpopo Province, South Africa. Design: A questionnaire-based cohort study, involving data collection from senior high school students. Setting: Randomly selected high schools in the Capricorn District, Limpopo Province, South…
Kerr, Jelani; Jackson, Trinidad
The relationship between drug policy and HIV vulnerability is well documented. However, little research examines the links between racial/ethnic HIV disparities via the Drug War, sexual risk, and stigma. The Drug War HIV/AIDS Inequities Model has been developed to address this dearth. This model contends that inequitable policing and sentencing promotes sexual risks, resource deprivation, and ultimately greater HIV risk for African-Americans. The Drug War also socially marginalizes African Americans and compounds stigma for incarcerated and formerly incarcerated persons living with HIV/AIDS. This marginalization has implications for sexual risk-taking, access to health-promoting resources, and continuum of care participation. The Drug War HIV/AIDS Inequities Model may help illuminate mechanisms that promote increased HIV vulnerability as well as inform structural intervention development and targeting to address racial/ethnic disparities.
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
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.
Fuqua, V; Scott, H; Scheer, S; Hecht, J; Snowden, J M; Raymond, H Fisher
African American men who have sex with men have been disproportionately affected by the HIV epidemic in the United States and remain to this day one of the groups with highest HIV prevalence and incidence. Our goal was to clarify the current state of HIV risk, sexual behaviors, and structural/network-network level factors that affect black MSM's population risk of HIV, enabling the formulation of targeted and up-to-date public health messages/campaigns directed at this vulnerable population. Our approach maximized the use of local data through a process of synthesis and triangulation of multiple independent and overlapping sources of information that are sometimes separately published and often not examined side-by-side. Among African American MSM, we observed stable HIV incidence despite increases in reported individual risk behavior and STDs. An increasing proportion of African American MSM are reporting HIV testing in the past 6 months and seroadaptive behaviors, which may play a role in this observed decline in HIV among MSM in San Francisco, California. Our analysis suggests that currently the HIV epidemic is stable among African American MSM in San Francisco. However, we suggest that the observed stability is due to factors prohibiting expansion of new infections rather than decreasing risks for HIV infection among African American MSM.
Goh, Yun Shan; Necchi, Francesca; O’Shaughnessy, Colette M.; Micoli, Francesca; Gavini, Massimiliano; Young, Stephen P.; Msefula, Chisomo L.; Gondwe, Esther N.; Mandala, Wilson L.; Gordon, Melita A.; Saul, Allan J.; MacLennan, Calman A.
Background 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. Methodology/Principal Findings 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. Conclusion/Significance 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
Growing evidence suggests that drug and alcohol use are fueling the heterosexual transmission of HIV among African Americans. This study aims to examine the relative contribution of drug and alcohol use of male and female partners to risks of heterosexual transmission of HIV among 535 African American HIV serodiscordant couples (N = 1,070 participants) who participated in an HIV prevention trial. Associations found between use of drugs and alcohol by one or both partners and sexual risk indicators varied by type of substance and whether male or female partner or both partners reported use. The findings suggest multiple ways in which substance use of male and female partners may be contributing to the heterosexual transmission of HIV and other STDs among African Americans and underscore the need for HIV prevention strategies to address dyadic patterns of substance use that lead to sexual risks.
Growing evidence suggests that drug and alcohol use are fueling the heterosexual transmission of HIV among African Americans. This study aims to examine the relative contribution of drug and alcohol use of male and female partners to risks of heterosexual transmission of HIV among 535 African American HIV serodiscordant couples (N = 1,070 participants) who participated in an HIV prevention trial. Associations found between use of drugs and alcohol by one or both partners and sexual risk indicators varied by type of substance and whether male or female partner or both partners reported use. The findings suggest multiple ways in which substance use of male and female partners may be contributing to the heterosexual transmission of HIV and other STDs among African Americans and underscore the need for HIV prevention strategies to address dyadic patterns of substance use that lead to sexual risks. PMID:20499153
Saleh, Lena D.; Chambers, Christopher S.; Operario, Don
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 behaviors. 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 multi-level interventions that enhance social support networks and address the social-psychological, emotional, and interpersonal factors that contribute to HIV risk among African American MSM. PMID:26588945
Saleh, Lena D; van den Berg, Jacob J; Chambers, Christopher S; Operario, Don
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.
Walensky, Rochelle P.; Park, Ji-Eun; Wood, Robin; Freedberg, Kenneth A.; Scott, Callie A.; Bekker, Linda-Gail; Losina, Elena; Mayer, Kenneth H.; Seage, George R.; Paltiel, A. David
Background. Recent trials report the short-term efficacy of tenofovir-based pre-exposure prophylaxis (PrEP) for prevention of human immunodeficiency virus (HIV) infection. PrEP’s long-term impact on patient outcomes, population-level transmission, and cost-effectiveness remains unknown. Methods. We linked data from recent trials to a computer model of HIV acquisition, screening, and care to project lifetime HIV risk, life expectancy (LE), costs, and cost-effectiveness, using 2 PrEP-related strategies among heterosexual South African women: (1) women receiving no PrEP and (2) women not receiving PrEP (a tenofovir-based vaginal microbicide). We used a South African clinical cohort and published data to estimate population demographic characteristics, age-adjusted incidence of HIV infection, and HIV natural history and treatment parameters. Baseline PrEP efficacy (percentage reduction in HIV transmission) was 39% at a monthly cost of $5 per woman. Alternative parameter values were examined in sensitivity analyses. Results. Among South African women, PrEP reduced mean lifetime HIV risk from 40% to 27% and increased population discounted (undiscounted) LE from 22.51 (41.66) to 23.48 (44.48) years. Lifetime costs of care increased from $7280 to $9890 per woman, resulting in an incremental cost-effectiveness ratio of $2700/year of life saved, and may, under optimistic assumptions, achieve cost savings. Under baseline HIV infection incidence assumptions, PrEP was not cost saving, even assuming an efficacy >60% and a cost <$1. At an HIV infection incidence of 9.1%/year, PrEP achieved cost savings at efficacies ≥50%. Conclusions. PrEP in South African women is very cost-effective by South African standards, conferring excellent value under virtually all plausible data scenarios. Although optimistic assumptions would be required to achieve cost savings, these represent important benchmarks for future PrEP study design. PMID:22474224
Siddiqi, Azfar-e-Alam; Hu, Xiaohong; Hall, H Irene
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.
BARSDORF, NICOLA; MAMAN, SUZANNE; KASS, NANCY; SLACK, CATHERINE
Access to treatment, in HIV vaccine trials (HVTs), remains ethically controversial. In most prevention trials, including in South Africa, participants who seroconvert are referred to publicly funded programmes for treatment. This strategy is problematic when there is inadequate and uneven access to public sector antiretroviral therapy (ART) and support resources. The responsibilities, if any, of researchers, sponsors and public health authorities involved in HVTs has been hotly debated among academics, scholars, representatives of international organizations and sponsors. However, there is little published on community perceptions. Recent guidance asserts that communities should make inputs into treatment and care decisions. This qualitative study explored a South African community’s perceptions of who should provide what to HVT participants as well as how and why this should be done. Twenty-nine adults working at or attending five primary health care clinics in two rural areas in KwaZulu-Natal participated in in-depth interviews. Respondents expressed that researchers should ‘help participants to access’ treatment and care ‘because they are in a position to do so’ and ‘are in a relationship with’ trial participants. Respondents suggested that researchers could help by ‘facilitating referral’ until such time that participants can access care and treatment on their own. We highlight a series of implications for researchers in HVTs, including their need to be aware of prospective participants’ considerable trust in and respect for researchers, the responsibility that this places on them, and the need for clear communication with communities so as not to erode community trust. PMID:19793135
Horne, Sharon G; Levitt, Heidi M; Sweeney, Kristin Kay; Puckett, Julia A; Hampton, Martavius L
Gay families are constructed support networks that gay, bisexual, and transgender individuals of color form, often in response to societal marginalization and rejection from biological families. Research on these family structures has been scarce, with little focus on the experience of African American gay family networks in the South. The current grounded theory qualitative study focused on the experiences of 10 African American male and transgender individuals between the ages of 18 and 29 from gay families in the Mid-South, and explored the ways these families addressed safe-sex issues and human immunodeficiency virus (HIV) risk prevention. Results revealed that families can play a role in either increasing HIV risk (e.g., ignoring HIV issues, encouraging such unsafe behaviors as exchanging sex for money or drugs, stigmatizing HIV-positive people) or decreasing it (e.g., intensive, family-level prevention efforts at safe-sex practices and family support for HIV treatment adherence). The potential of these family networks for HIV prevention and adherence efforts is considered.
Brown, T; Peerapatanapokin, W
Process models offer opportunities to explore the effectiveness of different programme and policy alternatives by varying input behaviours and model parameters to reflect programmatic/policy effects. The Asian Epidemic Model (AEM) has been designed to reflect the primary groups and transmission modes driving HIV transmission in Asia. The user adjusts AEM fitting parameters until HIV prevalence outputs from the model agree with observed epidemiological trends. The AEM resultant projections are closely tied to the epidemiological and behavioural data in the country. In Thailand and Cambodia they have shown good agreement with observed epidemiological trends in surveillance populations and with changes in HIV transmission modes, AIDS cases, male:female ratios over time, and other external validation checks. By varying the input behaviours and STI trends, one can examine the impact of different prevention efforts on the future course of the epidemic. In conclusion, the AEM is a semi-empirical model, which has worked well in Asian settings. It provides a useful tool for policy and programme analysis in Asian countries.
Logie, Carmen H.; Jenkinson, Jesse I. R.; Earnshaw, Valerie; Tharao, Wangari; Loutfy, Mona R.
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 health. PMID
Ley, Clemens; Leach, Lloyd; Barrio, María Rato; Bassett, Susan
This study aimed to analyse the physical health effects of a community based 10-week physical activity programme with people living with HIV. It was developed, implemented and evaluated in a disadvantaged community in South Africa. A pre-post research design was chosen. Major recruitment and adherence challenges resulted in a small sample. Among the 23 participants who took part in both baseline and final testing, compliant participants (n = 12) were compared to non-compliant participants (n = 11). Immunological (CD4, viral load), anthropometric (height, weight, skinfolds and waist to hip ratio), muscular strength (h1RM) and cardiopulmonary fitness (time on treadmill) parameters were measured. The compliant and non-compliant groups were not different at baseline. Muscular strength was the parameter most influenced by compliance with the physical activity programme (F = 4.516, p = 0.047). Weight loss and improvement in cardiopulmonary fitness were restricted by the duration of the programme, compliance and influencing factors (e.g. nutrition, medication). The increase in strength is significant and meaningful in the context, as the participants' goals were to look healthy and strong to avoid HIV related stigma. The improvements in appearance were a motivational factor, especially since the changes were made visible in a short time. Practical implications for health promotion are described. More research contextualised in disadvantaged settings is needed.
Miles, Margaret Shandor; Isler, Malika Roman; Banks, Bahby B.; Sengupta, Sohini; Corbie-Smith, Giselle
We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering—the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole. PMID:21041516
Farel, Claire E.; Parker, Sharon D.; Muessig, Kathryn E.; Grodensky, Catherine A.; Jones, Chaunetta; Golin, Carol E.; Fogel, Catherine I.; Wohl, David A.
Background Women who have been in prison carry a greater lifetime risk of HIV for reasons that are not well understood. This effect is amplified in the Southeastern United States, where HIV incidence and prevalence is especially high among African American (AA) women. The role of consensual sexual partnerships in the context of HIV risk, especially same-sex partnerships, merits further exploration. Methods We conducted digitally recorded qualitative interviews with 29 AA women (15 HIV-positive, 14 HIV-negative) within three months after entry into the state prison system. We explored potential pre-incarceration HIV risk factors, including personal sexual practices. Two researchers thematically coded interview transcripts and a consensus committee reviewed coding. Results Women reported complex sexual risk profiles during the six months prior to incarceration, including sex with women as well as prior sexual partnerships with both men and women. Condom use with primary male partners was low and a history of transactional sex work was prevalent. These behaviors were linked to substance use, particularly among HIV-positive women. Conclusions Although women may not formally identify as bisexual or lesbian, sex with women was an important component of this cohort’s sexuality. Addressing condom use, heterogeneity of sexual practices, and partner concurrency among at-risk women should be considered for reducing HIV acquisition and preventing forward transmission in women with a history of incarceration. PMID:24183410
Sutton, Madeline Y.; Hardnett, Felicia P.; Wright, Pierre; Wahi, Sagina; Pathak, Sonal; Warren-Jeanpiere, Lari; Jones, Sandra
Objective African American young adults are disproportionately affected by the HIV/AIDS epidemic and often unaware of their personal risk for HIV. Historically black colleges and universities (HBCUs) enroll 25% of college-educated African American young adults and can play an important role in HIV prevention. We examined HIV/AIDS knowledge of students at HBCUs to inform and strengthen our HIV prevention efforts at HBCUs. Methods African American undergraduate HBCU students completed online surveys assessing HIV/AIDS knowledge and behaviors, and we analyzed data to assess their knowledge and behaviors. Results A total of 1,051 of 1,230 surveys completed (85.4%) were analyzable. Eighty-two percent of students had average/high HIV knowledge scores. Seventy-nine percent of students surveyed perceived themselves to be at low risk for HIV infection; 64% of those who had at least two or more sex partners had not used a condom at last sex encounter. In the final model, significant independent effects were identified for average/high knowledge of HIV risk, including agreeing with assessing a potential partner's HIV risk by all of the five actions listed (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] 1.7, 4.3) and never using a needle to inject drugs (AOR=5.6, 95% CI 3.2, 9.7). Conclusions Educating students about effectively assessing sex partner risk will improve HIV knowledge and prevention efforts at HBCUs. PMID:21886325
Gentry, Quinn M.; Elifson, Kirk; Sterk, Claire
The purpose of this study was to examine how various living conditions impact the context within which low-income African American women engage in a diverse range of high-risk behavior that increases their risk for HIV infection. The study, based on 2 years of ethnographic fieldwork, analyzed the living conditions of 45 African American women at…
Center, Katherine E; Gunn, Jayleen K L; Asaolu, Ibitola O; Gibson, Steven J; Ehiri, John E
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 into family
Stein, E. M.; McMahon, D. J.; Shu, A.; Zhang, C. A.; Ferris, D. C.; Colon, I.; Dobkin, J. F.; Hammer, S. M.; Shane, E.
Summary We evaluated vitamin D status in HIV+ and HIV− postmenopausal African-American (AA) and Hispanic women. Most women (74–78%) had insufficient 25-hydroxyvitamin D (25OHD) levels, regardless of HIV status. 25OHD was lower in AA women and women lacking supplement use, providing support for screening and supplementation. Among HIV+ women, 25OHD was associated with current CD4 but not type of antiretroviral therapy. Introduction To evaluate vitamin D status and factors associated with vitamin D deficiency and insufficiency in HIV-infected (HIV+) postmenopausal minority women. Methods In this cross-sectional study, 89 HIV+ and 95 HIV− postmenopausal women (33% AA and 67% Hispanic) underwent assessment of 25OHD, 1,25-dihydroxyvitamin D, parathyroid hormone, markers of bone turnover and bone mineral density by dual energy X-ray absorptiometry. Results The prevalence of low 25OHD did not differ by HIV status; the majority of both HIV+ and HIV− women (74–78%) had insufficient levels (<30 ng/ml). Regardless of HIV status, 25OHD was significantly lower in AA subjects, and higher in subjects who used both calcium and multi-vitamins. In HIV+ women on antiretroviral therapy (ART), 25OHD was directly associated with current CD4 count (r= 0.32; p<0.01) independent of age, ethnicity, BMI, or history of AIDS-defining illness. No association was observed between 1,25(OH)2D and CD4 count or between serum 25OHD, 1,25(OH)2D or PTH and type of ART. Conclusions In postmenopausal minority women, vitamin D deficiency was highly prevalent and associated with AA race and lack of supplement use, as well as lower current CD4 cell count. These results provide support for screening and repletion of vitamin D in HIV+ patients. PMID:20585939
Foster, Michael L; Arnold, Emily; Rebchook, Gregory; Kegeles, Susan M
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.
Foster, Michael L.; Arnold, Emily; Rebchook, Gregory
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
Chandrashekar, Sudhashree; Guinness, Lorna; Pickles, Michael; Shetty, Govindraj Y.; Alary, Michel; Vickerman, Peter; Vassall, Anna
Objective The study objective is to measure, analyse costs of scaling up HIV prevention for high-risk groups in India, in order to assist the design of future HIV prevention programmes in South Asia and beyond. Design Prospective costing study. Methods This study is one of the most comprehensive studies of the costs of HIV prevention for high-risk groups to date in both its scope and size. HIV prevention included outreach, sexually transmitted infections (STI) services, condom provision, expertise enhancement, community mobilisation and enabling environment activities. Economic costs were collected from 138 non-government organisations (NGOs) in 64 districts, four state level lead implementing partners (SLPs), and the national programme level (Bill and Melinda Gates Foundation (BMGF)) office over four years using a top down costing approach, presented in US$ 2011. Results Mean total unit costs (2004–08) per person reached at least once a year and per monthly contact were US$ 235(56–1864) and US$ 82(12–969) respectively. 35% of the cost was incurred by NGOs, 30% at the state level SLP and 35% at the national programme level. The proportion of total costs by activity were 34% for expertise enhancement, 37% for programme management (including support and supervision), 22% for core HIV prevention activities (outreach and STI services) and 7% for community mobilisation and enabling environment activities. Total unit cost per person reached fell sharply as the programme expanded due to declining unit costs above the service level (from US$ 477 per person reached in 2004 to US$ 145 per person reached in 2008). At the service level also unit costs decreased slightly over time from US$ 68 to US$ 64 per person reached. Conclusions Scaling up HIV prevention for high risk groups requires significant investment in expertise enhancement and programme administration. However, unit costs decreased with programme expansion in spite of an increase in the scope of activities
Kogan, Steven M.; Brody, Gene H.; Gibbons, Frederick X.; Chen, Yi-fu; Grange, Christina M.; Simons, Ronald L.; Gerrard, Meg; Cutrona, Carolyn E.
A longitudinal model that tested mediating pathways between protective family processes and HIV-related behavior was evaluated with 195 African American youth. Three waves of data were collected when the youth were 13, 15, and 19 years old. Evidence of mediation and temporal priority were assessed for three constructs: academic engagement, evaluations of prototypical risk-taking peers, and affiliations with risk-promoting peers. Structural equation modeling indicated that protective family processes assessed during early adolescence were associated with HIV-related behavior during emerging adulthood and that academic engagement, evaluations of prototypical risk-taking peers, and affiliations with risk-promoting peers accounted for this association. Evidence of a specific pathway emerged: protective family processes → academic engagement negative → evaluations of prototypical risk-taking peers→ affiliations with risk-promoting peers→ HIV-related behavior. Academic engagement also was a direct predictor of HIV-related risk behavior. PMID:21643492
Peltzer, Jill N; Domian, Elaine W; Teel, Cynthia S
This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.
Carswell, J W; Lloyd, G; Howells, J
Sixty-eight lorry drivers and their assistants were examined for evidence of infection with HIV-1 because of their association and regular contact with prostitutes. Out of a total of 68 drivers, 24 (35.2%) were serologically found to be HIV-1 positive. Epidemiological evidence demonstrated a wide travel history involving seven different countries served by the port of Mombasa. History of other sexually transmitted disorders were significantly higher in HIV-seropositive individuals. The data presented here further support the hypothesis that a major route of heterosexual transmission of HIV in Africa is dissemination through a group such as lorry drivers and their assistants, whose behaviour puts them at risk of acquiring sexually transmitted diseases.
Murphy, Kerry; Richardson, Barbra A.; Dezzutti, Charlene S.; Marrazzo, Jeanne; Hillier, Sharon L.; Hendrix, Craig W.; Herold, Betsy C.
Problem To explore the impact of race and geographic region on biomarkers of HIV risk and vaginal health, differences in soluble immune mediators were measured in US vs. African and US white vs. US black women at enrollment into a phase 2 microbicide trial. Methods Levels of soluble mucosal immune mediators and inhibitory activity against E. coli, which may serve as biomarkers of risk for HIV and other genital tract infections, were quantified in cervicovaginal lavage (CVL) collected from HIV-uninfected women in the US (n=73) and Africa (n=73). Differences between groups were analyzed with multivariable logistic regression models for dichotomous variables and linear regression models for continuous variables. Results Secretory leukocyte protease inhibitor, lactoferrin, human beta defensins, interleukin (IL)-8 and interferon-gamma induced protein-10 were significantly higher in US compared to African women in multivariable analysis, but only IL-1β was significantly different between US white and black women. E. coli inhibitory activity did not differ among groups in adjusted analyses. Conclusion Differences in soluble mucosal immunity between US and African women may play an important role in women’s risk for HIV and other genital tract infections and response to prevention strategies including vaginal microbicides and should be considered in future studies. PMID:26094732
According to a 2009 UNAIDS report the HIV/AIDS prevalence rate in Zanzibar, Tanzania, is low in the general population (0.6%), but high among vulnerable groups, specifically sex workers (10.8%), injecting drug users (15.1%), and men who have sex with men (12.3%). In response to this concentrated epidemic, the Government of Zanzibar, international and local non-profit organisations have focused their prevention activities on these marginal populations. Although these efforts are beneficial in terms of disseminating information about HIV/AIDS and referring clients to health clinics, they fail to address how the socio-economic status of these groups places them at a greater risk for contracting and dying from the virus. Furthermore, there is an absence of qualitative research on these populations which is needed to understand the challenges these groups face and to improve the effectiveness of interventions. Through interviews with employees of government agencies and non-profit organisations, medical professionals, vulnerable populations and HIV/AIDS patients, this paper used a political economy of health and syndemic framework to examine how local realities inform and challenge HIV/AIDS programmes in Zanzibar.
Stewart, Jennifer M.
The African American church has promoted the health of African Americans through supporting interventions that target a wide variety of diseases, and it is a crucial community partner in the development of HIV prevention interventions. Although research has described the development of church-based HIV interventions, there is a significant lack of frameworks and approaches available to guide the implementation and maintenance of HIV interventions within church-based settings. A developing framework of a comprehensive church-based intervention, derived from an ethnographic study about the development, implementation, and maintenance of an HIV/AIDS Ministry within an African American church is presented. This approach can provide guidance to support the development, implementation, and maintenance of HIV interventions in faith settings. PMID:25702738
Hodge, David R.; Roby, Jini L.
From a global perspective, the typical person living with HIV/AIDS is likely a sub-Saharan African woman. Yet despite calls from NASW to adopt a global outlook on the HIV/AIDS crisis, little research has examined how such women cope. In this study, the authors used a mixed-methods approach to explore how one sample of sub-Saharan African women (N…
Jappah, Jlateh V.
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. PMID:23391163
Kamali, Anatoli; Price, Matt A.; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J.; Anzala, Omu; Latka, Mary H.; Bekker, Linda-Gail; Kaleebu, Pontiano; Asiki, Gershim; Ssetaala, Ali; Ruzagira, Eugene; Allen, Susan; Farmer, Paul; Hunter, Eric; Mutua, Gaudensia; Makkan, Heeran; Tichacek, Amanda; Brill, Ilene K.; Fast, Pat; Stevens, Gwynn; Chetty, Paramesh; Amornkul, Pauli N.; Gilmour, Jill
HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner. PMID:25602351
Kamali, Anatoli; Price, Matt A; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J; Anzala, Omu; Latka, Mary H; Bekker, Linda-Gail; Kaleebu, Pontiano; Asiki, Gershim; Ssetaala, Ali; Ruzagira, Eugene; Allen, Susan; Farmer, Paul; Hunter, Eric; Mutua, Gaudensia; Makkan, Heeran; Tichacek, Amanda; Brill, Ilene K; Fast, Pat; Stevens, Gwynn; Chetty, Paramesh; Amornkul, Pauli N; Gilmour, Jill
HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.
Brooks, Ronald A.; Etzel, Mark A.; Hinojos, Ernesto; Henry, Charles L.; Perez, Mario
HIV-related stigma, discrimination, and homophobia impede community based efforts to combat HIV disease among Latino and African American gay and bisexual men. This commentary highlights ways to address these social biases in communities of color in Los Angeles from the perspectives of staff from HIV prevention programs. Information was collected from HIV prevention program staff participating in a two-day symposium. The outcomes from the symposium offer strategies for developing and implementing HIV prevention services for Latino and African American gay and bisexual men, which include: 1) addressing social biases present in a community that can hinder, and even prohibit, utilization of effective HIV prevention programs; 2) recasting HIV prevention messages in a broader social or health context; 3) developing culturally appropriate HIV prevention messages; 4) exploring new modalities and venues for delivering HIV prevention messages that are appropriate for gay and bisexual men of color and the communities in which they live; and 5) broadening the target of HIV prevention services to include service providers, local institutions and agencies, and the community at-large. These strategies underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention programs. PMID:16283834
Mindry, Deborah; Maman, Suzanne; Chirowodza, Admire; Muravha, Tshifhiwa; van Rooyen, Heidi; Coates, Thomas
This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programmes can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception.
Nehl, Eric J.; Klein, Hugh; Sterk, Claire E.; Elifson, Kirk W.
The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1,535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographics, and psychological functioning factors helps explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems. PMID:26188618
Nehl, Eric J; Klein, Hugh; Sterk, Claire E; Elifson, Kirk W
The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.
Stephenson, Rob; Elfstrom, K. Miriam; Winter, Amy
Despite efforts to increase HIV testing in the African region, the proportion of men who report ever having been tested for HIV remains low. Research has focused on individual level determinants of women's testing however little is known about factors associated with men's testing behavior. This analysis investigates community influences on HIV testing among men ages 15–54, using Demographic and Health Survey (DHS) data from Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe. Multilevel models were fitted in each country for the outcome of ever receiving an HIV test. After controlling for individual and household level factors, community level factors of demographics, economics, and behavior and knowledge remain significantly associated with HIV testing among men. The results of this analysis highlight the need to recognize the impact of community influences on men's HIV test seeking behavior, and to harness these community factors in the design of programs aimed at encouraging the uptake of HIV testing among men in Africa. PMID:22677974
Gaskins, Susan W; Payne Foster, Pamela; Sowell, Richard L; Lewis, Timothy L; Gardner, Antonio; Parton, Jason M
The purpose of this study was to identify and describe the process of HIV disclosure for rural African American men-a population disproportionately affected by HIV/AIDS. Forty men were interviewed about their experience of making an HIV disclosure. Grounded theory methodology guided data collection and analysis. The core category or variable that emerged from the data was a process-Making Decisions: The Process of HIV Disclosure. Five categories accounted for variations in disclosures: (a) beliefs and knowledge about HIV/AIDS, (b) influencing factors, (c) disclosure decisions, (d) disclosure efficacy, and (e) outcomes of disclosure. Most of the men had disclosed to others; however, the disclosures were selective, and the decisions were iterative. The majority of the men did not disclose their diagnosis for several months to several years. The findings provide a framework of the many factors related to HIV disclosure that can guide health care providers in counseling persons living with HIV/AIDS in making disclosure decisions.
Fairfax, Colita Nichols
This article is an initial exploration about the impact of ideological beliefs on helping services in the African American community. Newly infected HIV/AIDS cases place African Americans at 45% of such new cases, with African American women becoming infected at a rate 18 times that of Whites. Yet, helping services that are organic to African American women should be stronger through a discussion of cultural beliefs held in the community, where the genesis of helping services exists. Values and beliefs should be at the center of community partnerships, public media strategies, generalist-practice curricula in macro-level systems, and creating more space for relationship dialogue between African American men and women, which includes gender and racial distortions. Given the exponentially high numbers of HIV/AIDS cases in the African American community, a more earnest examination of values and beliefs is warranted.
Turner-Musa, Jocelyn O.; Rhodes, Warren A.; Harper, P. Thandi Hicks; Quinton, Sylvia L.
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…
Valle, Maribel; Levy, Judith
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…
Gibbons, Maya A.
African American women are at the center of the discussion on health disparities, specifically disparities regarding HIV/AIDS and Sexually Transmitted Infections (STIs). Though there has been substantial research examining sexual risk behavior among low income African American women, little has been done to understand sexual behavior…
The South African State is mandated by Sections 28(2) and 29(1) of the South African Constitution to make provision for the education of a South African child in fulfilment of the child's constitutional rights. Teacher Unions (TUs) and provincial Departments of Basic Education (DBEs) have often promised South African high school student body, in…
HIV risk among teenagers is argued to be entangled with a plethora of other risks so that HIV-related risk may not be a paramount consideration. Teenage sexuality is a subject fraught with such consideration. This article is an ethnographic rendition of teenage sexuality in action in a South African township.
Women who become HIV infected through heterosexual transmission are faced with the task of making sense of how they became infected. This paper presents a qualitative analysis based on interviews with 35 HIV-positive South African Black women. A specific theme, that blame of a male partner was avoided or disavowed in interviews, is explored in…
MacMaster, Samuel A.; Rasch, Randolph F. R.; Kinzly, Mark L.; Cooper, R. Lyle; Adams, Susan M.
Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is…
Kanekar, Amar; Sharma, Manoj
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…
Colebunders, R; Greenberg, A E; Francis, H; Kabote, N; Izaley, L; Nguyen-Dinh, P; Quinn, T C; Van der Groen, G; Curran, J W; Piot, P
Three children are described in whom pre-transfusion samples were HIV-seronegative and post-transfusional samples, obtained within 1 week after transfusion, were HIV-seropositive. Two of them developed a transient fever within 1 week of receiving the blood transfusion, and a transient generalized skin eruption which lasted for about 2 weeks. All three developed persistent generalized lymphadenopathy. One child developed a lumbar herpes zoster 7 months after transfusion. IgM Western blots demonstrated the presence of antibodies to protein bands p17, p24 and p55 in all three children. These three case reports suggest that children who receive a seropositive blood transfusion are at high risk for developing acute manifestations of HIV infection.
Burns, Myron J; Feaster, Daniel J; Mitrani, Victoria B; Ow, Christina; Szapocznik, José
This study examined the mechanism by which stressors, dissatisfaction with family, perceived control, social support, and coping were related to psychological distress in a sample of HIV-positive African American mothers. Additional analyses explored whether women who had a history of a drug abuse or dependence diagnosis differed either on levels of the study variables or the model pathways. The results indicated that HIV-positive African American mothers who had higher levels of stressors perceived their stressors as a whole to be less controllable. Coping resources, available social support and perceived control, were positively associated with active coping and negatively associated with psychological distress. Avoidant coping was the most important predictor of psychological distress. Furthermore, the effect of avoidant coping on psychological distress was stronger for mothers with a history of drug diagnosis. The implications of these findings for targeting interventions are discussed.
Kevany, Sebastian; Benatar, Solomon R; Fleischer, Theodore
The escalating expenditure on patients with HIV/AIDS within an inadequately funded public health system is tending towards crowding out care for patients with non-HIV illnesses. Priority-setting decisions are thus required and should increasingly be based on an explicit, transparent and accountable process to facilitate sustainability. South Africa's public health system is eroding, even though the government has received extensive donor financing for specific conditions, such as HIV/AIDS. The South African government's 2007 HIV plan anticipated costs exceeding 20% of the annual health budget with a strong focus on treatment interventions, while the recently announced 2012-2016 National Strategic HIV plan could cost up to US$16 billion. Conversely, the total non-HIV health budget has remained static in recent years, effectively reducing the supply of health care for other diseases. While the South African government cannot meet all demands for health care simultaneously, health funders should attempt to allocate health resources in a fair, efficient, transparent and accountable manner, in order to ensure that publicly funded health care is delivered in a reasonable and non-discriminatory fashion. We recommend a process for resource allocation that includes ethical, economic, legal and policy considerations. This process, adapted for use by South Africa's policy-makers, could bring health, political, economic and ethical gains, whilst allaying a social crisis as mounting treatment commitments generated by HIV have the potential to overwhelm the health system.
Theo, Andros; Masebe, Tracy; Suzuki, Yasuhiro; Kikuchi, Haruhisa; Wada, Shoko; Obi, Chikwelu Larry; Bessong, Pascal Obong; Usuzawa, Motoki; Oshima, Yoshiteru; Hattori, Toshio
The biodiversity of medicinal plants in South Africa makes them rich sources of leading compounds for the development of novel drugs. Peltophorum africanum (Fabaceae) is a deciduous tree widespread in South Africa. The stem bark has been traditionally employed to treat diarrhoea, dysentery, sore throat, wounds, human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS), venereal diseases and infertility. To evaluate these ethnobotanical clues and isolate lead compounds, butanol and ethyl acetate extracts of the stem bark were screened for their inhibitory activities against HIV-1 using MAGI CCR5+ cells, which are derived from HeLa cervical cancer cells and express HIV receptor CD4, a chemokine receptor CCR5 and HIV-LTR-beta- galactosidase. Bioassay-guided fractionation using silica gel chromatography was also conducted. The ethyl acetate and butanol extracts of the stem bark of Peltophorum africanum showed inhibitory activity against HIV-1, CXCR4 (X4) and CCR5 (R5) tropic viruses. The ethyl acetate and butanol extracts yielded previously reported anti-HIV compounds, (+)-catechin, a flavonoid, and bergenin, a C-galloylglycoside, respectively. Furthermore, we identified betulinic acid from the ethyl acetate fraction for the first time. The fractions, which contained betulinic acid, showed the highest selective index. We therefore describe the presence of betulinic acid, a not well-known anti-HIV compound, in an African medicinal herb, which has been used for therapy, and claim that betulinic acid is the predominant anti-HIV-1 constituent of Peltophorum africanum. These data suggest that betulinic acid and its analogues could be used as potential therapeutics for HIV-1 infection.
Clarke, Juanne N; McLellan, Lianne; Hoffman-Goetz, Laurie
Mainstream magazines and other media have been found to both reflect and influence existing values and beliefs regarding health and medicine. Little is known about how media directed toward specific cultural or other market groups may differ. The present study examined how HIV and AIDS are portrayed within a specific ethnocultural medium, the two highest circulating magazines directed toward African American and African Canadian readers. The portrayal of HIV/AIDS from January 1997 to October 2001 in Ebony and Essence magazines was examined through manifest and latent content analysis. African American people were described paradoxically both as powerless victims in the face of the disease and as members of a strong and identifiable community of "sisters" and "brothers" available to respond to prevent and cope with the disease. Polarization between Blacks and Whites was accomplished by frequent emphasis on the higher rates of HIV/AIDS amongst Black Americans. Both the church and spirituality were highlighted as means of prevention education and coping.
Saberi, Parya; Yuan, Patrick; John, Malcolm; Sheon, Nicolas; Johnson, Mallory O
Abstract Antiretroviral nonadherence is a strong determinant of virologic failure and is negatively correlated with survival. HIV-positive African American youth have lower antiretroviral adherence and treatment engagement than other populations. We assessed the feasibility and acceptability of a telehealth (remote videoconferencing) medication counseling intervention as an innovative approach to address these disparities. HIV-positive African American youth (18-29 years old) on antiretrovirals were enrolled in a telehealth medication counseling session, followed by a semi-structured qualitative interview to explore likes/dislikes of the format, modality, and content; potential impact on adherence; privacy issues; and interaction quality. Fourteen participants with a mean age of 24 years, who were 86% male, and had a mean self-reported adherence in the past month of 89%, were interviewed. Participants stated that they liked telehealth, would use it if offered in clinic/research settings, and indicated that their privacy was maintained. Participants described telehealth as convenient and efficient, with positive impact on their knowledge. Telehealth provided a modality to interact with providers that participants described as less intimidating than in-person visits. Telehealth is feasible and acceptable for delivering medication counseling to HIV-positive African American youth when conducted in a controlled clinical setting and may improve quality of patient-provider dialogue. Use of telehealth may lead to more disclosure of treatment difficulties, increased patient comfort, and improved health education.
Schinke, Steven P.; Orlandi, Mario A.
The spread of the acquired immunodeficiency virus (AIDS) virus, human immunodeficiency virus (HIV) infection, is increasingly evident. Despite the attention that HIV infection has received, few effective prevention strategies have been developed. The present paper reviews the epidemiology of AIDS among African-American and Hispanic adolescents. From epidemiological data, the authors argue for preventive approaches to reduce the risks of HIV transmission among African-American and Hispanic adolescents. Emphasizing culturally sensitive prevention strategies, the authors describe an intervention for these adolescents that combines skills-based and interactive computer approaches. PMID:20589223
Schinke, Steven P; Orlandi, Mario A
The spread of the acquired immunodeficiency virus (AIDS) virus, human immunodeficiency virus (HIV) infection, is increasingly evident. Despite the attention that HIV infection has received, few effective prevention strategies have been developed. The present paper reviews the epidemiology of AIDS among African-American and Hispanic adolescents. From epidemiological data, the authors argue for preventive approaches to reduce the risks of HIV transmission among African-American and Hispanic adolescents. Emphasizing culturally sensitive prevention strategies, the authors describe an intervention for these adolescents that combines skills-based and interactive computer approaches.
African American community leaders' policy recommendations for reducing racial disparities in HIV infection, treatment and care: results from a community-based participatory research project in Philadelphia, PA
Nunn, Amy; Sanders, Julia; Carson, Lee; Thomas, Gladys; Cornwall, Alexandra; Towey, Caitlin; Lee, Hwajin; Tasco, Marian; Shabazz-El, Waheedah; Yolken, Annajane; Smith, Tyrone; Bell, Gary; Feller, Sophie; Smith, Erin; James, George; Dunston, Brenda Shelton; Green, Derek
African Americans account for 45% of new HIV infections in the United States. Little empirical research investigates African American community leaders' normative recommendations for addressing these disparities. Philadelphia's HIV infection rate is five times the national average, nearly 70% of new infections are among African Americans, and 2% of African Americans in Philadelphia are living with HIV/AIDS. Using a community-based participatory research (CBPR) approach, we convened focus groups among 52 African American community leaders from diverse backgrounds to solicit normative recommendations for reducing Philadelphia's racial disparities in HIV infection. Leaders recommended: 1) Philadelphia's city government should raise awareness about HIV/AIDS with media campaigns featuring local leaders; 2) Local HIV prevention interventions should address social and structural factors influencing HIV risks rather than focus exclusively on mode of HIV transmission; 3) Resources should be distributed to the most heavily impacted neighborhoods of Philadelphia; and 4) Faith institutions should play a critical role in HIV testing, treatment and prevention efforts. We developed a policy memo highlighting these normative recommendations for how to enhance local HIV prevention policy. This policy memo led to Philadelphia City Council hearings about HIV/AIDS in October 2010 and subsequently informed local HIV/AIDS prevention policy and development of local HIV prevention interventions. This CBPR case study offers important lessons for effectively engaging community leaders in research to promote HIV/AIDS policy change. PMID:24879446
African American community leaders' policy recommendations for reducing racial disparities in HIV infection, treatment, and care: results from a community-based participatory research project in Philadelphia, Pennsylvania.
Nunn, Amy; Sanders, Julia; Carson, Lee; Thomas, Gladys; Cornwall, Alexandra; Towey, Caitlin; Lee, Hwajin; Tasco, Marian; Shabazz-El, Waheedah; Yolken, Annajane; Smith, Tyrone; Bell, Gary; Feller, Sophie; Smith, Erin; James, George; Shelton Dunston, Brenda; Green, Derek
African Americans account for 45% of new HIV infections in the United States. Little empirical research investigates African American community leaders' normative recommendations for addressing these disparities. Philadelphia's HIV infection rate is 5 times the national average, nearly 70% of new infections are among African Americans, and 2% of African Americans in Philadelphia are living with HIV/AIDS. Using a community-based participatory research approach, we convened focus groups among 52 African American community leaders from diverse backgrounds to solicit normative recommendations for reducing Philadelphia's racial disparities in HIV infection. Leaders recommended that (a) Philadelphia's city government should raise awareness about HIV/AIDS with media campaigns featuring local leaders, (b) local HIV-prevention interventions should address social and structural factors influencing HIV risks rather than focus exclusively on mode of HIV transmission, (c) resources should be distributed to the most heavily affected neighborhoods of Philadelphia, and (d) faith institutions should play a critical role in HIV testing, treatment, and prevention efforts. We developed a policy memo highlighting these normative recommendations for how to enhance local HIV prevention policy. This policy memo led to Philadelphia City Council hearings about HIV/AIDS in October 2010 and subsequently informed local HIV/AIDS prevention policy and development of local HIV prevention interventions. This community-based participatory research case study offers important lessons for effectively engaging community leaders in research to promote HIV/AIDS policy change.
Derose, Kathryn Pitkin; Bogart, Laura M; Kanouse, David E; Felton, Alexandria; Collins, Deborah Owens; Mata, Michael A; Oden, Clyde W; Domínguez, Blanca X; Flórez, Karen R; Hawes-Dawson, Jennifer; Williams, Malcolm V
HIV-related stigma negatively affects prevention and care, and community-based interventions are needed. Here we describe the development of a multi-ethnic, faith-based intervention to reduce HIV stigma that included: educational workshops on HIV, testing, and stigma; peer leader workshops using role plays and drawing on principles of motivational interviewing; a pastor-delivered sermon on HIV that incorporated theological reflection and an imagined contact scenario; and congregation-based HIV testing events. Lessons learned include: partnership development is essential and requires substantial investment; tailoring intervention components to single race-ethnic groups may not be preferable in diverse community settings; and adapting testing processes to be able to serve larger numbers of people in shorter time frames is needed for congregational settings. This development process successfully combined the rigorous application of social science theory and community engagement to yield a multifaceted HIV stigma reduction intervention appropriate for Protestant and Catholic churches in African American and Latino communities.
Derose, Kathryn Pitkin; Bogart, Laura M.; Kanouse, David E.; Felton, Alexandria; Collins, Deborah Owens; Mata, Michael A.; Oden, Clyde W.; Domínguez, Blanca X.; Flórez, Karen R.; Hawes-Dawson, Jennifer; Williams, Malcolm V.
HIV-related stigma negatively affects prevention and care, and community-based interventions are needed. Here we describe the development of a multi-ethnic, faith-based intervention to reduce HIV stigma that included: educational workshops on HIV, testing, and stigma; peer leader workshops using role plays and drawing on principles of motivational interviewing; a pastor-delivered sermon on HIV that incorporated theological reflection and an imagined contact scenario; and congregation-based HIV testing events. Lessons learned include: partnership development is essential and requires substantial investment; tailoring intervention components to single race-ethnic groups may not be preferable in diverse community settings; and adapting testing processes to be able to serve larger numbers of people in shorter time frames is needed for congregational settings. This development process successfully combined the rigorous application of social science theory and community engagement to yield a multifaceted HIV stigma reduction intervention appropriate for Protestant and Catholic churches in African American and Latino communities. PMID:24450276
Sandfort, Theo G. M.; Knox, Justin; Collier, Kate L.; Lane, Tim; Reddy, Vasu
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. PMID:25103866
Moyi Okwaro, Ferdinand; Geissler, P. W.
This article examines collaboration in transnational medical research from the viewpoint of African scientists working in partnerships with northern counterparts. It draws on ethnographic fieldwork in an HIV laboratory of an East African state university, with additional data from interviews with scientists working in related research institutions. Collaboration is today the preferred framework for the mechanisms by which northern institutions support research in the south. The concept signals a shift away from the legacy of unequal (post‐) colonial power relations, although, amid persisting inequalities, the rhetorical emphasis on equality might actually hinder critical engagement with conflicts of interest and injustice. To collaborate, African scientists engage various strategies: They establish a qualified but flexible, non‐permanent workforce, diversify collaborators and research areas, source complementary funding to assemble infrastructures, and maintain prospective research populations to attract transnational clinical trials. Through this labor of collaboration, they sustain their institutions under prevailing conditions of scarcity. PMID:25800667
Moyi Okwaro, Ferdinand; Geissler, P W
This article examines collaboration in transnational medical research from the viewpoint of African scientists working in partnerships with northern counterparts. It draws on ethnographic fieldwork in an HIV laboratory of an East African state university, with additional data from interviews with scientists working in related research institutions. Collaboration is today the preferred framework for the mechanisms by which northern institutions support research in the south. The concept signals a shift away from the legacy of unequal (post-) colonial power relations, although, amid persisting inequalities, the rhetorical emphasis on equality might actually hinder critical engagement with conflicts of interest and injustice. To collaborate, African scientists engage various strategies: They establish a qualified but flexible, non-permanent workforce, diversify collaborators and research areas, source complementary funding to assemble infrastructures, and maintain prospective research populations to attract transnational clinical trials. Through this labor of collaboration, they sustain their institutions under prevailing conditions of scarcity.
Moore, DaKysha; Onsomu, Elijah O; Timmons, Shirley M; Abuya, Benta A; Moore, Christina
This study explores HIV/AIDS communication strategies among church leaders at predominately African American churches in a metropolitan city and surrounding areas in North Carolina. The church leaders contacted for the study are members of an interfaith-based HIV/AIDS program. The researchers used semi-standardized interviews to explore how church leaders address HIV/AIDS in the church. The findings indicate that the seven church leaders who participated in the study use a variety of communication channels to disseminate HIV/AIDS information for congregants and their surrounding communities, which include both interpersonal and mass media.
Mkandawire-Valhmu, Lucy; Kako, Peninnah; Kibicho, Jennifer; Stevens, Patricia E
Historically, African women have been viewed through a colonizing and Eurocentric lens emphasizing poverty, oppression, and suffering. A postcolonial, feminist approach to our two qualitative studies with human immunodeficiency virus (HIV)-infected women in Malawi and Kenya led us to depart from this discourse, highlighting women's capacity. Through this article, not only is a forum created for African women's voices to be heard as subaltern knowledge leading to transformational change, but also health care providers are made aware, through women's words, of how they might capitalize on grassroots women's movements, particularly in resource-poor communities, to implement effective HIV prevention and treatment strategies.
Frew, Paula M; Archibald, Matthew; Martinez, Nina; del Rio, Carlos; Mulligan, Mark J
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.
Frew, Paula M.; Archibald, Matthew; Martinez, Nina; del Rio, Carlos; Mulligan, Mark J.
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. PMID:20686675
Okoro, Olihe; Odedina, Folakemi
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.
Winskell, Kate; Beres, Laura K; Hill, Elizabeth; Mbakwem, Benjamin Chigozie; Obyerodhyambo, Oby
Despite the prominence of abstinence promotion in HIV prevention for young Africans, there is little documentation concerning its reception and interpretation. With the purpose of informing programmatic practice, we examined how young Africans from six countries with contrasting HIV prevalence rates make sense of abstinence. 'Scenarios from Africa' scriptwriting contests invite young people to contribute ideas for short films about HIV. Using thematic narrative-based approaches, we analyzed a stratified random sample of these narratives written in 2005 by young women and men aged 10-24 years from Senegal, Burkina Faso, South-East Nigeria, Kenya, Namibia and Swaziland. Abstinence was considerably more prominent as a theme in the samples from SE Nigeria, Kenya and Swaziland. It was articulated in relation to conservative Christian sexual morality and in opposition to condom use with particular intensity in SE Nigeria, with stigmatising implications for non-abstainers. However, cross-national commonalities were more striking than differences. Examples of non-stigmatising pro-abstinence messaging highlighted the appeal of discourses of romantic love and future plans across countries and demographic characteristics. The analysis yielded contextual understanding, youth-driven ideas and recommendations to inform comprehensive HIV-prevention efforts.
Young, Sean D; Szekeres, Greg; Coates, Thomas
This study explores the feasibility of recruiting minority men who have sex with men Facebook users for human immunodeficiency virus (HIV) prevention studies and notes demographic and sexual risk behaviours. Facebook-registered men who have sex with men (MSM; N = 118) were recruited using online and offline methods. Participants validated Facebook-user status through using a Facebook Connect (computer science) application. Participants were primarily Latino (60.2%) and African-American (28.0%), with 33.1% using social media to find sex partners. Black MSM social networking users reported engaging in a lower frequency (coefficient = -0.48, p < 0.05) of unprotected receptive anal intercourse compared to Latino MSM. Results suggest that minority social media users can be recruited for HIV studies and that sexual risk behavioural differences exist among minority social networking users. Findings highlight the importance of incorporating technologies into population-focused HIV interventions.
O'Daniel, Alyson J
In this article I examine variations in the ways in which low-income HIV-positive African American women in Midway, North Carolina engaged with and made meaningful laboratory-based knowledge of HIV disease. I highlight how women's engagement with "blood-work," as it was popularly called, reflected perceptions of survival with HIV disease and the material conditions and social relations in which these perceptions were embedded. Focusing less on the diagnostics themselves and more on the social contexts in which they became socially significant for study participants, I assert that "blood-work" provided a multiply constituted lens through which women expressed their subject positions and attendant material conditions within the context of a public health care program shaped by values associated with global neoliberalism.
Goparaju, Lakshmi; Warren-Jeanpiere, Lari
African American women are disproportionately affected by HIV. Some research has explored if non-disclosing men who have sex with men and women (MSMW) contribute to women’s HIV risk. Popular media discourse tends to refer to these men as “Down Low” or “DL”. Six focus groups were conducted with 36 African American women in Washington D.C. to examine their knowledge, attitudes, beliefs, and behaviours regarding “Down Low/DL” men. Three of the focus groups were composed of HIV positive women and three groups were composed of HIV negative women. Data analysis reveals six central subcategories related to women’s perspectives on the “DL”: awareness; suspicion; coping with partner infidelity: male vs. female; sexual health communication; empathy; and religion. No major differences were identified between the HIV positive and HIV negative focus groups. Findings from this study provide insight into African American women’s perceptions of African American male sexuality and how these perceptions serve to influence interpersonal relationship factors and women’s exposure to HIV risk. PMID:22804686
Williams, Michelle; Moneyham, Linda; Kempf, Mirjam-Colette; Chamot, Eric; Scarinci, Isabel
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.
ABSTRACT Background A group of experts attending a tripartite interregional meeting on best practices in HIV/AIDS workplace policies and programmes organised by the International Labour Organisation (ILO) in Geneva, Switzerland, identified 34 best practice workplace HIV programmes from across the world. Method The ten criteria that were used for reviewing best practice workplace HIV/AIDS programmes in South Africa include acceptability, accessibility, ethical soundness, perceived impact, relevance, appropriateness, innovativeness, efficiency, sustainability and replicability. Results More than one-third (35.3%) of the 34 best practice workplace interventions identified were found in businesses and industries in South Africa. This constitutes a significant and encouraging effort to deal with HIV/AIDS in the workplace. Approximately 16.7% of the best practice workplace HIV/AIDS interventions focused on policy and legal frameworks, 50% of these interventions focused on prevention, 16.7% provided links beyond the workplace and a further 16.7% were interventions that focused on knowledge and evidence. A third (33.3%) of practices were found in the mining industry, 16.7% in the motor industry, 16.7% from workers’ unions, and the rest (33.3%) were found in a sugar company, an electricity supply company, a pharmaceutical company and the ministry of Public Service and Administration. Conclusion It is encouraging that over one-third of all best practice workplace HIV interventions identified by the ILO experts were found in South Africa. The majority of these policies and programmes were focused on HIV prevention.
Mason-Jones, Amanda J; Flisher, Alan J; Mathews, Catherine
Characteristics of learners who become peer educators are rarely explored despite the potential relevance to the success of peer education programmes. Fifteen high schools selected to implement peer education HIV prevention programmes in South Africa were recruited. A total of 2339 Grade 10 learners were surveyed and comparisons were made between socio-demographic characteristics, key skills, school experience and sexual behaviour of those students who had volunteered or been chosen by teachers to be peer educators (n = 295) and their fellow students (n = 2044), the potential recipients of the programme. On most of the socio-demographic variables, school experiences, aspirations, sexual debut and use of condoms at last sex or whether they had been tested for HIV status, there were no significant differences between the two groups. Volunteers and teacher-chosen peer educators tended to be younger than their classmates (16.19 versus 16.52, P < 0.0001), score higher on a goal-orientation scale (3.27 versus 3.15, P =< 0.0001) and had more access to basic resources [electricity (97.9% versus 94.0%, P = 0.006), a bicycle (41.9% versus 32.7%, P = 0.004) or car (50.2% versus 41.0%, P = 0.005)]. Further research is needed to explore specific peer educator characteristics and recruitment and selection approaches that are associated with effective HIV prevention interventions.
Dunne, Eugene M; Dyer, Typhanye Penniman; Khan, Maria R; Cavanaugh, Courtenay E; Melnikov, Alex; Latimer, William W
Trading sex for money, drugs, goods, services, or a place to stay is prevalent among women who use drugs and has been associated with women's risk of HIV acquisition. There is evidence that trading sex for drugs only may be associated with elevated risk of HIV compared with trading sex for money. The purpose of this study was to assess whether HIV risk behaviors and HIV prevalence differ among African American drug using women (N = 92) who traded sex for drugs only, traded sex for economic resources (defined as money, shelter, or other resources) only, or traded sex for both economic resources and drugs. In this study, lower rates of condom use and higher rates of HIV were found among women who traded sex for drugs only compared to women who traded sex for economic resources or for economic resources and drugs. These findings suggest that African American women who trade sex for drugs only represent an understudied yet highly vulnerable group.
Ndirangu, Eunice W; Evans, Catrin
In the U.K. immigrant women from Africa constitute an increasingly large proportion of newly diagnosed cases of HIV. A significant minority of these are refugees and asylum seekers. Very little is known about their experiences of living with HIV/AIDS, their psychosocial needs or their views of health care provision. This paper reports the results of a qualitative study that explored these issues by interviewing eight African women living with HIV in the British city of Nottingham. Women's ability to live positively with HIV was found to be strongly shaped by their migration history, their legal status, their experience of AIDS-related stigma and their Christian faith. Significantly, health services were represented as a safe social space, and were highly valued as a source of advice and support. The findings indicate that non-judgemental, personalised health care plays a key role in encouraging migrant African women to access psychosocial support and appropriate HIV services.
This study assessed the policies, strategic plans and structures that have been put in place in Zimbabwe to address the HIV/AIDS epidemic in the education sector. It also examined the comprehensiveness of projects and programmes currently being implemented by the government in collaboration with partner organisations and NGOs. The findings show…
The question addressed in this paper is whether the beneficial effects of Primary School Action for Better Health (PSABH), an HIV prevention programme delivered in Kenyan primary schools, continue once students move on to secondary schools. Questionnaires were completed in December 2005 and January 2006 by all form 1-3 students in 154 randomly…
Lu, Yanhui; Celum, Connie; Wald, Anna; Baeten, Jared M; Cowan, Frances; Delany-Moretlwe, Sinead; Reid, Stewart E; Hughes, James P; Wilcox, Ellen; Corey, Lawrence; Hendrix, Craig W
Acyclovir pharmacokinetics was evaluated in 68 HIV-seronegative, herpes simplex virus 2 (HSV-2)-seropositive African women, who received a single oral 400-mg dose of acyclovir, with plasma acyclovir concentrations measured over 8 h. Geometric mean peak concentration and area under the concentration-time curve were 0.31 μg/ml and 1.59 h · μg/ml, respectively, 54% and 52% lower than values from non-Africans. Lower acyclovir concentrations may partly explain the reduced acyclovir suppression of HSV-2 genital ulcer recurrence in HPTN 039 African women participants.
Gosmann, Christina; Anahtar, Melis N; Handley, Scott A; Farcasanu, Mara; Abu-Ali, Galeb; Bowman, Brittany A; Padavattan, Nikita; Desai, Chandni; Droit, Lindsay; Moodley, Amber; Dong, Mary; Chen, Yuezhou; Ismail, Nasreen; Ndung'u, Thumbi; Ghebremichael, Musie S; Wesemann, Duane R; Mitchell, Caroline; Dong, Krista L; Huttenhower, Curtis; Walker, Bruce D; Virgin, Herbert W; Kwon, Douglas S
Elevated inflammation in the female genital tract is associated with increased HIV risk. Cervicovaginal bacteria modulate genital inflammation; however, their role in HIV susceptibility has not been elucidated. In a prospective cohort of young, healthy South African women, we found that individuals with diverse genital bacterial communities dominated by anaerobes other than Gardnerella were at over 4-fold higher risk of acquiring HIV and had increased numbers of activated mucosal CD4(+) T cells compared to those with Lactobacillus crispatus-dominant communities. We identified specific bacterial taxa linked with reduced (L. crispatus) or elevated (Prevotella, Sneathia, and other anaerobes) inflammation and HIV infection and found that high-risk bacteria increased numbers of activated genital CD4(+) T cells in a murine model. Our results suggest that highly prevalent genital bacteria increase HIV risk by inducing mucosal HIV target cells. These findings might be leveraged to reduce HIV acquisition in women living in sub-Saharan Africa.
Hargreaves, James R; Delany-Moretlwe, Sinead; Hallett, Timothy B; Johnson, Saul; Kapiga, Saidi; Bhattacharjee, Parinita; Dallabetta, Gina; Garnett, Geoff P
Theories of epidemiology, health behaviour, and social science have changed the understanding of HIV prevention in the past three decades. The HIV prevention cascade is emerging as a new approach to guide the design and monitoring of HIV prevention programmes in a way that integrates these multiple perspectives. This approach recognises that translating the efficacy of direct mechanisms that mediate HIV prevention (including prevention products, procedures, and risk-reduction behaviours) into population-level effects requires interventions that increase coverage. An HIV prevention cascade approach suggests that high coverage can be achieved by targeting three key components: demand-side interventions that improve risk perception and awareness and acceptability of prevention approaches; supply-side interventions that make prevention products and procedures more accessible and available; and adherence interventions that support ongoing adoption of prevention behaviours, including those that do and do not involve prevention products. Programmes need to develop delivery platforms that ensure these interventions reach target populations, to shape the policy environment so that it facilitates implementation at scale with high quality and intensity, and to monitor the programme with indicators along the cascade.
Fernández-Balbuena, Sonia; Belza, María José; Zulaica, Daniel; Martinez, Jose Luis; Marcos, Henar; Rifá, Benet; Arrillaga, Arantxa; de la Fuente, Luis; Hoyos, Juan
Background and Objective Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV. Methods The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS) assessing the contribution to the total new diagnosis in each region and if priority groups are being reached. Results 45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8–1.1); 3.4% in MSM (95%CI: 2.8–4.0). The prevalence among Spaniards was 0.8% (0.7–1.0) vs. 2.2 (1.6–2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions. Conclusions In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic
Ogundipe, Olasimbo A; Olagunju, Andrew T; Adeyemi, Joseph D
The paucity of information on suicide and its related issues among people living with HIV/AIDS (PLWHA) can impair evidence guided intervention. This study was set to determine the prevalence of suicidal ideation and the associated risk factors among PLWHA. A total of 295 participants made up of HIV positive individuals were subjected to a sociodemographic/clinical profile questionnaire. This was followed by the 28-item General Health Questionnaire (GHQ-28), suicidal intention item from the Beck Depression Inventory (BDI) and World Health Organisation Quality of Life (WHOQOL)--Bref scale to assess emotional distress, suicidal ideation, and quality of life respectively. The prevalence of suicidal ideation among PLWHA was 13.6%; and being unmarried, poor medication adherence, and poorer quality of life were significantly associated (p < 0.05) with suicidal ideation; while unemployment (odds ratio [OR] = 0.200; 95% Confidence Interval [CI] = 0.084-0.476; P < 0.001), emotional distress (OR = 5.734; 95% CI = 2.119-15.519; P--0.001), religion (OR = 4.829; 95% CI = 1.639-14.231; P--0.004), HIV status non-disclosure (OR = 2.630; 95% CI = 1.015-6.809; P--0.046) and previous suicidal attempt (OR = 0.172, 95% CI = 0.042-0.705; P--0.014) were not only associated but predictive of suicidal ideation in PLWHA. These findings indicate a significant burden of suicidal ideation, and psychosocial with clinical factors constitute identifiable risk factors among PLWHA. The development of evidence guided preventive and treatment measures against suicide among PLWHA are implied.
Slogrove, Amy L.; Esser, Monika M.; Cotton, Mark F.; Speert, David P.; Kollmann, Tobias R.; Singer, Joel
Background: Much evidence of HIV-exposed uninfected (HEU) infant infectious morbidity predates availability of maternal combination antiretroviral therapy and does not control for universal risk factors (preterm birth, low birth weight, suboptimal breastfeeding and poverty). Methods: This prospective cohort study identified HIV-infected and HIV-uninfected mothers and their newborns from South African community midwife unit. The primary outcome, infectious cause hospitalization or death before 6 months of age, was compared between HEU and HIV-unexposed (HU) infants and classified for type and severity using validated study-specific case definitions. Adjusted odds ratios (aORs) were calculated by logistic regression including stratified analyses conditioned on breastfeeding. Results: One hundred and seventy-six (94 HEU and 82 HU) mother–infant pairs were analyzed. HIV-infected mothers were older (median, 27.8 vs. 24.7 years; P < 0.01) and HU infants more often breastfed (81/82 vs. 35/94; P < 0.001). Groups were similar for maternal education, antenatal course, household characteristics, birth weight, gestational age and immunizations. The primary outcome occurred in 17 (18%) HEU and 10 (12%) HU infants [aOR, 1.45; 95% confidence interval (CI): 0.44–4.55]. In stratified analysis restricted to breastfed infants, the aOR for hospitalization due to very severe infection or death was 4.2 (95% CI: 1.00–19.2; P = 0.05) for HEU infants. Hospitalization for diarrhea was more common in HEU than HU infants [8/94 (8.5%) vs. 1/82 (1.2%); P = 0.04]. Conclusion: The difference between HEU and HU infants in the probability of infectious cause hospitalization or death in the first 6 months of life was not significant. However, among breastfed infants, severe infectious morbidity occurred more often in HEU than HU infants. PMID:28081048
Jashi, Mariam; Viswanathan, Rekha; Ekpini, Rene; Chandan, Upjeet; Idele, Priscilla; Luo, Chewe; Legins, Ken; Chatterjee, Anirban
In 2005, due to slow global progress in the scale-up of prevention of mother-to-child transmission (PMTCT) and paediatric HIV programmes, the Inter-agency Task Team (IATT) on the Prevention of HIV infection among Pregnant Women, Mothers, and their Children initiated joint technical missions (JTMs) to countries of high HIV disease burden. The JTMs were intended to galvanize country actions for a more comprehensive response to PMTCT and paediatric HIV by bringing national and global stakeholders together to review national policies and programmes and develop country-specific recommendations for accelerating scale-up. Between 2005 and 2010, the IATT conducted JTMs in 18 low- and middle-income countries. In 2007, to assess the role played by the missions, a review in the first eight countries (Burkina Faso, Cameroon, Côte d'Ivoire, India, Malawi, Rwanda, Tanzania and Zambia) that hosted JTMs was undertaken. Country progress was assessed through desk review and key informant interviews. For each country, documents reviewed included JTM reports, baseline data for PMTCT and paediatric HIV care and treatment, and 2004 to 2007 trend data on key PMTCT and paediatric HIV indicators. Drawing upon the findings, this paper posits that JTMs contributed to national scale-up of PMTCT and paediatric HIV programmes through strengthening governance and co-ordination mechanisms for the programmes, promoting enabling policy environments, and supporting the development of national scale-up plans, which have been critical for leveraging additional financial resources for scale-up. Although the impact of the JTMs could be enhanced through greater follow-up and continued targeted assistance in technical areas such as infant and young child feeding, community-based programming and supply chain management, findings indicate that the JTMs are a useful mechanism for informing policy and programme decisions necessary for scaling up PMTCT and paediatric HIV responses. Moreover, by bringing
Using the resiliency model as a framework, this qualitative description study was designed to elicit the experiences of African American women living with HIV/AIDS serving as informal kinship care providers. Themes emerging from the interviews included (a) strengths of informal social supports, (b) benefits of living with HIV as opposed to women who are not HIV positive, and (c) negative experiences of child welfare services. Findings suggest a plethora of resources women accessed through community-based agencies because of their HIV/AIDS status, as opposed to child welfare agencies.
This paper describes men's experiences of disclosing their HIV status, arguing that disclosure restored their social respect, which was previously undermined by an illness from AIDS. Results are from a 14-month ethnographic study conducted in rural South African health facility, among a group of 25 men attending an AIDS support group. The men included in this study tested while they were critically ill and some were negatively labelled as 'already dead' because of their poor state of health. The majority voluntarily disclosed their HIV status to the public after recovering from the physical symptoms of AIDS. This elicited positive reaction from the community, who treated them with admiration for disclosing their HIV status. The paper emphasises the fact that the good response received by participants from the community was predicated mainly on having healthy physical looks that men gained from using antiretroviral medication. This paper then further analyses the ways in which a 'healthy appearance' facilitates disclosure of HIV status and also disrupts the stigma attached to HIV in the studied community.
Kelvin, Elizabeth A; Cheruvillil, Sonia; Christian, Stephanie; Mantell, Joanne E; Milford, Cecilia; Rambally-Greener, Letitia; Mosery, Nzwakie; Greener, Ross; Smit, Jennifer A
Combination HIV prevention is being widely promoted by funders. This strategy aims to offer HIV prevention choices that can be selected and combined to decrease HIV risk in ways that fit with each individual's situation. Treatment as prevention and pre-exposure prophylaxis are two new evidence-based strategies to decrease HIV incidence, both of which require high HIV testing rates to be effective, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 90% of HIV-positive individuals knowing their status by 2030. However, HIV testing rates in many countries remain suboptimal. Just as no single HIV prevention method is ideal for all people in all situations, no single HIV testing modality is likely to be acceptable to everyone. By offering HIV testing choices, we may be able to increase testing rates. However, many low-resourced countries have been slow to take up new HIV testing options such as the self-administered at-home oral HIV test that is currently available in the United States. In this paper, we present findings from 20 in-depth interviews, conducted in 2010, documenting opinions about self-administered at-home oral HIV testing, a testing modality still largely unavailable in Africa. Participants were clients of three primary healthcare clinics in South Africa. Self-testing was seen as enabling confidentiality/privacy, saving time, and facilitating testing together with partners. However, concerns were raised about psychological distress when testing at home without a counsellor. Some suggested this concern could be minimised by having experienced clinic-based HIV testing and counselling before getting self-testing kits for home use. Thus, self-administered HIV testing could be an option added to the current testing modalities to address some important barriers to testing.
Chireshe, Regis; Rutondoki, Edward Ntare; Ojwang, Paul
The study investigated perceptions of the availability and effectiveness of HIV/AIDS awareness and intervention programmes by people with disabilities in Uganda. Participants (N=95) were made up of 15 leaders of disabled people's organisations (DPOs) and 80 people with disabilities (PWDs). A survey design which used both quantitative and qualitative research methods was adopted. A questionnaire was used for leaders of DPOs while focus group discussions (FGDs) were held with the rest of the participants. Descriptive statistics were used to analyse the quantitative data. The qualitative data were analysed by means of a content analysis. The study found that although PWDs were aware of the HIV/AIDS pandemic, they felt discriminated against on HIV/AIDS issues. The PWDs had difficulties in accessing HIV/AIDS services because of mainly communication problems. Results further revealed that the HIV/AIDS policy on disability was not very clear. The PWDs requested for full involvement in HIV/AIDS advocacy and training programmes. Recommendations were made.
Walsh, Kate; McCauley, Jenna; Ruggiero, Kenneth J.; Brown, Jennifer L.; Sales, Jessica M.; Rose, Eve; Wingood, Gina M.; DiClemente, Ralph J.
Abstract Background: 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. Methods: 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. Results: 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. Conclusions: 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. PMID
Gqaleni, Nceba; Ngcobo, Mlungisi; Parboosing, Raveen; Naidoo, Anneta
African Traditional Medicines (ATMs) serve as a major source of primary healthcare for African people. The reasons for their use range from easy access, affordability, beliefs in traditional systems and long term safety. ATMs have been used to treat individuals infected with HIV and therefore need scientific validation; a view supported by Traditional Health Practitioners (THPs). This study aimed to evaluate the in vitro cytotoxicity, immune modulatory and anti-HIV activities of traditional multiple herbal preparations from local THPs. Ugambu, Ihashi, Product Nene, Product Blue, SPNa and SDKc ATM were supplied by local THPs. Changes in adenosine triphosphate (ATP) & glutathione (GSH) over 24 hours were measured using luminometry. Changes in 12 cytokines were assayed using an ELISA-based absorbance assay. Protective effects against HIV killing of MT-4 cells were tested using the XTT assay and antiviral activity was measured using an HIV-1 viral load assay. Cyclosporine and AZT were used as positive controls. Ugambu, Ihashi, Product Nene and SDKc induced a dose dependent toxicity on treated PBMCs by reducing ATP and GSH at high doses (p< 0.001). These medicinal preparations, along with SPNa, showed immunomodulatory activity by significantly (p< 0.001) changing the secretion of pro-inflammatory cytokines. Product Blue stimulated the levels of ATP and GSH in treated PBMCs at all doses however this product did not show any immunomodulatory activity on cytokine secretion when compared to control cells. Ugambu, Ihashi, Product Nene showed promising anti-HIV activity relative to AZT (p< 0.01). This study has shown that some of these traditional medicinal preparations have at least one or all the properties of immunostimulation, immunomodulation or antiretroviral effects. The mechanism of action of the shown activities should further be investigated.
Ellen, J M; McCree, D H; Muvva, R; Chung, S-E; Miazad, R M; Arrington-Sanders, R; Jones, K; Burnett, P; Fichtenberg, C
To determine effectiveness of alternate venue testing (AVT), social network strategy (SNS) and provider referral (PR) for identifying previously undiagnosed HIV-infected 18-64-year-old African American men who have sex with men (AA MSM) by a health department. For AVT, staff used a mobile clinic to conduct HIV testing. For PR, staff solicited contact information from HIV-infected AA MSM, located contacts and offered HIV testing. For SNS, HIV-positive AA MSM recruited network associates for HIV testing. Two hundred and eighteen self-identified AA MSM were tested through AVT (25.2% HIV positivity) of whom 20 were newly identified HIV-positive. Fourteen HIV-positive men participated in SNS; 22 AA MSM contacts were recruited through SNS, eight (36.4%) were HIV positive and none were new positives. Two HIV-infected men participated in the PR strategy, yielding two AA MSM sex partners (one previously positive). The results suggest the need for health departments to consider using several complimentary strategies for identifying previously undiagnosed HIV infections in AA MSM in urban environments such as Baltimore.
Winskell, Kate; Hill, Elizabeth; Obyerodhyambo, Oby
HIV-related symbolic stigma arises from moralistic value judgements attached to people living with HIV and has negative consequences from both public health and human rights perspectives. Relatively little is known about cross-national variation in symbolic stigma. With the purpose of informing stigma reduction efforts within and across settings, we compared social representations of HIV in six African countries with estimated adult HIV prevalence rates ranging from 1 to 33%. Our study used a unique data source, namely a stratified random sample (n = 586, ∼5%) from 11,354 creative ideas contributed from six countries to a continent-wide HIV-related scriptwriting contest held between February and April 2005. The narratives were written by equal numbers of males and females aged 10-24 in urban and rural areas of Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics on certain quantifiable characteristics of the narratives, thematic data analysis, and a narrative-based approach. The association of HIV with outsiders ("othering") and preoccupation with the circumstances of infection are more common in lower prevalence countries but vary substantially in tone depending on the sociocultural context. The highest proportion both of moralising narratives and of narratives with pessimistic outcomes come from South-East Nigeria and, to a lesser extent, from Kenya, countries with prevalence levels of 3.9 and 6.1% respectively, in which evangelical Christian movements, including Pentecostalism, have sizeable followings. The data provide a rare cross-cultural overview of symbolic stigma, identify country-specific needs, and point to strategies for future programming. Social representations from the highest prevalence countries, Swaziland and Namibia, and from lower prevalence Burkina Faso offer potential models for the framing of HIV in ways that serve to increase social proximity and counteract
de Vries, Jantina; Slabbert, Melodie; Pepper, Michael S
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.
The Centers for Disease Control and Prevention (2010) reports that approximately 1 million people in the United States are living with HIV. African Americans comprise 12% of the population yet account for approximately 46% of the people living with HIV. The rising prevalence rate among African Americans is an anomaly given that the prevalence rate…
Glover, Dorie A; Garcia-Aracena, Elena F; Lester, Patricia; Rice, Eric; Rothram-Borus, Mary Jane
Mothers living with HIV (MLH) are at high risk for acute and chronic stress, given challenges related to their HIV status, ethnicity, economic and urban living conditions. Biomarkers combined into a composite index show promise in quantifying psychosocial stress in healthy people, but have not yet been examined among MLH. According, we examined potential biomarker correlates of stress [cortisol and catecholamines from home-collected urine and basic health indicators (blood pressure, height and weight, waist-to-hip ratio) measured during an interview] among 100 poor African American and Latina mothers MLH and demographic-matched control mothers without HIV (n = 50). Participants had been enrolled in a randomized controlled trial about 18 months earlier and had either received (MLH-I) or were awaiting (MLH-W) the psychosocial intervention. Participation was high, biomarkers were correctly collected for 93% of cases, and a complete composite biomarker index (CBI) calculated for 133 mothers (mean age = 42). As predicted, MLH had a significantly higher CBI than controls, but there was no CBI difference across ethnicity or intervention group. CBI predicted CD4 counts independently after controlling for age, years since diagnosis, prior CD4 counts, medication adherence, and depression symptoms. The study demonstrates acceptability, feasibility and potential utility of community-based biomarker collections in evaluating individual differences in psychosocial stress.
Mendenhall, Emily; Norris, Shane A.
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. PMID:25643001
Abstract Clergy and lay leaders have a pivotal role in the development and maintenance of HIV Ministries within the African American church. However, little is known about the actual roles these men and women have, the barriers they face and the supports they have found in the development and maintenance of an HIV Ministry. The purpose of this study is to examine the role, barriers and supports clergy and lay leaders experienced in the development of a long-standing HIV ministry in an African American church. These data were gathered from a larger ethnographic study, which examined the role of religious culture in the development, implementation and maintenance of an HIV ministry. Data for this study were collected through in-depth semi-structured interviews. Results revealed that the primary role of clergy and lay leaders involved dispelling myths surrounding HIV and ensuring congregational support. The primary barrier to the development and maintenance was views regarding sexuality. The primary support was their relationships with congregants that lived with HIV and AIDS. This information can assist in developing interventions to enhance the African American church movement toward HIV ministries. PMID:22870846
Gaston, Gina B; Alleyne-Green, Binta
Disparities in access to and retention of regular HIV medical treatment persist among African Americans living with HIV. Many scholars believe that the mistrust of health care held by many African Americans stems from a legacy of abuse, from medical experimentation on slaves to the unethical practices with patients in the Tuskegee Syphilis study. We performed a systematic appraisal of the literature, using several key terms, in order to understand how attitudes about HIV-related health care influence African Americans' engagement in care. We examined peer-reviewed studies published during the period January 2001 through May 2012. An initial search generated 326 studies. Sixteen descriptive studies met our inclusion criteria. Experiences of racism, conspiracy beliefs and the quality of provider relationships appeared to impact engagement. Providers should openly investigate personal beliefs that adversely affect their treatment decisions, listen to patient narratives, and share treatment decisions in order to create a transparent environment.
Noar, Seth M.; Webb, Elizabeth M.; Van Stee, Stephanie K.; Redding, Colleen A.; Feist-Price, Sonja; Crosby, Richard; Troutman, Adewale
New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans—the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups. PMID:21257676
Renner, Lorna A; Dicko, Fatoumata; Kouéta, Fla; Malateste, Karen; Gueye, Ramatoulaye D; Aka, Edmond; Eboua, Tanoh K; Azondékon, Alain; Okomo, Uduok; Touré, Pety; Ekouévi, Didier; Leroy, Valeriane
Introduction There is a risk of anaemia among HIV-infected children on antiretroviral therapy (ART) containing zidovudine (ZDV) recommended in first-line regimens in the WHO guidelines. We estimated the risk of severe anaemia after initiation of a ZDV-containing regimen in HIV-infected children included in the IeDEA West African database. Methods Standardized collection of data from HIV-infected children (positive PCR<18 months or positive serology ≥18 months) followed up in HIV programmes was included in the regional IeDEA West Africa collaboration. Ten clinical centres from seven countries contributed (Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal) to this collection. Inclusion criteria were age <16 years and starting ART. We explored the data quality of haemoglobin documentation over time and the incidence and predictors of severe anaemia (Hb<7g/dL) per 100 child-years of follow-up over the duration of first-line antiretroviral therapy. Results As of December 2009, among the 2933 children included in the collaboration, 45% were girls, median age was five years; median CD4 cell percentage was 13%; median weight-for-age z-score was −2.7; and 1772 (60.4%) had a first-line ZDV-containing regimen. At baseline, 70% of the children with a first-line ZDV-containing regimen had a haemoglobin measure available versus 76% in those not on ZDV (p≤0.01): the prevalence of severe anaemia was 3.0% (n=38) in the ZDV group versus 10.2% (n=89) in those without (p<0. 01). Over the first-line follow-up, 58.9% of the children had ≥1 measure of haemoglobin available in those exposed to ZDV versus 60.4% of those not (p=0.45). Severe anaemia occurred in 92 children with an incidence of 2.47 per 100 child-years of follow-up in those on a ZDV-containing regimen versus 4.25 in those not (p≤0.01). Adjusted for age at ART initiation and first-line regimen, a weight-for-age z-score ≤−3 was a strong predictor associated with a 5.59 times risk of severe
Fletcher, Faith; Ingram, Lucy Annang; Kerr, Jelani; Buchberg, Meredith; Richter, Donna L; Sowell, Richard
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.
Mathiti, V; Simbayi, L C; Jooste, S; Kekana, Q; Nibe, X P; Shasha, L; Bidla, P; Magubane, P; Cain, D; Cherry, C; Kalichman, S C
South Africa urgently needs HIV prevention interventions that can be disseminated for use in clinical and community settings. A brief theory-based HIV risk reduction counselling intervention originally developed in the USA has recently been adapted for use in a South African sexually transmitted infection clinic. The 60-minute risk reduction counselling intervention was grounded in the Information-Motivation-Behavioural Skills (IMB) model of HIV preventive behaviour change, adapted through a series of interdisciplinary collaborative workshops. This paper reports the process of developing and culturally adapting the brief risk reduction counselling intervention. The processes used for adapting the HIV risk reduction counselling for South Africa provides a potential model for conducting technology transfer activities with other HIV prevention interventions. Several lessons learned from this process may help guide future efforts to transfer HIV prevention technologies.
Neufeld, Stewart; Berry, Rico; Luborsky, Mark
Abstract To date, only modest gains have been achieved in explaining adherence to medical regimens, limiting effective interventions. This is a particularly important issue for African Americans who are disproportionately affected by the HIV epidemic. Few studies have focused on intragroup variation among African Americans in adherence to ART. The aim of this study was to identify and describe the cultural rationales guiding African American patients' formulation and evaluation of adherence. Rationales are key features of purposeful human action. In-depth interviews with 80 seropositive African Americans were tape recorded, transcribed, and analyzed. Participant CD4, viral load and medical histories were collected at each data point. Analysis of four waves of panel data identified three types of adherence rationales: Authoritative Knowledge Rationale (AKR; n=29, 36.3%), Following Doctors' Orders Rationale (DOR; n=24, 30.0%) and Individualized Adherence Rationale (IAR; n=27, 33.8%). Differences in mean reported adherence between the rationale groups did not achieve statistical significance. However, the fraction reporting low adherence (<70%), although not different by rationale group at the first interview (T1), was significantly higher for the IAR group by the fourth interview (T4). Objective clinical markers (CD4 and viral load) improved over time (from T1 to T4) for AKR and DOR groups, but remained unchanged for the IAR group, yet self-reported adherence declined for all groups over the course of the four interviews. PMID:21777141
Prado, Guillermo; Pratt, Indira Abraham; Feaster, Daniel J.; Robinson-Batista, Carleen; Smith, Lila; Charles, Marie; Szapocznik, José
This preliminary study explores differences in adjustment in lesbians and heterosexual women by examining three dimensions: psychological distress, major depression, and social support. Surveys were administered to 48 participants. HIV-positive African American lesbians experienced higher levels of psychological distress, anxiety, and current major depression than did their heterosexual counterparts. Lesbians reported less social support from their immediate family, but not from other sources such as friends, compared to the heterosexual women. Lesbians also reported less satisfaction with their social support network. The results presented here highlight the merit of future research to examine factors associated with the lack of family-based social support in HIV-infected lesbians and the potential of developing interventions that assess relationships with members of the immediate family, explore the possibility of repairing these relationships, and capitalize on social support from friends. PMID:16609748
Penn, Claire; Watermeyer, Jennifer
The role of culture in community beliefs about HIV is important to understand, given poor adherence to treatment and the failure of prevention programs in some contexts. An exploration of such models may yield important insight into barriers to care, treatment-seeking paths, and intergenerational differences in cultural beliefs and practices. Our study aimed to understand South African grandmothers' traditional beliefs about HIV. Three focus groups were conducted with 15 grandmothers from different cultural backgrounds in an urban community. Results indicated a variety of cultural explanations for causes, treatments, and prevention strategies. The lack of coherence and fluidity in opinions in this group suggests ways in which grandmothers may have a bridging role in the clinic that may help to validate and alleviate uncertainty, harmonize the voices of medicine and the lifeworld, and provide greater insight into people's ideas about health and treatment seeking, also known as the healthworld.
Chindelevitch, Leonid; Menzies, Nicolas A; Pretorius, Carel; Stover, John; Salomon, Joshua A; Cohen, Ted
HIV has fuelled increasing tuberculosis (TB) incidence in sub-Saharan Africa. Better control of TB in this region may be achieved directly through TB programme improvements and indirectly through expanded use of antiretroviral therapy (ART) among those with HIV. We used a mathematical model of TB and HIV in South Africa to examine the potential epidemiological impact in scenarios involving improvements in three dimensions of TB programmes: coverage, diagnosis and treatment effectiveness, as well as expanded ART use through broadened eligibility. We projected the effect of alternative scenarios on TB prevalence, incidence and TB-related mortality over 20 years. Of the three dimensions of TB programme improvement, expanding coverage would produce the greatest reduction in TB burden. Compared with current performance, combined TB programme improvements were projected to decrease TB incidence by 30% over 5 years and 46% over 20 years, and decrease TB-related mortality by 45% over 5 years and 69% over 20 years. Expanded ART eligibility was projected to decrease TB incidence by 22% over 5 years and 45% over 20 years, and TB-related mortality by 22% over 5 years and 50% over 20 years. We found that over a 20-year horizon, TB-specific and HIV-specific programme changes contribute equally to incidence reductions, whereas the TB-specific changes produce a majority of the mortality benefits. An aggressive expansion of ART alongside traditional TB-specific control measures has the potential to greatly reduce TB burden, with the different elements of a combined approach having a synergistic effect in reducing long-term TB incidence and mortality.
Wright, Patricia B.; Stewart, Katharine E.; Curran, Geoffrey M.; Booth, Brenda M.
This qualitative study is about barriers to the utilization of HIV testing as perceived by African Americans who have recently used cocaine and who live in the rural Delta region of Arkansas. Affordability, physical accessibility, and geographic availability were not perceived as barriers to HIV testing in this sample, yet acceptability was still perceived as poor. Acceptability due to social mores and norms was a major barrier. Many said testing was unacceptable because of fear of social costs. Many were confident of being HIV-negative based on risky assumptions about testing and the notification process. Small-town social and sexual networks added to concerns about reputation and risk. System approaches may fail if they focus solely on improving access to HIV services but do not take into consideration deeply internalized experiences of rural African Americans as well as involvement of the community in developing programs and services. PMID:24039279
DeMarco, Rosanna F
It is challenging to develop and assess skills in a classroom setting, for graduate students particularly, in the area of quality improvement project plans that are real, relevant, and sensitive in a unique health care context. Although understanding significant issues related to palliative care needs of U.S. citizens through the interpretation of those who publish in this area is extremely helpful to students, it does not allow for an experience uniquely situated in realities faced by those living with life-threatening and chronic illness or in a time frame that is current. Graduate students in a Health Resources and Services Administration-funded program of study completed a secondary data analysis of digitally recorded conversations of African American women living with human immunodeficiency virus or acquired immune deficiency syndrome to identify consumer-driven palliative care needs and create possible quality improvement program solutions. This exercise supports the World Health Organization's advice to become palliative care leaders through engagement in clients' realities.
Bogart, Laura M.; Thorburn, Sheryl
Although prior research shows that substantial proportions of African Americans hold conspiracy beliefs, little is known about the subgroups of African Americans most likely to endorse such beliefs. We examined the relationship of African Americans' sociodemographic characteristics to their conspiracy beliefs about HIV/AIDS and birth control. Anonymous telephone surveys were conducted with a targeted random-digit-dial sample of 500 African Americans (15-44 years) in the contiguous United States. Respondents reported agreement with statements capturing beliefs in HIV/AIDS conspiracies (one scale) and birth control conspiracies (two scales). Sociodemographic variables included gender, age, education, employment, income, number of people income supports, number of living children, marital/cohabitation status, religiosity and black identity. Multivariate analyses indicated that stronger HIV/AIDS conspiracy beliefs were significantly associated with male gender, black identity and lower income. Male gender and lower education were significantly related to black genocide conspiracy beliefs, and male gender and high religiosity were significantly related to contraceptive safety conspiracy beliefs. The set of sociodemographic characteristics explained a moderately small amount of the variance in conspiracy beliefs regarding HIV/AIDS (R2 range=0.07-0.12) and birth control (R2 range=0.05-0.09). Findings suggest that conspiracy beliefs are not isolated to specific segments of the African-American population. PMID:16895286
Dalmida, Safiya George; Holstad, Marcia McDonnell; DiIorio, Colleen; Laderman, Gary
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. PMID:22566288
Dalmida, Safiya George; Holstad, Marcia McDonnell; DiIorio, Colleen; Laderman, Gary
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.
Kohi, Thecla W; Makoae, Lucy; Chirwa, Maureen; Holzemer, William L; Phetlhu, Deliwe René; Uys, Leana; Naidoo, Joanne; Dlamini, Priscilla S; Greeff, Minrie
The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries (Lesotho, Malawi, South Africa, Swaziland and Tanzania). A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed that the human rights of people living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people.
Henrickson, Mark; Brown, Derek Brian; Fouché, Christa; Poindexter, Cynthia C; Scott, Kay
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.
Shisana, Olive; Risher, Kathryn; Celentano, David D; Zungu, Nompumelelo; Rehle, Thomas; Ngcaweni, Busani; Evans, Meredith G B
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.
Shisana, Olive; Risher, Kathryn; Celentano, David D; Zungu, Nompumelelo; Rehle, Thomas; Ngcaweni, Busani; Evans, Meredith GB
Recently, 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 status 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 spouse compared to all other marital status groups. HIV prevention messages therefore need to be targeted to unmarried populations, especially cohabitating populations. As low socioeconomic 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. PMID:26551532
Gentry, Quinn M; Elifson, Kirk; Sterk, Claire
The purpose of this study was to examine how various living conditions impact the context within which low-income African American women engage in a diverse range of high-risk behavior that increases their risk for HIV infection. The study, based on 2 years of ethnographic fieldwork, analyzed the living conditions of 45 African American women at risk for HIV infection in a high-risk neighborhood in Atlanta, Georgia. A black feminist perspective guided the study's analytical framework as a way to extend knowledge about the social conditions, the social interactions, and the meaning of high-risk behavior in the lives of African American women. Using black feminist theory and the constant comparison method, two groups emerged: "street" women and "house" women. Street women were defined as the absolute homeless, the rooming housed, and the hustling homeless. House women were defined as the family housed, the heads of household, and the steady-partner housed. Results reveal that various types of living arrangements place women at risk in different ways and suggest that low-income African American women at high risk for HIV infection-a group often considered homogeneous-have unique "within group" needs that must be addressed in HIV prevention intervention research.
Rikard, R V; Thompson, Maxine S; Head, Rachel; McNeil, Carlotta; White, Caressa
The rate of HIV infection among African Americans is disproportionately higher than for other racial groups in the United States. Previous research suggests that low level of health literacy (HL) is an underlying factor to explain racial disparities in the prevalence and incidence of HIV/AIDS. The present research describes a community and university project to develop a culturally tailored HIV/AIDS HL toolkit in the African American community. Paulo Freire's pedagogical philosophy and problem-posing methodology served as the guiding framework throughout the development process. Developing the HIV/AIDS HL toolkit occurred in a two-stage process. In Stage 1, a nonprofit organization and research team established a collaborative partnership to develop a culturally tailored HIV/AIDS HL toolkit. In Stage 2, African American community members participated in focus groups conducted as Freirian cultural circles to further refine the HIV/AIDS HL toolkit. In both stages, problem posing engaged participants' knowledge, experiences, and concerns to evaluate a working draft toolkit. The discussion and implications highlight how Freire's pedagogical philosophy and methodology enhances the development of culturally tailored health information.
Mishra, Sharmistha; Sgaier, Sema K.; Thompson, Laura H.; Moses, Stephen; Ramesh, B. M.; Alary, Michel; Wilson, David; Blanchard, James F.
Background 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. Methods and Findings 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. Conclusions 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
Joshua, Stephen Muoki
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.
Hennig, Stefanie; Naiker, Suhashni; Reddy, Tarylee; Egan, Deirdre; Kellerman, Tracy; Wiesner, Lubbe; Owen, Andrew; McIlleron, Helen; Pym, Alexander
Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.).
Naiker, Suhashni; Reddy, Tarylee; Egan, Deirdre; Kellerman, Tracy; Wiesner, Lubbe; Owen, Andrew; McIlleron, Helen; Pym, Alexander
Rifabutin, used to treat HIV-infected tuberculosis, shows highly variable drug exposure, complicating dosing. Effects of SLCO1B1 polymorphisms on rifabutin pharmacokinetics were investigated in 35 African HIV-infected tuberculosis patients after multiple doses. Nonlinear mixed-effects modeling found that influential covariates for the pharmacokinetics were weight, sex, and a 30% increased bioavailability among heterozygous carriers of SLCO1B1 rs1104581 (previously associated with low rifampin concentrations). Larger studies are needed to understand the complex interactions of host genetics in HIV-infected tuberculosis patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT00640887.) PMID:26482301
Klein, Charles H; Card, Josefina J
This study translated SiHLE (Sisters Informing, Healing, Living, and Empowering), a 12-hour Centers for Disease Control and Prevention evidence-based group-level intervention for African American females 14-18 years of age, into a 2-hour computer-delivered individual-level intervention. A randomized controlled trial (n = 178) was conducted to examine the efficacy of the new Multimedia SiHLE intervention. Average condom-protected sex acts (proportion of vaginal sex acts with condoms, last 90 days) for sexually active participants receiving Multimedia SiHLE rose from M = 51% at baseline to M = 71% at 3-month follow-up (t = 2.06, p = .05); no statistically significant difference was found in the control group. Non-sexually active intervention group participants reported a significant increase in condom self-efficacy (t = 2.36, p = .02); no statistically significant difference was found in the control group. The study provides preliminary support for the efficacy of a computer-delivered adaptation of a proven HIV prevention program for African American teenage women. This is consistent with meta-analyses that have shown that computer-delivered interventions, which can often be disseminated at lower per-capita cost than human-delivered interventions, can influence HIV risk behaviors in positive fashion.
Lebel, T.; Janicot, S.; Redelsperger, J. L.; Parker, D. J.; Thorncroft, C. D.
The AMMA international project aims at improving our knowledge and understanding of the West African monsoon and its variability with an emphasis on daily-to-interannual timescales. AMMA is motivated by an interest in fundamental scientific issues and by the societal need for improved prediction of the WAM and its impacts on water resources, health and food security for West African nations. The West African monsoon (WAM) has a distinctive annual cycle in rainfall that remains a challenge to understand and predict. The location of peak rainfall, which resides in the Northern Hemisphere throughout the year, moves from the ocean to the land in boreal spring. Around the end of June there is a rapid shift in the location of peak rainfall between the coast and around 10°N where it remains until about the end of August. In September the peak rainfall returns equatorward at a relatively steady pace and is located over the ocean again by November. The fact that the peak rainfall migrates irregularly compared to the peak solar heating is due to the interactions that occur between the land, the atmosphere and the ocean. To gain a better understanding of this complex climate system, a large international research programme was launched in 2002, the biggest of its kind into environment and climate ever attempted in Africa. AMMA has involved a comprehensive field experiment bringing together ocean, land and atmospheric measurements, on timescales ranging from hourly and daily variability up to the changes in seasonal activity over a number of years. This presentation will focus on the description of the field programme and its accomplishments, and address some key questions that have been recently identified to form the core of AMMA-Phase 2.
McDermott, Adam; Zaporojan, Lilia; McNamara, Patricia; Doherty, Colin P; Redmond, Janice; Forde, Cuisle; Gormley, John; Egaña, Mikel; Bergin, Colm
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.
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.
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
Whyte, James; Whyte, Maria D; Hires, Kimberly
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
Lazaryan, Aleksandr; Song, Wei; Lobashevsky, Elena; Tang, Jianming; Shrestha, Sadeep; Zhang, Kui; Gardner, Lytt I; McNicholl, Janet M; Wilson, Craig M; Klein, Robert S; Rompalo, Anne; Mayer, Kenneth; Sobel, Jack; Kaslow, Richard A
The role of human leukocyte antigen (HLA) class I supertypes in controlling human immunodeficiency virus type 1 (HIV-1) infection in African Americans has not been established. We examined the effects of the HLA-A and HLA-B alleles and supertypes on the outcomes of HIV-1 clade B infection among 338 African American women and adolescents. HLA-B58 and -B62 supertypes (B58s and B62s) were associated with favorable HIV-1 disease control (proportional odds ratio [POR] of 0.33 and 95% confidence interval [95% CI] of 0.21 to 0.52 for the former and POR of 0.26 and 95% CI of 0.09 to 0.73 for the latter); B7s and B44s were associated with unfavorable disease control (POR of 2.39 and 95% CI of 1.54 to 3.73 for the former and POR of 1.63 and 95% CI of 1.08 to 2.47 for the latter). In general, individual alleles within specific B supertypes exerted relatively homogeneous effects. A notable exception was B27s, whose protective influence (POR, 0.58; 95% CI, 0.35 to 0.94) was masked by the opposing effect of its member allele B*1510. The associations of most B supertypes (e.g., B58s and B7s) were largely explained either by well-known effects of constituent B alleles or by effects of previously unimplicated B alleles aggregated into a particular supertype (e.g., B44s and B62s). A higher frequency of HLA-B genotypic supertypes correlated with a higher mean viral load (VL) and lower mean CD4 count (Pearson's r = 0.63 and 0.62, respectively; P = 0.03). Among the genotypic supertypes, B58s and its member allele B*57 contributed disproportionately to the explainable VL variation. The study demonstrated the dominant role of HLA-B supertypes in HIV-1 clade B-infected African Americans and further dissected the contributions of individual class I alleles and their population frequencies to the supertype effects.
In 2006, the Kenyan state joined the international commitment to make antiretroviral treatment free in public health institutions to people infected with HIV. Less than a decade later, treatment has reached over 60% of those who need it in Kenya. This paper, which is based on an in-depth ethnographic case study of the HIV treatment programme at Kenyatta National Hospital, conducted intermittently between 2008 and 2014, examines how HIV-positive peer mentors encourage and track adherence to treatment regimens within and beyond the clinic walls using mobile phones and computer technology. This research into the everyday practices of patient monitoring demonstrates that both surveillance and adherence are collective activities. Peer mentors provide counselling services, follow up people who stray from treatment regimens, and perform a range of other tasks related to patient management and treatment adherence. Despite peer mentors’ involvement in many tasks key to encouraging optimal adherence, their role is rarely acknowledged by co-workers, hospital administrators, or public health officials. Following a biomedical paradigm, adherence at Kenyatta and in Kenya is framed by programme administrators as something individual clients must do and for which they must be held accountable. This framing simultaneously conceals the sociality of adherence and undervalues the work of peer mentors in treatment programmes. PMID:25175291
In 2006, the Kenyan state joined the international commitment to make antiretroviral treatment free in public health institutions to people infected with HIV. Less than a decade later, treatment has reached over 60% of those who need it in Kenya. This paper, which is based on an in-depth ethnographic case study of the HIV treatment programme at Kenyatta National Hospital, conducted intermittently between 2008 and 2014, examines how HIV-positive peer mentors encourage and track adherence to treatment regimens within and beyond the clinic walls using mobile phones and computer technology. This research into the everyday practices of patient monitoring demonstrates that both surveillance and adherence are collective activities. Peer mentors provide counselling services, follow up people who stray from treatment regimens, and perform a range of other tasks related to patient management and treatment adherence. Despite peer mentors' involvement in many tasks key to encouraging optimal adherence, their role is rarely acknowledged by co-workers, hospital administrators, or public health officials. Following a biomedical paradigm, adherence at Kenyatta and in Kenya is framed by programme administrators as something individual clients must do and for which they must be held accountable. This framing simultaneously conceals the sociality of adherence and undervalues the work of peer mentors in treatment programmes.
Nunes, Marta C.; Downs, Sarah; Jones, Stephanie; van Niekerk, Nadia; Cutland, Clare L.; Madhi, Shabir A.
Background. There is a paucity of data regarding the burden of Bordetella pertussis in African women and young infants, and particularly the impact of maternal human immunodeficiency virus (HIV) infection thereon. We performed a retrospective analysis of respiratory illness samples from longitudinal cohorts of HIV-uninfected and HIV-infected women and their infants to evaluate the burden of pertussis illness in a black-African community. Methods. The women were followed up for respiratory illness from midpregnancy and together with their infants until 24 weeks postpartum. Respiratory samples obtained at the time of illness visits were tested for B. pertussis by polymerase chain reaction (PCR). Results. The study included 194 HIV-infected and 1060 HIV-uninfected women, and 188 and 1028 infant offspring, respectively. There were 7 PCR-confirmed pertussis cases in the HIV-exposed infants and 30 in HIV-unexposed infants (7.4 vs 5.5 episodes per 1000 infant-months; P = .47), at a mean age of 70.9 days. All infant pertussis cases had a history of cough (mean duration, 6.3 days). Six of 17 (35.3%) pertussis-confirmed cases in infants <2 months of age were admitted to hospital within 21 days of B. pertussis detection, whereas none of the 20 cases ≥2 months of age required hospitalization. Ten PCR-positive pertussis-associated illnesses were detected in HIV-infected women compared with 32 in the HIV-uninfected women (6.8 vs 3.9 episodes per 1000 person-months; P = .12). Conclusions. Bordetella pertussis identification was common among young infants with respiratory illness, most of whom were too young to be fully protected through direct vaccination. Vaccination of pregnant women might be a valuable strategy in a setting such us ours to prevent B. pertussis–associated illness in women and their young infants. PMID:27838670
Griffith, Derek M.; Pichon, Latrice C.; Campbell, Bettina; Allen, Julie Ober
Despite substantial federal, state, and local efforts to reduce the transmission of HIV/AIDS, African Americans experience higher rates of infection than any other ethnic or racial group in the United States. It is imperative to develop culturally and ecologically sensitive interventions to meet the sexual health needs of this population.…
Szapocznik, Jose; Feaster, Daniel J.; Mitrani, Victoria B.; Prado, Guillermo; Smith, Lila; Robinson-Batista, Carleen; Schwartz, Seth J.; Mauer, Magaly H.; Robbins, Michael S.
This study tests the efficacy of Structural Ecosystems Therapy (SET), a family-ecological intervention, in improving psychosocial functioning when compared with an attention-comparison person-centered condition and a community control condition. A sample of 209 HIV-seropositive, urban, low-income, African American women was randomized into 1 of…
Jewkes, Rachel K.; Dunkle, Kristin; Nduna, Mzikazi; Jama, P. Nwabisa; Puren, Adrian
Objectives: To describe prevalence of childhood experiences of adversity in rural South African youth and their associations with health outcomes. Methods: We analyzed questionnaires and blood specimens collected during a baseline survey for a cluster randomized controlled trial of a behavioral intervention, and also tested blood HIV and herpes…
Stockman, Jamila K.; Lucea, Marguerite B.; Draughon, Jessica E.; Sabri, Bushra; Anderson, Jocelyn C.; Bertrand, Desiree; Campbell, Doris W.; Callwood, Gloria B.; Campbell, Jacquelyn C.
Despite progress against intimate partner violence (IPV) and HIV/AIDS in the past two decades, both epidemics remain major public health problems, particularly among women of color. The objective of this study was to assess the relationship between recent IPV and HIV risk factors (sexual and drug risk behaviors, STIs, condom use and negotiation) among women of African descent. We conducted a comparative case-control study in women’s health clinics in Baltimore, Maryland and St. Thomas and St. Croix, US Virgin Islands (USVI). Women aged 18–55 years who experienced physical and/or sexual IPV in the past two years (Baltimore, n=107; USVI, n=235) were compared to women who never experienced any form of abuse (Baltimore, n=207; USVI, n=119). Logistic regression identified correlates of recent IPV by site. In both sites, having a partner with concurrent sex partners was independently associated with a history of recent IPV (Baltimore, AOR: 3.91, 95% CI:1.79–8.55 and USVI, AOR: 2.25, 95% CI:1.11–4.56). In Baltimore, factors independently associated with recent IPV were lifetime casual sex partners (AOR: 1.99, 95% CI: 1.11–3.57), exchange sex partners (AOR: 5.26, 95% CI:1.92–14.42), infrequent condom use during vaginal sex (AOR: 0.24, 95% CI:0.08–0.72), and infrequent condom use during anal sex (AOR: 0.29, 95% CI:0.09–0.93). In contrast, in the USVI, having a concurrent sex partner (AOR: 3.33, 95% CI:1.46–7.60), frequent condom use during vaginal sex (AOR: 1.97, 95% CI:1.06–3.65), frequent condom use during anal sex (AOR: 6.29, 95% CI:1.57–25.23), drug use (AOR: 3.16, 95% CI:1.00–10.06), and a past-year STI (AOR: 2.68, 95% CI:1.25–5.72) were associated with recent IPV history. The divergent results by site warrant further investigation into the potential influence of culture, norms, and intentions on the relationships examined. Nonetheless, study findings support a critical need to continue the development and implementation of culturally tailored
Tietjen, Ian; Ntie-Kang, Fidele; Mwimanzi, Philip; Onguéné, Pascal Amoa; Scull, Margaret A; Idowu, Thomas Oyebode; Ogundaini, Abiodun Oguntuga; Meva'a, Luc Mbaze; Abegaz, Berhanu M; Rice, Charles M; Andrae-Marobela, Kerstin; Brockman, Mark A; Brumme, Zabrina L; Fedida, David
The continued burden of HIV in resource-limited regions such as parts of sub-Saharan Africa, combined with adverse effects and potential risks of resistance to existing antiretroviral therapies, emphasize the need to identify new HIV inhibitors. Here we performed a virtual screen of molecules from the pan-African Natural Product Library, the largest collection of medicinal plant-derived pure compounds on the African continent. We identified eight molecules with structural similarity to reported interactors of Vpu, an HIV-1 accessory protein with reported ion channel activity. Using in vitro HIV-1 replication assays with a CD4+ T cell line and peripheral blood mononuclear cells, we confirmed antiviral activity and minimal cytotoxicity for two compounds, ixoratannin A-2 and boldine. Notably, ixoratannin A-2 retained inhibitory activity against recombinant HIV-1 strains encoding patient-derived mutations that confer resistance to protease, non-nucleoside reverse transcriptase, or integrase inhibitors. Moreover, ixoratannin A-2 was less effective at inhibiting replication of HIV-1 lacking Vpu, supporting this protein as a possible direct or indirect target. In contrast, boldine was less effective against a protease inhibitor-resistant HIV-1 strain. Both ixoratannin A-2 and boldine also inhibited in vitro replication of hepatitis C virus (HCV). However, BIT-225, a previously-reported Vpu inhibitor, demonstrated antiviral activity but also cytotoxicity in HIV-1 and HCV replication assays. Our work identifies pure compounds derived from African plants with potential novel activities against viruses that disproportionately afflict resource-limited regions of the world.
Tietjen, Ian; Ntie-Kang, Fidele; Mwimanzi, Philip; Onguéné, Pascal Amoa; Scull, Margaret A.; Idowu, Thomas Oyebode; Ogundaini, Abiodun Oguntuga; Meva’a, Luc Mbaze; Abegaz, Berhanu M.; Rice, Charles M.; Andrae-Marobela, Kerstin; Brockman, Mark A.; Brumme, Zabrina L.; Fedida, David
The continued burden of HIV in resource-limited regions such as parts of sub-Saharan Africa, combined with adverse effects and potential risks of resistance to existing antiretroviral therapies, emphasize the need to identify new HIV inhibitors. Here we performed a virtual screen of molecules from the pan-African Natural Product Library, the largest collection of medicinal plant-derived pure compounds on the African continent. We identified eight molecules with structural similarity to reported interactors of Vpu, an HIV-1 accessory protein with reported ion channel activity. Using in vitro HIV-1 replication assays with a CD4+ T cell line and peripheral blood mononuclear cells, we confirmed antiviral activity and minimal cytotoxicity for two compounds, ixoratannin A-2 and boldine. Notably, ixoratannin A-2 retained inhibitory activity against recombinant HIV-1 strains encoding patient-derived mutations that confer resistance to protease, non-nucleoside reverse transcriptase, or integrase inhibitors. Moreover, ixoratannin A-2 was less effective at inhibiting replication of HIV-1 lacking Vpu, supporting this protein as a possible direct or indirect target. In contrast, boldine was less effective against a protease inhibitor-resistant HIV-1 strain. Both ixoratannin A-2 and boldine also inhibited in vitro replication of hepatitis C virus (HCV). However, BIT-225, a previously-reported Vpu inhibitor, demonstrated antiviral activity but also cytotoxicity in HIV-1 and HCV replication assays. Our work identifies pure compounds derived from African plants with potential novel activities against viruses that disproportionately afflict resource-limited regions of the world. PMID:25830320
Long, Carol; Eagle, Gillian; Stevens, Garth
There is increasing interest, both internationally and in South Africa, in strengthening the relationship between psychoanalytic practice and research. This paper reports on a psychoanalytically oriented doctoral programme offered at the University of the Witwatersrand in South Africa. The programme is described in relation to the broader context of the historical relationship of psychoanalysis to the university as well as to the specific context of the history of psychoanalysis in South Africa. Key challenges of the programme, specifically concerning research tensions and methodological and theoretical tolerance, are subsequently explored. The way in which these challenges manifested within a group context illustrates their potential for conflict as well as productive debate. The paper reflects on how this specific programme illuminates and extends some of the broader debates in the field of psychoanalysis.
Jemmott, L S
Adolescence is normally a healthy period of life. For some young people it is a period of experimentation with risky behavior. For others, it marks the development of habitual risk behaviors that persist into adulthood. Of special concern is adolescent involvement with sexual behaviors that increase the risk of infection with HIV and other sexually transmitted diseases (STDs). Nurses who work with adolescents are seeing an increase in STDs, including HIV infection occurring disproportionately among African-American adolescents. Although the use of condoms can reduce the risk of these sexually transmitted diseases, most sexually active adolescents do not consistently use condoms. This paper will discuss the scope of the problem of STDs, especially HIV infection among African-American adolescents. It will describe the Theory of Planned Behavior as a framework for designing interventions to reduce the sexual transmission of HIV and other STDs. Finally, it will provide strategies for nurses to intervene by empowering African-American adolescents to reduce their risk for sexually transmitted HIV infection.
Logie, Carmen; James, Llana; Tharao, Wangari; Loutfy, Mona
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.
International and African discourses on the HIV/AIDS pandemic and intervention neglect the role of religion and religious organizations. Social science perspectives in tackling health and disease neglect religious doctrines and faith central to worldviews and praxis of religious groups. Both aspects are important for religious groups and individuals affected by HIV/AIDS. Informed by a religious studies paradigm and through the religious ethnography of the Redeemed Christian Church of God (RCCG) in Nigeria and the Diaspora, this article demonstrates mechanisms employed by African Pentecostals to combat the epidemic and provide support for infected members. The RCCG conceptualization of disease and healing is central to understanding responses and measures in combating HIV/AIDS.
Sznitman, Sharon; DiClemente, Ralph; Salazar, Laura F.; Vanable, Peter A.; Carey, Michael P.; Hennessy, Michael; Brown, Larry K.; Valois, Robert F.; Stanton, Bonita F.; Fortune, Thierry; Juzang, Ivan
The evidence base and theoretical frameworks for mass media HIV-prevention campaigns in the United States are not well-developed. We describe an intervention approach using culturally sensitive mass media messages to enhance protective beliefs and behavior of African American adolescents at risk for HIV. This approach exploits the potential that mass media messages have, not only to reach a large segment of the adolescent population and thereby support normative change, but also to engage the most vulnerable segments of this audience to reduce HIV-associated risk behaviors. The results from an ongoing HIV-prevention trial implemented in 2 medium-sized cities in the United States illustrate the effectiveness of this intervention approach. PMID:19833995
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.
Sutton, Madeline Y; Parks, Carolyn P
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.
Murray, Ashley; Toledo, Lauren; Brown, Emma Ej; Sutton, Madeline Y
HIV testing for some African American men remains a challenge, and effective interventions are lacking. We explored facilitators and barriers associated with HIV testing among heterosexual African American men in rural Florida. We conducted focus group interviews with 67 African American men who were low-income, and HIV-uninfected based on prior testing or had unknown HIV status. Using computer-assisted thematic analyses, we examined transcribed focus group responses for main themes. Thematic analyses revealed three main themes regarding facilitators of HIV testing: 1) using preferred HIV testing community locations (park, library, gym); 2) receiving incentives (food or money); and 3) the importance of peer-led messaging for free, rapid HIV testing. Barriers included HIV testing at the local health department, and perceived social and emotional consequences to testing and the possibility of receiving a positive result. Effective HIV testing interventions for heterosexual African American men in rural Florida may need to incorporate suggested facilitators and reduce perceived barriers in order to improve HIV testing strategies.
Seeley, Janet; Watts, Charlotte H; Kippax, Susan; Russell, Steven; Heise, Lori; Whiteside, Alan
The social, economic, political and environmental structural factors that increase susceptibility to HIV infection and undermine prevention and treatment efforts continue to pose a challenge. The papers in this series highlight the importance of sustaining those efforts to address the structural drivers of the HIV epidemic, and that initiatives to achieve HIV elimination will only come about through a comprehensive HIV response, that includes meaningful responses to the social, political, economic and environmental factors that affect HIV risk and vulnerability. In the context of declining resources for HIV/AIDS, the papers speak to the need to integrate responses to the structural drivers of HIV/AIDS into future HIV investments, with both initiatives to integrate HIV into broader gender and development initiatives, as well as adaptations of current service models, to ensure that they are sensitive to and able to respond to the broader economic and social responsibilities that their clients face.
Davis, Kevin C; Uhrig, Jennifer; Rupert, Douglas; Fraze, Jami; Goetz, Joshua; Slater, Michael
"Take Charge. Take the Test." (TCTT), a media campaign promoting HIV testing among African American women, was piloted in Cleveland and Philadelphia from October 2006 to October 2007. This study assesses TCTT's effectiveness in promoting HIV testing information seeking among target audiences in each pilot city. The authors analyzed data on telephone hotlines promoted by the campaign and the www.hivtest.org Web site to examine trends in hotline calls and testing location searches before, during, and after the campaign. Cleveland hotline data were available from October 1, 2005, through February 28, 2008, for a total of 29 months (N = 126 weeks). Philadelphia hotline data were available from May 1, 2006, through February 28, 2008, for a total of 22 months (N = 96 weeks). The authors assessed the relation between market-level measures of the campaign's advertising activities and trends in hotline call volume and testing location searches. They found a significant relation between measures of TCTT advertising and hotline calls. Specifically, they found that increases in advertising gross ratings points were associated with increases in call volume, controlling for caller demographics and geographic location. The campaign had similar effects on HIV testing location searches. Overall, it appears the campaign generated significant increases in HIV information seeking. Results are consistent with other studies that have evaluated the effects of media campaigns on similar forms of information seeking. This study illustrates useful methods for evaluating campaign effects on information seeking with data on media implementation, hotline calls, and zip code-based searches for testing locations.
Simbayi, Leickness C.; Cain, Demetria; Carey, Kate B.; Carey, Michael P.; Eaton, Lisa; Harel, Ofer; Mehlomakhulu, Vuyelwa; Mwaba, Kelvin
Background: South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink. Purpose: To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens. Methods: Twelve matched pairs of township neighbourhoods were randomized to receive either (i) an HIV prevention intervention (guided by Social Action Theory) to reduce sexual risk and increase risk reduction communication in social networks, or (ii) an attention-matched control intervention that focused on the prevention of relationship violence. At the individual level, the interventions delivered skills building workshops focused on sexual risk reduction. At the social structural level, the intervention aimed to increase conversations about safer sex among men in the shebeens, distributed small media and implemented community educational events. Individual-level outcomes were assessed by following the workshop cohorts for 1 year (N = 984), and community-level outcomes were examined through cross-sectional community surveys conducted for 1 year in the shebeens (N = 9,678). Results: Men in the HIV prevention workshops demonstrated greater condom use, more HIV prevention-oriented conversations and greater perceptions of safer sex norms than men in the comparison workshops. Changes at the community level demonstrated significant differences in condom use, although the pattern was not consistent over time. Conclusions: Multi-level interventions that target men who drink in South African shebeens may help reduce risks for HIV and other sexually transmitted infections. PMID:24248803
Moizel, Jennifer; Panos, Stella E.; Patel, Sapna M.; Byrd, Desiree A.; Myers, Hector F.; Wyatt, Gail E.; Hinkin, Charles H.
Abstract Modest or even occasional nonadherence to combined antiretroviral therapy (cART) can result in adverse clinical outcomes. African Americans demonstrate lower rates of adherence than Caucasians or Latinos. Identifying factors that influence medication adherence among African Americans is a critical step toward reducing HIV/AIDS disease progression and mortality. In a sample of 181 African American (n=144) and Caucasian (n=37) HIV-positive drug-using individuals [age (M=42.31; SD=6.6) education (M=13.41; SD=2.1)], we examined the influence of baseline drug use, literacy, neurocognition, depression, treatment-specific social support, and patient satisfaction with health care provider on medication adherence averaged over the course of 6 months (study dates 2002–2006). Our findings suggest differential baseline predictors of medication adherence for African Americans and Caucasians, such that patient satisfaction with provider was the strongest predictor of follow-up medication adherence for African Americans whereas for Caucasians depressive symptoms and treatment-specific social support were predictive of medication adherence (after controlling for duration of drug use). PMID:22889235
Rahbar, T; Garg, S; Tripathi, R; Gupta, V K; Singh, M M
In India, several thousand HIV-infected babies are expected to be born every year. Despite effective intervention, the identification of HIV infected pregnant women prior to delivery is a major problem. KABP and acceptance of rapid screening of women for HIV among pregnant women attending ANC clinic and availing Voluntary Counselling and Confidential Testing services was assessed. The study was done among 90 pregnant women. There was no significant difference between one's husbands's job and income with respect to pregnant women's awareness of risk factors except that of tattooing. Education level had significant bearing on awareness level. Attitude about PLWHA indicates that 29% of the participants believed individuals with HIV shouldn't be allowed to get married, while 31% saying that they should not be allowed to have children. Participants supported compulsory HIV testing for pregnant women (39%) and couples before marriage. Almost 96% of participants had unprotected sex, though 41% casually used condom. All denied herself or her husband indulging in extramarital sex. The country is about to embark on its prevention of mother to child transmission (PMTCT) programme. This study throws some light on the level of knowledge acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries.
The Black community continues to be ravished by HIV/AIDS infection despite the marked expenditures utilized to reduce incidence among this cohort. Efforts to produce culturally appropriate programs that work continues to elude officials and HIV/AIDS has become endemic among specific subgroups in this cohort (e.g., Black men who have sex with men). Large-scale prevention programs have not worked and although community-based interventions have proven to be effective in eliciting behavior change, the numbers that they have been producing have not been enough to make a substantial impact on HIV incidence. The purpose of this exploratory article is to rehash how HIV/AIDS infection continues to devastate the African American community in an effort to elicit renewed vigilance in combating the disease in this community, describe the elements that continue to impede prevention and risk reduction efforts, and present a potential framework that may work to decrease incidence in this community. This article presents a multi-pronged approach to addressing the epidemic of HIV/AIDS in the African American community.
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
Summary Background 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. Methods 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. Findings 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
Mukeredzi, Tabitha Grace; Sibanda, Doras
The purpose of this study was to understand the nature and extent of subject content and curriculum knowledge that part-time Post Graduate Certificate in Education students in one South African university, brought to the classroom, and the kind and level of knowledge that they expected and sought from the programme. The study employed a…
Brown, Emma J; Hill, Mary Angelique
HIV/AIDS disproportionately affects African Americans, yet knowledge gaps exist regarding their views of risks and effective prevention strategies. This focus group study of rural and small city African Americans who use drugs sought to assess these perceptions. Common views of HIV risks included drug use, physical appearance as an indicator of HIV status, intentional transmission, having multiple partners, unprotected sex, bisexuality, and unfounded trust. Trading sex for drugs and unprotected sex when high were seen as drug use/HIV risk links, while HIV education and condom use were identified as ways to decrease risk. Perceptions of effective strategies included community-based programs, gender specific groups, providing food or other incentives, and making the program fun. Healthcare professionals and parents were viewed as the best people to promote HIV prevention. Based on the findings, effective intervention for this target group should encompass ethnocentric community-based strategies that focus on HIV education, condom use skills, and drug risk reduction.
Wong, Ambrose H.W.; Williams, Katie; Reddy, Sharon; Wilson, Douglas; Giddy, Janet; Alter, Galit; Ghebremichael, Musie; Carrington, Mary N.; Ndung'u, Thumbi; Walker, Bruce D.; Altfeld, Marcus
Abstract Recent studies suggest that innate immune responses by natural killer (NK) cells play a significant role in restricting human immunodeficiency virus type-1 (HIV-1) pathogenesis. Our aim was to characterize changes in NK cells associated with HIV-1 clade C disease progression. Here we used multiparametric flow cytometry (LSRII) to quantify phenotype and function of NK cells in a cross-sectional analysis of cryopreserved blood samples from a cohort of 41 chronically HIV-1-infected, treatment-naive adult South Africans. These individuals ranged in disease severity from early (CD4 count >500) to advanced HIV-1 disease (CD4 count <50). We found that the frequency of NK cells expressing KIR2DL1, an inhibitory receptor, and/or KIR2DS1, an activating receptor, tended to decrease with increasing HIV-1 viral load. We also discovered a significant increase (p < 0.05) in overall NK cell degranulation with disease progression. We found that acutely activated NK cells (CD69pos) were deficient in NKp46 expression ex vivo. In conclusion, we observed that with viremia and advanced HIV-1 disease, activated NK cells lack NKp46 expression, and KIR2DS1pos and/ or KIR2DL1pos NK cells are reduced in frequency. These findings suggest that modulation of receptor expression on NK cells may play a role in HIV-1 pathogenesis, and provide new insights on immunological changes in advanced HIV-1 disease. PMID:20380481
Chan, Philip A; Mena, Leandro; Patel, Rupa; Oldenburg, Catherine E; Beauchamps, Laura; Perez-Brumer, Amaya G; Parker, Sharon; Mayer, Kenneth H; Mimiaga, Matthew J; Nunn, Amy
Introduction Despite the efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV transmission, few studies have evaluated PrEP use and retention in care outcomes in real-world settings outside of clinical trials. Methods Data were collected from PrEP clinical care programmes in three mid-size US cities: Providence, Rhode Island (RI); Jackson, Mississippi (MS); and St. Louis, Missouri (MO). We assessed the demographic and social characteristics of patients prescribed PrEP and documented their insurance and copayment experiences. We assessed retention in PrEP care at three and six months. Multivariate analyses were used to predict retention in care among men who have sex with men (MSM). HIV acquisition among the cohort was also assessed. Results A total of 267 (RI: 117; MS: 88; MO: 62) patients were prescribed PrEP; 81% filled prescriptions (RI: 73%; MS: 82%; MO: 94%; p<0.001). Patients in MS and MO were more commonly African American than in RI (72% and 26% vs. 7%, respectively), but less frequently Latino (2% and 3% vs. 24%, respectively). More patients reported living below the federal poverty line in MS (52%) compared to MO (23%) and RI (26%). Most patients were MSM (RI: 92%; MS: 88%; MO: 84%). The majority of MSM reported recent condomless anal sex (RI: 70%; MS: 65%; MO: 75%). Among 171 patients prescribed PrEP at least six months beforehand, 72% were retained in care at three months (RI: 68%; MS: 70%; MO: 87%; p=0.12) and 57% were retained in PrEP care at six months (RI: 53%: MS: 61%; MO: 63%; p=0.51). Insurance status and medication costs were not found to be significant barriers for obtaining PrEP. Three patients became infected with HIV during the six-month period after being prescribed PrEP (1.1%; 3/267), including one in RI (suspected acute HIV infection), one in MO (confirmed poor adherence) and one in MS (seroconverted just prior to initiation). Conclusions PrEP initiation and retention in care differed across these distinct settings. In contrast
Albritton, Tashuna; Hodge-Sallah, Stepheria; Akers, Aletha; Blumenthal, Connie; O'Brien, Sarah; Council, Barbara; Muhammad, Melvin; Corbie-Smith, Giselle
We evaluated the fidelity and implementation of an HIV/AIDS and sexually transmitted infections intervention for rural African American youth. Using a community-based evaluation approach, community partners and researchers monitored four core process-evaluation components: reach, fidelity, dose delivered, and dose received. Researchers collected evaluation data through session observations, facilitator debriefing interviews, a youth focus group, and a satisfaction survey. For reach, more than half of the participants attended the 13 sessions. Participation varied between 62% and 100%. For fidelity, not all sessions were implemented as intended; multiple modifications occurred across sessions. For dose delivered, some lessons were missing materials and content was omitted; facilitators omitted content when there was insufficient time to complete a lesson. For dose received, engagement varied across lessons but youth reported high levels of satisfaction with the intervention. This formative process evaluation enabled us to identify and address multiple challenges to implementation. PMID:24939390
Louw, Ina; Zuber-Skeritt, Ortrun
Leadership development in higher education is of vital importance to South Africa's future. We present a case study that focuses on a leadership development programme (LDP) through action learning and action research (ALAR) for women academics in South Africa during 2000 and 2001. It identifies the effects of the LDP on participants five years…
Boekeloo, B; Geiger, T; Wang, M; Ishman, N; Quinton, S; Allen, G; Ali, B; Snow, D
African American/Black (Black) women suffer disproportionately to other women from HIV. An HIV prevention intervention combining two previous evidenced-based intervention programs; "Coping with Work and Family Stress" and "Hip Hop 2 Prevent Substance Abuse and HIV", was evaluated in a diverse sample of Black women (n = 205). Study participants at ten recruitment sites were assigned non-randomly to either the intervention or comparison group and then surveyed at baseline, immediate posttest, and 6-month follow-up. General Estimating Equation modeling revealed that participants in the comparison group reported less unprotected sex at immediate post-test and the intervention group less unprotected sex at 6-month follow-up. Despite the initial drop in reported unprotected sex in the comparison group, this study suggests that an HIV risk reduction intervention tailored to address Black women's socio-cultural stress and enhance their coping may reduce their unprotected sex at 6-months.
Balkus, Jennifer E; Nair, Gonasagrie; Montgomery, Elizabeth T; Mishra, Anu; Palanee-Phillips, Thesla; Ramjee, Gita; Panchia, Ravindre; Selepe, Pearl; Richardson, Barbra A; Chirenje, Zvavahera M; Marrazzo, Jeanne M
A recent analysis from South Africa reported no association between age-disparate relationships and HIV-1 acquisition. We assessed the association between male partner age and HIV-1 acquisition among South African women participating in the VOICE trial. Of 4077 women enrolled, 3789 had complete data; 26% and 5% reported having a partner >5 and >10 years older at enrollment, respectively. Reporting a partner >5 years older (hazard ratio = 1.00; 95% confidence interval: 0.74 to 1.35) or >10 older (hazard ratio = 0.92; 95% confidence interval: 0.49 to 1.74) was not associated with HIV-1 acquisition. These data corroborate recent reports and may suggest a shift in local epidemiology of heterosexual HIV-1 transmission.
ABC-based HIV-prevention programmes have been widely employed in northern Tanzanian wildlife conservation settings in an attempt to (re)shape the sexual behaviours of conservation actors. Utilising findings from 66 semi-structured interviews conducted in 2009-2010, this paper examines ABC prevention as a form of Foucauldian governmentality--circulating technologies of power that mobilise disciplinary technologies and attempt to transform such efforts into technologies of the self--and explores how individuals understand and respond to attempts to govern their behaviour. ABC regimes attempt to rework subjectivity, positioning HIV-related behaviours within a risk-based neoliberal rationality. However, efforts to use ABC as a technology to govern populations and individual bodies are largely incommensurate with existing Tanzanian sociocultural formations, including economic and gendered inequalities, and local understandings of sexuality. The language research participants used to talk about ABC and the justifications they offered for non-compliance illuminate this discrepancy. Data reveal that the recipients of ABC campaigns are active producers of understandings that work for them in their lives, but may not produce the behavioural shifts envisioned by programme goals. These findings corroborate previous research, which questions the continued plausibility of ABC as a stand-alone HIV- prevention framework.
Turner-Musa, Jocelyn O; Rhodes, Warren A; Harper, P Thandi Hicks; Quinton, Sylvia L
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.
Robinson, LaShun R.; Braxton, Nikia D.; Er, Deja L.; Conner, Anita C.; Renfro, Tiffaney L.; Rubtsova, Anna A.; Hardin, James W.; DiClemente, Ralph J.
Objectives. We assessed the effectiveness of P4 for Women, a faith-based HIV intervention. Methods. We used a 2-arm comparative effectiveness trial involving 134 African American women aged 18 to 34 years to compare the effectiveness of the Centers for Disease Control and Prevention–defined evidence-based Sisters Informing Sisters about Topics on AIDS (SISTA) HIV intervention with P4 for Women, an adapted faith-based version of SISTA. Participants were recruited from a large black church in Atlanta, Georgia, and completed assessments at baseline and follow-up. Results. Both SISTA and P4 for Women had statistically significant effects on this study’s primary outcome—consistent condom use in the past 90 days—as well as other sexual behaviors. However, P4 for Women also had statistically significant effects on the number of weeks women were abstinent, on all psychosocial mediators, and most noteworthy, on all measures of religious social capital. Results were achieved by enhancing structural social capital through ministry participation, religious values and norms, linking trust and by reducing negative religious coping. High intervention attendance may indicate the feasibility of conducting faith-based HIV prevention research for African American women. Conclusions. P4 for Women enhanced abstinence and safer sex practices as well as religious social capital, and was more acceptable than SISTA. Such efforts may assist faith leaders in responding to the HIV epidemic in African American women. PMID:24134367
Longo-Mbenza, Benjamin; Longokolo Mashi, Murielle; Lelo Tshikwela, Michel; Mokondjimobe, Etienne; Gombet, Thierry; Ellenga-Mbolla, Bertrand; Nge Okwe, Augustin; Kangola Kabangu, Nelly; Mbungu Fuele, Simon
Background and Purpose. It now appears clear that both HIV/AIDS and antiretroviral therapy (HAART) use are associated with higher risk of cardiovascular disease such as stroke. In this study, we evaluated the prevalence, the risk factors, and the cardiometabolic comorbidities of stroke in HIV/AIDS Central African patients. Methods. This hospital-based cross-sectional study collected clinical, laboratory, and imaging data of black Central African heterosexual, intravenous drug nonuser, and HIV/AIDS patients. Results. There were 54 men and 62 women, with a female to male ratio of 1.2 : 1. All were defined by hypercoagulability and oxidative stress. Hemorrhagic stroke was reported in 1 patient, ischemic stroke in 17 patients, and all stroke subtypes in 18 patients (15%). Younger age <45 years (P = .003), autoimmunity (P < .0001), and metabolic syndrome defined by IDF criteria (P < .0001) were associated with ischemic stroke. Conclusions. Clustering of several cardiometabolic factors, autoimmunity, oxidative stress, and lifestyle changes may explain accelerated atherosclerosis and high risk of stroke in these young black Africans with HIV/AIDS. Prevention and intervention programs are needed.
Whiters, David L; Santibanez, Scott; Dennison, David; Clark, H Westley
This case study examined programmatic data from a federally funded faith-based rapid HIV testing initiative. In 2004, Recovery Consultants of Atlanta, Inc. (RCA, Inc.) began providing rapid HIV testing in collaboration with six Atlanta-based African-American churches. Of the 1,947 persons tested from January 2004 to July 2005, 1,872 (96.1%) were African-American, 1,247 (64%) were male, and 1,612 (82.8%) were between the age of 26 and 56. A total of 85 HIV-infected individuals were identified and 72 were identified as previously undiagnosed cases (positivity rate of 3.7%). This case study highlights and promotes rapid HIV testing offered in partnership with African American churches as a strategy for raising HIV awareness among inner-city substance users.
Amazigo, Uche; Okeibunor, Joseph; Matovu, Victoria; Zouré, Honorat; Bump, Jesse; Seketeli, Azodoga
The predictors of sustainability of community-directed treatment with ivermectin (CDTI) at four implementation levels were evaluated in 41 African Programme for Onchocerciasis Control (APOC) projects, encompassing 492 communities in 10 countries. A model protocol provided information on indicators corresponding to nine aspects of a project that is likely to be sustainable at community level after the cessation of external support. Six of the nine aspects had components of community ownership as predictors of project sustainability. Quantitative and qualitative assessments were used to obtain individual community scores and an overall sustainability score for each project graded on a scale of 0-4. Of the 41 projects evaluated, 70% scored "satisfactorily" to "highly sustainable" at the community level. We found variations among countries and that health system weaknesses could hamper community efforts in sustaining a project, such as when ivermectin was delivered late. Community ownership was of primary importance to the community score, and the community-level scores correlated with overall project sustainability. The therapeutic coverage achieved in each project correlated with the ratio of volunteer ivermectin distributors per population served. Surprisingly, the performance of these distributors was not affected by the direct incentives offered, and coverage appeared to be highest when cash or in-kind compensation was not given at all. Although further research is required, anecdotal evidence pointed to diverse indirect benefits for distributors-political goodwill, personal satisfaction and altruistic fulfillment. The results demonstrate that community ownership is among the important determining factors of sustainability of community-based programmes.
Prakash, Ravi; Isac, Shajy; Washington, Reynold; Halli, Shiva S.
Background In Indian context, limited attempts have been made to estimate the mortality risks among people living with HIV (PLHIV). We estimated the rates of mortality among PLHIV covered under an integrated HIV-prevention cum care and support programme implemented in Karnataka state, India, and attempted to identify the key programme components associated with the higher likelihood of their survival. Methods Retrospective programme data of 55,801 PLHIV registered with the Samastha programme implemented in Karnataka state during 2006–11 was used. Kaplan-Meier survival methods were used to estimate the ten years expected survival probabilities and Cox-proportional hazard model was used to examine the factors associated with risk of mortality among PLHIV. We also calculated mortality rates (per 1000 person-year) across selected demographic and clinical parameters. Results Of the total PLHIV registered with the programme, about nine percent died within the 5-years of programme period with an overall death rate of 38 per 1000 person-years. The mortality rate was higher among males, aged 18 and above, among illiterates, and those residing in rural areas. While the presence of co-infections such as Tuberculosis leads to higher mortality rate, adherence to ART was significantly associated with reduction in overall death rate. Cox proportional hazard model revealed that increase in CD4 cell counts and exposure to intensive care and support programme for at least two years can bring significant reduction in risk of death among PLHIV [(hazard ratio: 0.234; CI: 0.211–0.260) & (hazard ratio: 0.062; CI: 0.054–0.071), respectively] even after adjusting the effect of other socio-demographic, economic and health related confounders. Conclusion Study confirms that while residing in rural areas and presence of co-infection significantly increases the mortality risk among PLHIV, adherence to ART and improvement in CD4 counts led to significant reduction in their mortality risk
This paper builds on the growing literature in 'postcolonial technoscience' by examining how science and ethics travel in transnational HIV research. I use examples of two controversial US-funded studies of mother-to-child transmission in Africa as case studies through which to explore quandaries of difference and inequality in global health research. My aim is not to adjudicate the debates over these studies, but rather to raise some questions about transnational research, science, and ethics that often get lost in public controversies over the moral status of such trials. Using interviews conducted with American and Ugandan HIV researchers as well as relevant material published in the popular and medical press, I argue that debates over research practice and the conditions under which practices are deemed ethically legitimate or questionable reflect the challenges faced by African researchers seeking to participate in global health science. In doing so, I show how questions of scientific legitimacy and authority are played out in debates over who decides what constitutes 'the normal' in human biological research and who can legitimately 'speak for Africa' regarding the ethics of research design and practice. I conclude that researchers from'resource-poor settings' must often walk a tightrope between claims of difference from the global North and assertions of sameness, in which a claim too forceful in either direction can undermine the ethical--and thus scientific--legitimacy of their research.
St Lawrence, Janet S.; Tarima, Sergey S.; DiFranceisco, Wayne J.; Amirkhanian, Yuri A.
Objectives. We examined correlates of condomless anal intercourse with nonmain sexual partners among African American men who have sex with men (MSM). Methods. We recruited social networks composed of 445 Black MSM from 2012 to 2014 in Milwaukee, Wisconsin; Cleveland, Ohio; and Miami Beach, Florida. Participants reported past-3-month sexual behavior, substance use, and background, psychosocial, and HIV-related characteristics. Results. Condomless anal intercourse outside main concordant partnerships, reported by 34.4% of MSM, was less likely in the case of no alcohol and marijuana use in the past 30 days, and higher risk-reduction behavioral intentions. High frequency of condomless anal intercourse acts with nonmain partners was associated with high gay community participation, weak risk-reduction intentions, safer sex not being perceived as a peer norm, low condom-use self-efficacy, and longer time since most recent HIV testing. Conclusions. Condomless anal intercourse with nonmain partners among Black MSM was primarily associated with gay community participation, alcohol and marijuana use, and risk-reduction behavioral intentions. PMID:26562130
Orr, Neil; Myers, Laura; Makhubele, Mzamani Benjamin; Matekane, Tselisehang; Delate, Richard; Mahlasela, Lusanda; Goldblatt, Brenda
Introduction: South African men are less likely to get tested for HIV than women and are more likely to commence antiretroviral treatment (ART) at later stages of disease, default on treatment, and to die from AIDS compared with women. The purpose of this study was to conduct formative research into the ideational and behavioral factors that enable or create obstacles to mens' uptake of HIV counseling and testing (HCT) and ART. The study consulted men with a goal of developing a communication campaign aimed at improving the uptake of HIV testing and ART initiation among men. Methods: Eleven focus groups and 9 in-depth interviews were conducted with 97 male participants in 6 priority districts in 4 South African provinces in rural, peri-urban, and urban localities. Results: Fears of compromised masculine pride and reputation, potential community rejection, and fear of loss of emotional control (“the stress of knowing”) dominated men's rationales for avoiding HIV testing and treatment initiation. Conclusions: A communication campaign was developed based on the findings. Creative treatments aimed at redefining a ‘strong’ man as someone who faces his fears and knows his HIV status. The resultant campaign concept was: “positive or negative—you are still the same person.” PMID:27930614
Whitehead, Nicole Ennis; Hearn, Lauren E; Burrell, Larry
By 2015, half of those living with HIV in the United States will be ≥50 years of age. Research suggests that perceived social support is an important factor in maintaining positive health behaviors in this population. The present study examined the relationship between depressive symptoms and trait anger on perceived social support in a sample of low-income HIV positive (HIV+) African Americans ≥50 years of age. Additionally, we examined life stressors moderated the relationship between mental health and perceived support. This study includes 95 HIV+ men and women ≥50 years of age who identify as black/African American. As expected, depressive symptoms and trait anger showed a strong inverse relationship with perceived support resources. Furthermore, life stressors also showed a strong inverse relationship with perceived support. However, life stressors did not moderate the relationship between depressive symptoms and anger. Instead life stressors demonstrated a strong independent relationship with perceived support. The association between depressive symptoms, trait anger, life stressors, and lower perceived support suggests that these factors play a role in one's ability to access needed support resources. Greater perceived support is associated with improved health in HIV+ persons, and may be especially important in tailoring interventions for those ≥50 years of age.
Matthews, Philippa C; Carlson, Jonathan M; Beloukas, Apostolos; Malik, Amna; Jooste, Pieter; Ogwu, Anthony; Shapiro, Roger; Riddell, Lynn; Chen, Fabian; Luzzi, Graz; Jesuthasan, Gerald; Jeffery, Katie; Jojic, Nebojsa; Ndung'u, Thumbi; Carrington, Mary; Goulder, Philip J R; Geretti, Anna Maria; Klenerman, Paul
Outcomes of chronic infection with hepatitis B virus (HBV) are varied, with increased morbidity reported in the context of human immunodeficiency virus (HIV) coinfection. The factors driving different outcomes are not well understood, but there is increasing interest in an HLA class I effect. We therefore studied the influence of HLA class I on HBV in an African HIV-positive cohort. We demonstrated that virologic markers of HBV disease activity (hepatitis B e antigen status or HBV DNA level) are associated with HLA-A genotype. This finding supports the role of the CD8(+) T-cell response in HBV control, and potentially informs future therapeutic T-cell vaccine strategies.
Relancio, Javier; Cuellar, Alberto; Walker, Gregg; Ettmayr, Chris
Thus far seven Concentrated Solar Power (CSP) projects have been awarded under the Renewable Energy Independent Power Producer Procurement Programme (REIPPPP), totalling 600MW: one project is in operation, four under construction and two on their way to financial close. This provides an excellent opportunity for analysis of key features of the projects that have contributed to or detracted from the programme's success. The paper draws from Mott MacDonald's involvement as Technical Advisor on the seven CSP projects that have been successful under the REIPPPP to date as well as other global CSP developments. It presents how various programme requirements have affected the implementation of projects, such as the technical requirements, time of day tariff structure, economic development requirements and the renewable energy grid code. The increasingly competitive tariffs offered have encouraged developers to investigate efficiency maximising project configurations and cost saving mechanisms, as well as featuring state of the art technology in their proposals. The paper assesses the role of the project participants (developers, lenders and government) with regards to these innovative technologies and solutions. In our paper we discuss the status of projects and the SA market, analysing the main challenges and opportunities that in turn have influenced various aspects such as technology choice, operational regimes and supply chain arrangements.
Veeken, H; Bermejo, A
Worldwide, approximately 1.7 billion persons are infected with M. tuberculosis, and 5 million with HIV. In developing countries, a strong association exists between the 2 pathogens, with 14-30% of AIDS patients having tuberculosis (TB), and 12-60% of TB patients HIV-seropositive (HIV+). TB is one of the most frequent opportunistic infection in AIDS, and is a common way for AIDS to present. Evidence suggests that most TB cases in HIV+ patients are due to the endogenous reactivation of past TB infection instead of from new exogenous infection. Particular cause for concern exists in developing countries where approximately 1/2 of the population aged 20-40 years is infected with TB. While 10% of HIV-individuals may develop TB over their lifetimes, HIV+ individuals are at far greater risk of developing the disease. The paper discusses diagnosis, chemoprophylaxis, and treatment of TB. To help stymie major increases in TB patients as HIV spreads across populations with high prevalence of TB, the authors recommend offering HIV testing and counseling to all patients, including TB in the differential diagnoses of all pulmonary diseases in HIV+ patients, offering BCG vaccination to every nonsymptomatic AIDS newborn in countries with high levels of TB infection, routinely obtaining mycobacterial stains and cultures on specimens from HIV+ patients with respiratory symptoms, making clinicians aware of the many false negative tuberculin tests and atypical radiographic patterns in advanced HIV infection, offering 12 months of isoniazid chemoprophylaxis to those HIV+, treating HIV patients with TB with isoniazid, rifampicin, and 1 or 2 of pyrazinamide, ethambutol, or streptomycin during the 1st 2 months, and making health workers aware of infection risks from doing tuberculin tests and injecting streptomycin.
Anema, A; Freifeld, C C; Druyts, E; Montaner, J S G; Hogg, R S; Brownstein, J S
No studies to date have assessed the quantity of HIV/AIDS-related media on the Internet. We assessed the quantity of language-specific HIV/AIDS Internet-based news coverage, and the correlation between country-specific HIV/AIDS news coverage and HIV/AIDS prevalence. Internet-based HIV/AIDS news articles were queried from Google News Archives for 168 countries, for the year 2007, in the nine most commonly spoken languages worldwide. English, French and Spanish sources had the greatest number of HIV/AIDS-related articles, representing 134,000 (0.70%), 11,200 (0.65%) and 24,300 (0.49%) of all news articles, respectively. A strong association between country-specific HIV/AIDS news coverage and HIV/AIDS prevalence was found, Spearman's rank correlation: 0.6 (P < 0.001). Among countries with elevated HIV/AIDS prevalence (> or =10%), the volume of HIV/AIDS-specific media was highest in Swaziland (15.9%) and Malawi (13.2%), and lowest in South Africa (4.8%) and Namibia (4.9%). Increased media attention should be placed on countries with high HIV/AIDS prevalence and limited HIV/AIDS-specific news coverage.
Jennings, Larissa; Rompalo, Anne M; Wang, Jing; Hughes, James; Adimora, Adaora A; Hodder, Sally; Soto-Torres, Lydia E; Frew, Paula M; Haley, Danielle F
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 years (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.
Murry, Velma McBride; Berkel, Cady; Chen, Yi-fu; Brody, Gene H.; Gibbons, Frederick X.; Gerrard, Meg
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…
MacPhail, Catherine Lorne; Pettifor, Audrey; Coates, Tom; Rees, Helen
Reduced HIV risk behavior and increased use of care and support services have been demonstrated among adults accessing HIV voluntary counseling and testing (VCT). The impact of VCT on adolescents is, however, not known. Focus group discussions were held with adolescents and parents in two South African townships to establish the perceptions of and…
Tobin, Karin; Kuramoto, Satoko J.; German, Danielle; Fields, Errol; Spikes, Pilgrim S.; Patterson, Jocelyn; Latkin, Carl
Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men. The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older,…
Crosby, Richard A.; DiClemente, Ralph J.; Wingood, Gina M.; Harrington, Kathy
Investigated whether living in a supportive family was an HIV/STD-protective factor for at-risk African American adolescent girls. Surveys supported the association between living in perceived supportive families and HIV/STD protective benefits. Supportive families enhanced girls' confidence in their ability to negotiate condom use and helped them…
Valois, Robert F.; DiClemente, Ralph J.; Carey, Michael P.; Stanton, Bonita; Romer, Daniel; Fletcher, Faith; Farber, Naomi; Brown, Larry K.; Vanable, Peter A.; Salazar, Laura F.; Juzang, Ivan; Fortune, Thierry
Abstract HIV-related stigma undermines HIV prevention, testing, and treatment. Multipronged risk-reduction strategies may reduce stigma among African American adolescents. To test the effectiveness of a risk-reduction strategy in addressing stigma, 1613 African American adolescents from four mid-sized cities participated in a randomized control trial. Participants received a sexual-risk reduction [Focus on Youth (FOY)] or general health curriculum [Promoting Health Among Teens (PHAT)]. Two cities received a culturally-tailored media intervention. Participants completed baseline, 3-, 6-, and 12-month surveys to measure HIV-related stigma and knowledge. Analysis of covariance tested for stigma and knowledge differences by media city status and curriculum/media city status (PHAT media vs. PHAT non-media, FOY media vs. FOY non-media; FOY media vs. PHAT media; FOY non-media vs. PHAT non-media) at each measurement. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over time. Media participants demonstrated greater HIV-related knowledge (p<0.10) at 6 months and lower stigma at 3 months (p<0.10). FOY media participants had lower 3-month (p<0.05) and 12-month (p<0.10) stigma scores than non-media FOY participants. FOY media and non-media participants had greater knowledge than PHAT for all intervals after baseline. FOY media had lower stigma than PHAT media after baseline for all intervals after baseline. HLM indicated greater knowledge slopes for the media group (p<0.05). FOY media participants had greater knowledge slopes (p<0.05) relative to non-media FOY participants and media PHAT participants (p<0.01). A combination of a HIV risk-reduction curriculum and culturally-tailored media demonstrated some effectiveness in reducing stigma. Future use of media in HIV-prevention should include and evaluate effects on stigma. PMID:25738952
Makoae, Lucy N.; Portillo, Carmen J.; Uys, Leana R.; Dlamini, Priscilla S.; Greeff, Minrie; Chirwa, Maureen; Kohi, Thecla W.; Naidoo, Joanne; Mullan, Joseph; Wantland, Dean; Durrheim, Kevin; Holzemer, William L.
Aim This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. Design A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1,454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARV self-reported a mean CD4 count of 418. Results Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. Discussion This study documents that this sample of 1,454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors’ opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications. PMID:20024711
Durosinmi-Etti, F A; Mouelle-Sone, A
With 47% of the population under 15 years of age and the control of infectious and other communicable diseases, cancer will likely constitute a major health problem in West Africa in future. Radiotherapy facilities and trained manpower to run them are very limited within the subregion. This paper quantifies the severity of the situation and discusses a practical approach aimed at coping with the situation through the organisation of a training programme for radiotherapists, medical physicists and radiation technologists as part of the strategies for cancer control in West Africa. A curriculum is proposed for the training of radiotherapists.
Mlisana, Koleka; Werner, Lise; Garrett, Nigel J.; McKinnon, Lyle R.; van Loggerenberg, Francois; Passmore, Jo-Ann S.; Gray, Clive M.; Morris, Lynn; Williamson, Carolyn; Abdool Karim, Salim S.
Background. Whereas human immunodeficiency virus (HIV) subtype B–infected individuals generally progress to AIDS within 8–10 years, limited data exist for other clades, especially from Africa. We investigated rates of HIV disease progression of clade C–infected South African women. Methods. Prospective seroincidence cohorts in KwaZulu-Natal were assessed for acute HIV infection monthly (n = 245) or every 3 months (n = 594) for up to 4 years. Rapid disease progression was defined as CD4 decline to <350 cells/µL by 2 years postinfection. Serial clinical and laboratory assessments were compared using survival analysis and logistic regression models. Results. Sixty-two women were identified at a median of 42 days postinfection (interquartile range, 34–59), contributing 282 person-years of follow-up. Mean CD4 count dropped by 39.6% at 3 months and 46.7% at 6 months postinfection in women with preinfection measurements. CD4 decline to <350 cells/µL occurred in 31%, 44%, and 55% of women at 1, 2, and 3 years postinfection, respectively, and to <500 cells/µL in 69%, 79%, and 81% at equivalent timepoints. Predictors of rapid progression were CD4 count at 3 months postinfection (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.31–3.28; P = .002), setpoint viral load (HR, 3.82; 95% CI, 1.51–9.67; P = .005), and hepatitis B coinfection (HR, 4.54; 95% CI, 1.31–15.69; P = .017). Conversely, presence of any of HLAB*1302, B*27, B*57, B*5801, or B*8101 alleles predicted non–rapid progression (HR, 0.19; 95% CI, .05–.74; P = .016). Conclusions. Nearly half of subtype C–infected women progressed to a CD4 count <350 cells/µL within 2 years of infection. Implementing 2013 World Health Organization treatment guidelines (CD4 count <500 cells/µL) would require most individuals to start antiretroviral therapy within 1 year of HIV infection. PMID:25038116
Wilkinson, Eduan; Engelbrecht, Susan; de Oliveira, Tulio
HIV has spread at an alarming rate in South Africa, making it the country with the highest number of HIV infections. Several studies have investigated the histories of HIV-1 subtype C epidemics but none have done so in the context of social and political transformation in southern Africa. There is a need to understand how these processes affects epidemics, as socio-political transformation is a common and on-going process in Africa. Here, we genotyped strains from the start of the epidemic and applied phylodynamic techniques to determine the history of the southern Africa and South African epidemic from longitudinal sampled data. The southern African epidemic’s estimated dates of origin was placed around 1960 (95% HPD 1956–64), while dynamic reconstruction revealed strong growth during the 1970s and 80s. The South African epidemic has a similar origin, caused by multiple introductions from neighbouring countries, and grew exponentially during the 1980s and 90s, coinciding with socio-political changes in South Africa. These findings provide an indication as to when the epidemic started and how it has grown, while the inclusion of sequence data from the start of the epidemic provided better estimates. The epidemic have stabilized in recent years with the expansion of antiretroviral therapy. PMID:26574165
Wilkinson, Eduan; Engelbrecht, Susan; de Oliveira, Tulio
HIV has spread at an alarming rate in South Africa, making it the country with the highest number of HIV infections. Several studies have investigated the histories of HIV-1 subtype C epidemics but none have done so in the context of social and political transformation in southern Africa. There is a need to understand how these processes affects epidemics, as socio-political transformation is a common and on-going process in Africa. Here, we genotyped strains from the start of the epidemic and applied phylodynamic techniques to determine the history of the southern Africa and South African epidemic from longitudinal sampled data. The southern African epidemic's estimated dates of origin was placed around 1960 (95% HPD 1956-64), while dynamic reconstruction revealed strong growth during the 1970s and 80s. The South African epidemic has a similar origin, caused by multiple introductions from neighbouring countries, and grew exponentially during the 1980s and 90s, coinciding with socio-political changes in South Africa. These findings provide an indication as to when the epidemic started and how it has grown, while the inclusion of sequence data from the start of the epidemic provided better estimates. The epidemic have stabilized in recent years with the expansion of antiretroviral therapy.
Andrasik, Michele Peake; Clad, Rachel; Bove, Joanna; Tsegaselassie, Solomon; Morris, Martina
We evaluate an innovative grassroots community-based campaign in Seattle, WA focused on educating African American and African-born communities about concurrent partnerships and HIV transmission. Respondents completed a short self-administered questionnaire on a handheld personal digital assistant to evaluate the reach, acceptability and preliminary efficacy of the campaign. Of those who remembered seeing the campaign materials (82 %), social networks were the most common source of exposure (80 %). Respondents rated campaign materials very visually attractive (86 %), very interesting (91 %), and very important for themselves (90 %) and their community (93 %). Respondents reported that the campaign increased their knowledge about concurrency (84 %), changed their attitudes about it (77 %), and 65 % said it was likely or very likely that they would change their behavior as a result. This inexpensive grassroots campaign demonstrated extensive reach in the local black community and was able to move beyond individual exposure and into social networks.
This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIV-negative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.
Introduction Extant studies universally document a positive gradient between socioeconomic status (SES) and health. A notable exception is the apparent concentration of HIV/AIDS among wealthier individuals. This paper uses data from the Demographic Health Surveys and AIDS Indicator Surveys to examine socioeconomic inequalities in HIV/AIDS prevalence in 24 sub-Saharan African (SSA) countries, the region that accounts for two-thirds of the global HIV/AIDS burden. Methods The relative and generalized concentration indices (RC and GC) were used to quantify wealth-based socioeconomic inequalities in HIV/AIDS prevalence for the total adult population (aged 15-49), for men and women, and in urban and rural areas in each country. Further, we decomposed the RC and GC indices to identify the determinants of socioeconomic inequalities in HIV/AIDS prevalence in each country. Results Our findings demonstrated that HIV/AIDS was concentrated among higher SES individuals in the majority of SSA countries. Swaziland and Senegal were the only countries in the region where HIV/AIDS was concentrated among individuals living in poorer households. Stratified analyses by gender showed HIV/AIDS was generally concentrated among wealthier men and women. In some countries, including Kenya, Lesotho Uganda, and Zambia, HIV/AIDS was concentrated among the poor in urban areas but among wealthier adults in rural areas. Decomposition analyses indicated that, besides wealth itself (median = 49%, interquartile range [IQR] = 90%), urban residence (median = 54%, IQR = 81%) was the most important factor contributing to the concentration of HIV/AIDS among wealthier participants in SSA countries. Conclusions Further work is needed to understand the mechanisms explaining the concentration of HIV/AIDS among wealthier individuals and urban residents in SSA. Higher prevalence of HIV/AIDS could be indicative of better care and survival among wealthier individuals and urban adults, or reflect
Du Mortier, Stéphane; Mukangu, Silas; Sagna, Charles; Nyffenegger, Laurent; Aebischer Perone, Sigiriya
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.
Arnold, Emily A; Bailey, Marlon M
This article focuses on the construction of homes and families within the ballroom community, a prominent feature of urban GLBTQ communities of color in cities across the United States. Based on two ethnographic studies with ballroom communities in the San Francisco Bay Area, California, and Detroit, Michigan, we explore the importance of gender and sexual identity in informing community practice around HIV prevention and treatment. As a community, the ballroom scene provides African American queer youth with support for same-sex desire and identity, along with multiple forms of support for HIV prevention. Our study of the ballroom community documents current forms of "intravention" occurring within the community and the importance of the gender-sex system in organizing these practices. We also offer recommendations for community-based organizations to partner with the ballroom community, making use of existing social structures within the community and the salient concepts of home and family, to provide HIV-related services and support. We argue for HIV-prevention interventions to take a more culturally appropriate, nuanced approach to reaching African American youth at risk, utilizing community and family structures, in whatever forms these may take.
Griffith, Derek M; Pichon, Latrice C; Campbell, Bettina; Allen, Julie Ober
Despite substantial federal, state, and local efforts to reduce the transmission of HIV/AIDS, African Americans experience higher rates of infection than any other ethnic or racial group in the United States. It is imperative to develop culturally and ecologically sensitive interventions to meet the sexual health needs of this population. Capitalizing on the assets, resources, and strengths of faith-based organizations, YOUR Blessed Health (YBH) is a community-based participatory research project developed to increase HIV/AIDS awareness and reduce HIV-related stigma among the African American faith community in Flint, Michigan. This article describes the historical context and development of YBH, discusses the results of the pilot study, and illustrates how YBH grew into a community mobilization effort led by faith leaders and their congregations to address HIV/AIDS. YBH highlights the importance of developing and testing intervention models that originate from community-based organizations to address complex and sensitive health issues among marginalized populations.
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.
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
Mossoro-Kpinde, CD; Jenabian, MA; Gody, JC; Robin, L; Talla, P; Longo, JDD; Grésenguet, G; Belec, L
Background: Several commercially available molecular techniques were developed based on subtype B of HIV-1, which represents only 10% of HIV strains worldwide. Indeed, in sub-Saharan Africa, non-B subtypes of HIV-1 are predominant. The aim of this study was to evaluate the performances of the COBAS® AmpliPrep/COBAS® (CAP/CTM) HIV-1 Qualitative assays to detect the broad range of HIV-1 variants circulating in Central Africa and compare to the outgoing CAP/CTM HIV-1 Quantitative test v2.0 (Roche Molecular Systems), chosen as reference gold standard molecular assay. Methods: The CAP/CTM HIV-1 Qualitative tests versions 1.0 and 2.0 (Roche Molecular Systems, Inc., Branchburg, NJ, USA) were evaluated compared to CAP/CTM TaqMan HIV-1 Quantitative test v2.0 (Roche Molecular Systems) on 239 dried plasma spot (DPS) from 133 HIV-1-infected (with detectable plasma HIV RNA load) and 106 uninfected children, followed-up at Complexe Pédiatrique, Bangui, Central African Republic. Results: The version 1.0 showed low sensitivity (93.2%), with 9 (6.8%) false negative results, demonstrating under-detection of non-B HIV-1 subtypes. In contrast, the upgraded version 2.0 showed 100%-sensitivity, 100%-specificity and perfect agreement (κ coefficient, 1.0). Conclusion: Our evaluation in the Central African Republic demonstrates the clinical implications of the accuracy and reliability of the CAP/CTM HIV-1 Qualitative assay for early diagnosis of HIV-1 in Central African children. PMID:27857825
Shrestha, Sadeep; Wiener, Howard W.; Aissani, Brahim; Song, Wei; Shendre, Aditi; Wilson, Craig M.; Kaslow, Richard A.; Tang, Jianming
Background 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. Methodology/Principal Findings 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. Conclusions/Significance 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. PMID:20976276
McLaren, Paul J; Ripke, Stephan; Pelak, Kimberly; Weintrob, Amy C; Patsopoulos, Nikolaos A; Jia, Xiaoming; Erlich, Rachel L; Lennon, Niall J; Kadie, Carl M; Heckerman, David; Gupta, Namrata; Haas, David W; Deeks, Steven G; Pereyra, Florencia; Walker, Bruce D; de Bakker, Paul I W
A small proportion of human immunodeficiency virus-1 (HIV-1) infected individuals, termed HIV-1 controllers, suppress viral replication to very low levels in the absence of therapy. Genetic investigations of this phenotype have strongly implicated variation in the class I major histocompatibility complex (MHC) region as key to HIV-1 control. We collected sequence-based classical class I HLA genotypes at 4-digit resolution in HIV-1-infected African American controllers and progressors (n = 1107), and tested them for association with host control using genome-wide single nucleotide polymorphism data to account for population structure. Several classical alleles at HLA-B were associated with host control, including B*57:03 [odds ratio (OR) = 5.1; P= 3.4 × 10(-18)] and B*81:01 (OR = 4.8; P= 1.3 × 10(-9)). Analysis of variable amino acid positions demonstrates that HLA-B position 97 is the most significant association with host control in African Americans (omnibus P = 1.2 × 10(-21)) and explains the signal of several HLA-B alleles, including B*57:03. Within HLA-B, we also identified independent effects at position 116 (omnibus P= 2.8 × 10(-15)) in the canonical F pocket, position 63 in the B pocket (P= 1.5 × 10(-3)) and the non-pocket position 245 (P= 8.8 × 10(-10)), which is thought to influence CD8-binding kinetics. Adjusting for these HLA-B effects, there is evidence for residual association in the MHC region. These results underscore the key role of HLA-B in affecting HIV-1 replication, likely through the molecular interaction between HLA-B and viral peptides presented by infected cells, and suggest that sites outside the peptide-binding pocket also influence HIV-1 control.
McLaren, Paul J.; Ripke, Stephan; Pelak, Kimberly; Weintrob, Amy C.; Patsopoulos, Nikolaos A.; Jia, Xiaoming; Erlich, Rachel L.; Lennon, Niall J.; Kadie, Carl M.; Heckerman, David; Gupta, Namrata; Haas, David W.; Deeks, Steven G.; Pereyra, Florencia; Walker, Bruce D.; de Bakker, Paul I. W.
A small proportion of human immunodeficiency virus-1 (HIV-1) infected individuals, termed HIV-1 controllers, suppress viral replication to very low levels in the absence of therapy. Genetic investigations of this phenotype have strongly implicated variation in the class I major histocompatibility complex (MHC) region as key to HIV-1 control. We collected sequence-based classical class I HLA genotypes at 4-digit resolution in HIV-1-infected African American controllers and progressors (n = 1107), and tested them for association with host control using genome-wide single nucleotide polymorphism data to account for population structure. Several classical alleles at HLA-B were associated with host control, including B*57:03 [odds ratio (OR) = 5.1; P= 3.4 × 10–18] and B*81:01 (OR = 4.8; P= 1.3 × 10−9). Analysis of variable amino acid positions demonstrates that HLA-B position 97 is the most significant association with host control in African Americans (omnibus P = 1.2 × 10−21) and explains the signal of several HLA-B alleles, including B*57:03. Within HLA-B, we also identified independent effects at position 116 (omnibus P= 2.8 × 10−15) in the canonical F pocket, position 63 in the B pocket (P= 1.5 × 10−3) and the non-pocket position 245 (P= 8.8 × 10−10), which is thought to influence CD8-binding kinetics. Adjusting for these HLA-B effects, there is evidence for residual association in the MHC region. These results underscore the key role of HLA-B in affecting HIV-1 replication, likely through the molecular interaction between HLA-B and viral peptides presented by infected cells, and suggest that sites outside the peptide-binding pocket also influence HIV-1 control. PMID:22718199
O'Leary, Ann; Jemmott, John B; Jemmott, Loretta S; Bellamy, Scarlett; Icard, Larry D; Ngwane, Zolani
"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.
Rao, Vasudev R.; Neogi, Ujjwal; Eugenin, Eliseo; Prasad, Vinayaka R.
Regional differences in neurovirulence have been documented among subtype/clade-C HIV-1 isolates in India and Southern Africa. We previously demonstrated that a C31S substitution in Clade-C Tat dicysteine motif reduces monocyte recruitment, cytokine induction and direct neurotoxicity. Therefore, this polymorphism is considered to be a causative factor for these differences in neurovirulence. We previously reported on the genotypic differences in Tat protein between clade-C and rest of the clades showing that approximately 90% of clade-C HIV-1 Tat sequences worldwide contained this C31S polymorphism, while 99% of non-clade C isolates lacked this Tat polymorphism at C31 residue (Ranga et al. (2004) J Virol 78∶2586–2590). Subsequently, we documented intra-clade-C differences in the frequency of Tat dicysteine variants between India and Southern Africa, as the basis for differential disease severity and showed the importance of the Tat dicysteine motif for neuropathogenesis using small animal models. We have now examined if determinants of neurovirulence besides Tat are different between the clade-C HIV-1 isolates from Southern Africa and India. Envelope glycoprotein gp120 is a well-documented contributor to neurotoxicity. We found that gp120 sequences of HIV-1 isolates from these two regions are genetically distinct. In order to delineate the contribution of gp120 to neurovirulence, we compared direct in vitro neurotoxicity of HIV-infected supernatants of a representative neurovirulent US clade-B isolate with two isolates each from Southern Africa and India using primary human neurons and SH-SY5Y neuroblastoma cells. Immunodepletion of gp120 of both US clade B and the Southern African clade C isolates revealed robust decreases in neurotoxicity, while that of the Indian isolates showed minimal effect on neurotoxicity. The gp120 as a cause of differential neurotoxicity was further confirmed using purified recombinant gp120 from HIV isolates from these regions. We
Ngene, Nnabuike C; Moodley, Jagidesa
In South Africa, new drug regimens (WHO treatment Option B) used to manage HIV infection in pregnancy and the national strategic plan on HIV have resulted in improved health outcomes. Among these outcomes are reductions in the following: mother-to-child transmission (MTCT) of HIV to 2.4%; maternal deaths attributable to HIV; and adverse reactions due to antiretroviral therapy (ART). The present article describes these new drug regimens and the national strategic HIV management plan, as well as their challenges and the implications of improved health outcomes. Such outcomes imply that further decreases in MTCT of HIV, and HIV attributable maternal deaths are possible if potential challenges are addressed and treatment option B+ offered. A confidential enquiry into each case of MTCT is advocated to reduce vertical transmission rates to zero levels.
Conseil, Alexandra; Mounier-Jack, Sandra; Coker, Richard
This case study on Vietnam aims to generate empirical evidence on the relative merits of integration of two priority health interventions, HIV/AIDS and tuberculosis (TB), into six functions of the wider health system: stewardship and governance, service delivery, demand generation, monitoring and evaluation, planning, and financing. Selective documentary reviews and 25 qualitative, semi-structured interviews were conducted in early 2009 in Hanoi, Hai Duong province, Chih Linh district and Hoang Tien commune with informants from international, national and sub-national agencies steering or managing the HIV/AIDS and TB programmes and from health facilities providing HIV/AIDS and TB services. Data collected were collated and evaluated against 25 elements of integration. Each element of integration was ultimately classified as being 'fully/predominantly integrated', 'partially integrated', 'not or predominantly not integrated'. The results showed that none of the six programme functions was fully integrated into the general health care system as a whole. They were established either in parallel, notably at higher administrative levels, or were partially integrated. The study findings also revealed that little integration across all functional levels has occurred between the two programmes. Generally international agencies and sub-national domestic stakeholders supported more integration between vertical programmes (HIV and TB) and the general health systems, while national bodies responsible for HIV and TB favoured reinforcing a more vertical and thus less integrated approach. In the absence of shared assumptions and goals, this polarization of views may result in sub-optimal effectiveness and efficiency of each of the disease programmes as well as of HIV/TB interventions.
Tobin, Karin; Kuramoto, Satoko J; German, Danielle; Fields, Errol; Spikes, Pilgrim S; Patterson, Jocelyn; Latkin, Carl
Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men. The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older, identified as African American/Black race, reported having at least two sex partners in the prior 90 days (at least one of whom must be a male partner), unprotected anal sex with male partner in the prior 90 days, and willing to test for HIV. Retention exceeded 95% at 3-month follow-up. Results of multivariate logistic regression analysis adjusting for baseline risk, HIV status, and health insurance indicate intervention efficacy in decreasing the number of male sex partners and marginal effects on condom use with male partners and HIV-negative/unknown partners. Specifically, intervention condition was associated with increased odds of zero male sex partners (adjusted odds ratio [AOR] = 3.03, 95% confidence interval [CI] = 1.26-7.28), condom use with male partners (AOR = 2.64, 95% CI = 0.95-7.36), and HIV-negative/unknown status partners (AOR = 3.19, 95% CI = 0.98-10.38) at follow-up. These results contribute to the limited number of culturally appropriate models of HIV prevention intervention that are urgently needed for African American men who have sex with men to address their persistently high rates of HIV.
Montgomery, Chantal A; Henning, Katherine J; Kantarzhi, Sarah R; Kideckel, Tamar B; Yang, Cheryl F M; O'Brien, Kelly K
Objectives Our aim was to explore the experiences of engaging in a community-based exercise programme (CBEP) from the perspective of people living with HIV (PLWH). Design We conducted a descriptive qualitative study using semistructured interviews. Setting We recruited adults living with HIV who participated in a 16-week CBEP in Toronto, Canada. Participants 11 participants, the majority men (64%), with a median age of 52 years, and living with a median of 5 concurrent health conditions in addition to HIV participated in the study. Outcome measures We asked participants about their overall experiences: strengths, limitations and perceived benefits of the CBEP; factors influencing participation and current level of exercise after completion of the CBEP. We administered a self-reported demographic questionnaire followed by the Rapid Assessment of Physical Activity (RAPA) questionnaire. We analysed interview data using thematic analysis. Results We developed a framework that describes the experiences before, during and after the CBEP; and the perceived impact of the CBEP on health, which influenced the intent to, engagement in and sustainability of exercise among PLWH. Participants described the positive impact of the CBEP on their physical, mental and social health. Interviews were completed at a median of 6 months after the CBEP, when 9 participants reported ongoing engagement in exercise, but to a lesser extent than during the CBEP. Intrinsic and extrinsic factors facilitated or hindered engagement in exercise throughout all phases of the CBEP. The episodic nature of HIV and multimorbidity influenced engagement in exercise and posed challenges to re-engagement after periods of inactivity. Conclusions CBEPs provide an opportunity to enhance physical activity, perceived health outcomes and knowledge about exercise for PLWH. Community-based exercise is a strategy that may be used by health providers to promote engagement in sustained physical activity for PLWH
Hatzakis, Angelos; Sypsa, Vana; Paraskevis, Dimitrios; Nikolopoulos, Georgios; Tsiara, Chrissa; Micha, Katerina; Panopoulos, Anastasios; Malliori, Meni; Psichogiou, Mina; Pharris, Anastasia; Wiessing, Lucas; van de Laar, Marita; Donoghoe, Martin; Heckathorn, Douglas D.; Friedman, Samuel R.; Des Jarlais, Don C.
Aims To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. Design A ‘seek, test, treat, retain’ intervention employing five rounds of respondent-driven sampling. Setting Athens, Greece (2012–13). Participants A total of 3320 individuals who had injected drugs in the past 12 months. Intervention ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs (‘seek’), engaging them in HIV testing and providing information and materials to prevent HIV (‘test’) and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive (‘treat’ and ‘retain’). Measurements Blood samples were collected for HIV testing and personal interviews were conducted. Findings ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no=1.89, 95% confidence interval (CI)=1.41, 2.52]while, in female PWIDS, the number of sexual partners (OR for >5 versus one partner in the past year=4.12, 95% CI=1.93, 8.77) and history of imprisonment (OR yes versus no=2.76, 95% CI=1.43, 5.31) were associated with HIV. Conclusions In Athens, Greece, the ARISTOTLE intervention for identifying HIV
Sandfort, Theodorus G. M.; Lane, Tim; Dolezal, Curtis; Reddy, Vasu
To explore demographic, behavioral and psychosocial risk factors for HIV infection in South African MSM we recruited 480 MSM (aged 18 and 44 years) using respondent-driven sampling. Data were collected through individual computer-assisted face-to-face interviews. Participants were tested for HIV. RDS-adjusted HIV prevalence is 30.1% (unadjusted 35.6%). Few participants had ever engaged in both receptive and insertive anal sex; sex with women was frequently reported. Independent demographic and behavioral correlates of HIV infection include age, education, number of male sexual partners, ever having been forced to have sex, and ever having engaged in transactional sex; engagement in sex with women was a protective factor. Psychosocial risk factors independently associated with HIV infection were feminine identification, internalized homophobia, and hazardous drinking. Our findings confirm what has been found in other studies, but also suggest that the dynamics and context of sexual transmission among MSM in South Africa differ from those among MSM in Western countries. PMID:25869555
Kaufman, Michelle R; Shefer, Tamara; Crawford, Mary; Simbayi, Leickness C; Kalichman, Seth C
The Gender Attitudes-Power-Risk (GAPR) model of HIV risk behavior was tested using survey data collected from among 309 men who were attending STI services in a primary health care clinic in Cape Town, South Africa. Results showed that negative attitudes towards women were significantly positively associated with a high level of HIV risk behavior, and that endorsement of traditional male roles was negatively associated with HIV risk behavior. Endorsement of traditional male gender roles was also inversely related to relationship control but positively to a high degree of decision-making dominance in one's relationship. Sexual relationship power did not significantly mediate the relationships between gender attitudes and HIV risk behavior. A better understanding of gender roles and ideologies in combination with one's power in sexual relationships as they relate to HIV risk behavior among men could better inform future HIV prevention interventions.
Harinarain, Nishani; Haupt, Theo Conrad
Different industries manage the threats presented by HIV and AIDS in different ways. The construction industry is particularly vulnerable to the pandemic because of its large unskilled labour force, high labour turnover and the migratory nature of the workforce. The study reported on in this paper, the first of its kind in the South African construction industry, aimed to identify the important drivers needed for the effective management of HIV and AIDS and to understand their impact on the construction industry. The aim was achieved in two stages. The first stage involved an extensive literature review to determine the factors that drive corporate response in the management of HIV and AIDS in the South African construction sector. Six drivers, namely legal requirements, social pressures, business costs, voluntary regulation, visibility of the disease, and individuals within companies with a total of 87 items were identified. An iterative Delphi technique with a panel of experts was used to validate the factors identified in the literature review and formed the second stage of this research. The Delphi method was used as it provided a systematic approach to achieve consensus on the six drivers for effective management of HIV and AIDS management in the construction industry. An expert panel responded to three iterations of questionnaires to achieve consensus. The experts reached consensus on 56 items categorised under the 6 drivers. This study found that the legal driver was considered most important but only second in terms of impact. The second most important driver was the visibility of the disease and was regarded as the driver with the highest impact. Internal agents ranked third in terms of importance and impact. This study can be used for further research to assist the construction industry in helping fight HIV and AIDS.
Winskell, Kate; Hill, Elizabeth; Obyerodhyambo, Oby
HIV-related symbolic stigma arises from moralistic value judgements attached to people living with HIV and has negative consequences from both public health and human rights perspectives. Relatively little is known about cross-national variation in symbolic stigma. With the purpose of informing stigma reduction efforts within and across settings, we compared social representations of HIV in six African countries with estimated adult HIV prevalence rates ranging from 1 to 33%. Our study used a unique data source, namely a stratified random sample (n=586, ~5%) from 11,354 creative ideas contributed from six countries to a continent-wide HIV-related scriptwriting contest held between February and April2005. The narratives were written by equal numbers of males and females aged 10–24 in urban and rural areas of Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso and Senegal. We combined three analytical approaches: descriptive statistics on certain quantifiable characteristics of the narratives, thematic data analysis, and a narrative-based approach. The association of HIV with outsiders (“othering”)and preoccupation with the circumstances of infection are more common in lower prevalence countries but vary substantially in tone depending on the sociocultural context. The highest proportion both of moralising narratives and of narratives with pessimistic outcomes come from South-East Nigeria and, to a lesser extent, from Kenya, countries with prevalence levels of 3.9 and 6.1% respectively, in which evangelical Christian movements, including Pentecostalism, have sizeable followings. The data provide a rare cross-cultural overview of symbolic stigma, identify country-specific needs, and point to strategies for future programming. Social representations from the highest prevalence countries, Swaziland and Namibia, and from lower prevalence Burkina Faso offer potential models for the framing of HIV in ways that serve to increase social proximity and counteract
Anaky, M-F; Duvignac, J; Wemin, L; Kouakoussui, A; Karcher, S; Touré, S; Seyler, C; Fassinou, P; Dabis, F; N’Dri-Yoman, T; Anglaret, X
Abstract Objective To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Côte d’Ivoire. Methods Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged < 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections, (ii) losses to the programme (i.e. death or loss to follow-up) before ART, (iii) mortality and loss-to-programme rates during 12 months of ART, and (iv) determinants of mortality and losses to the programme. Findings The analysis included 3876 ART-naïve children. Of the 1766 with HIV-1 infections (17% aged < 18 months), 124 (7.0%) died, 52 (2.9%) left the programme, 354 (20%) were lost to follow-up before ART, 259 (15%) remained in care without ART, and 977 (55%) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4–12: 32.8 and 6.9 per 100 child-years of follow-up, respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight-for-age z-score < –2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl. Conclusion The large-scale programme to scale up paediatric ART in Côte d’Ivoire was effective. However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems. PMID:20616968
Mays, Vickie M.; Cochran, Susan D.; Zamudio, Anthony
Two decades of HIV prevention efforts with men who have sex with men (MSM) have not eliminated the risk of new HIV infections in this vulnerable population. Indeed, current incidence rates in African American MSM are similar to those usually only seen in developing countries. A review of the existing literature suggests that the prevention research agenda for Black MSM could benefit from reframing conceptualization of risk as a function of individual properties to a broad consideration of social and interpersonal determinants. Studies that investigate dyadic and social-level influences on African American MSM’s relationships are needed. This includes research explicating the diversity existing within the categorizations of Black MSM with respect to perceived identity (gay, bisexual, “men on the down low,” “homo thugz”), constructions of masculinity, sexual scripts, sources of social support, and perceived norms and expectations. Recommendations are proposed for a research agenda focusing on linkages between interpersonal and social-structural determinants of HIV risk. PMID:20041036
Heeren, G. Anita; Jemmott, John B.; Ngwane, Zolani; Mandeya, Andrew; Tyler, Joanne C.
This pilot study used a randomized controlled trial to test the efficacy of an HIV risk-reduction intervention for university students in Eastern Cape Province, South Africa. Randomly selected second-year students were randomized to one of two interventions based on social cognitive theory and qualitative research: HIV risk-reduction, targeting sexual-risk behaviors; health-promotion control, targeting health behaviors unrelated to sexual risks. Participants completed behavioral assessments via audio computer-assisted self-interviewing pre-intervention, 6, and 12 months post intervention, with 97.2% retained at 12-month follow-up. Averaged over the 2 follow-ups, HIV risk-reduction intervention participants reported less unprotected vaginal intercourse and more frequent condom use than control participants, with greater efficacy in non-South Africans than South Africans. Positive changes were also observed on theoretical mediators of condom use that the intervention targeted. Interventions based on social cognitive theory integrated with qualitative information from the population may reduce sexual risk behaviors among university students in sub-Saharan Africa. PMID:22246515
Garett, Renee; Smith, Justin; Chiu, Jason; Young, Sean D
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.
This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003. Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere). The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X's contractual process was further weakened by inadequate human resources. The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these
Watkins, Richard R.; Morrison, Charles S.; Kwok, Cynthia; Chipato, Tsungai; Musoke, Robert; Arts, Eric J.; Nankya, Immaculate; Salata, Robert A.
Little is known about the differences in clinical manifestations between women with various HIV-1 subtypes during acute (AI) and early (EI) HIV infection. In a longitudinal cohort study, clinical signs and symptoms among Uganda and Zimbabwe women with AI and EI were compared with HIV-negative controls; symptoms were assessed quarterly for 15 to 24 months. Early HIV infection was defined as the first visit during which a woman tested HIV antibody positive. Women who were HIV negative serologically but DNA polymerase chain reaction positive were considered AI. In all, 26 women were classified AI and 192 EI, with 654 HIV-negative controls. Primary HIV infection (AI and EI) was associated with unexplained fever (P <.01), weight loss (P <.01), fatigue (P <.01), inguinal adenopathy (P <.01), and cervical friability (P =.01). More women with subtype C infection had unexplained fever, fatigue, and abnormal vaginal discharge compared to subtype A or D infection. Inguinal adenopathy occurred less often in women with subtype A infection than those with subtype C or D infection. PMID:24106054
Lemonovich, Tracy L; Watkins, Richard R; Morrison, Charles S; Kwok, Cynthia; Chipato, Tsungai; Musoke, Robert; Arts, Eric J; Nankya, Immaculate; Salata, Robert A
Little is known about the differences in clinical manifestations between women with various HIV-1 subtypes during acute (AI) and early (EI) HIV infection. In a longitudinal cohort study, clinical signs and symptoms among Uganda and Zimbabwe women with AI and EI were compared with HIV-negative controls; symptoms were assessed quarterly for 15 to 24 months. Early HIV infection was defined as the first visit during which a woman tested HIV antibody positive. Women who were HIV negative serologically but DNA polymerase chain reaction positive were considered AI. In all, 26 women were classified AI and 192 EI, with 654 HIV-negative controls. Primary HIV infection (AI and EI) was associated with unexplained fever (P <.01), weight loss (P <.01), fatigue (P <.01), inguinal adenopathy (P <.01), and cervical friability (P =.01). More women with subtype C infection had unexplained fever, fatigue, and abnormal vaginal discharge compared to subtype A or D infection. Inguinal adenopathy occurred less often in women with subtype A infection than those with subtype C or D infection.
Field Evaluation of a Rapid Human Immunodeficiency Virus (HIV) Serial Serologic Testing Algorithm for Diagnosis and Differentiation of HIV Type 1 (HIV-1), HIV-2, and Dual HIV-1-HIV-2 Infections in West African Pregnant Women
Rouet, François; Ekouevi, Didier K.; Inwoley, André; Chaix, Marie-Laure; Burgard, Marianne; Bequet, Laurence; Viho, Ida; Leroy, Valériane; Simon, François; Dabis, François; Rouzioux, Christine
We evaluated a two-rapid-test serial algorithm using the Determine and Genie II rapid assays, performed on-site in four peripheral laboratories during the French Agence Nationale de Recherches sur le SIDA (ANRS) 1201/1202 Ditrame Plus cohort developed for prevention of mother-to-child transmission of human immunodeficiency virus (HIV) infection in Côte d'Ivoire. A total of 1,039 specimens were retested by two commercial enzyme-linked immunosorbent assays (ELISAs). The following specimens were tested: 315 specimens found on-site to be infected with HIV type 1 (HIV-1), 8 specimens found on-site to be infected with HIV-2, 71 specimens found on-site to be infected with both HIV-1 and HIV-2, 40 specimens found on-site to have indeterminate results for HIV infection, and 605 specimens taken during a quality assurance program. For HIV discrimination, 99 positive serum samples (20 with HIV-1, 8 with HIV-2, and 71 with HIV-1 and HIV-2 on the basis of our rapid test algorithm) were retested by the Peptilav test, Western blot (WB) assays, and homemade monospecific ELISAs. Real-time DNA PCRs for the detection of HIV-1 and HIV-2 were performed with peripheral blood mononuclear cells from 35 women diagnosed on-site with HIV-1 and HIV-2 infections. Compared to the results of the ELISAs, the sensitivities of the Determine and Genie II assays were 100% (95% lower limit [95% LL], 99.1%) and 99.5% (95% confidence interval [95% CI], 98.2 to 99.9%), respectively. The specificities were 98.4% (95% CI, 96.9 to 99.3%) and 100% (95% LL, 99.3%), respectively. All serological assays gave concordant results for infections with single types. By contrast, for samples found to be infected with dual HIV types by the Genie II assay, dual reactivity was detected for only 37 samples (52.1%) by WB assays, 34 samples (47.9%) by the Peptilav assay, and 23 samples (32.4%) by the monospecific ELISAs. For specimens with dual reactivity by the Genie II assay, the rates of concordance between the real
Chamla, Dick; Luo, Chewe; Adjorlolo-Johnson, Georgette; Vandelaer, Jos; Young, Mark; Costales, Maria Otelia; McClure, Craig
Background: Integration of HIV infant testing into immunization sessions is one of the strategies designed to increase coverage of early infant diagnosis. Objective: To determine the evidence on the outcomes of such integration. Methods: A systematic review of peer-reviewed and grey literature was undertaken from electronic sources such as MEDLINE, Google Scholar, websites of international agencies, past conferences and ministries of health reports published between year 2002 and 2013. Randomized controlled trials, observational and qualitative studies were searched and those meeting selection criteria were selected and relevant information extracted using structured tool. Statistical pooling was not possible owing to the heterogeneity of the study designs and outcome measures. Results: Of the nine articles which met the selection criteria, none used a randomized controlled design. Of these, five articles measured mother's acceptability of their infants being tested for HIV during its first pentavalent or DPT vaccination visit, and 89·5-100% accepted. Four articles reported the proportion of mothers who returned for HIV test results, ranging from 56·8% to 86·0%. Increased uptake of HIV testing following integration was confirmed by two articles. Only one study in Tanzania determined the uptake of vaccinations following integration, with urban facilities showing stable or slight increase of monthly vaccine uptake while decreases were observed across the rural sites. In two articles, stigma was perceived by service-providers and mothers as the potential risk following integration, particularly in rural settings. Discussion: Despite the limited number of articles, the findings in this systematic review suggest that HIV testing during immunization clinic visits is acceptable and feasible as a possible model for service delivery. However, the impact on vaccination uptake needs further study.
Acceptability of a Community-Based Outreach HIV-Testing Intervention Using Oral Fluid Collection Devices and Web-Based HIV Test Result Collection Among Sub-Saharan African Migrants: A Mixed-Method Study
Manirankunda, Lazare; Platteau, Tom; Albers, Laura; Fransen, Katrien; Vermoesen, Tine; Namanya, Fiona; Nöstlinger, Christiana
Background Late human immunodeficiency virus (HIV) diagnosis is common among sub-Saharan African migrants. To address their barriers to HIV testing uptake and improve timely HIV diagnoses and linkage to care, the outreach HIV testing intervention, “swab2know,” was developed. It combined a community-based approach with innovative testing methods: oral fluid self-sampling and the choice between Web-based HIV test result collections using a secured website or post-test counseling at a sexual health clinic. The sessions included an informational speech delivered by a physician of sub-Saharan African origin and testimonies by community members living with HIV. Objectives The objectives of this study were to evaluate the intervention’s acceptability among sub-Saharan African migrants and its potential to reach subgroups at higher risk for HIV infection and to identify facilitators and barriers for HIV testing uptake. Methods This mixed-method study combined qualitative (participant observations and informal interviews with testers and nontesters) and quantitative data (paper–pencil survey, laboratory data, and result collection files). Data were analyzed using a content analytical approach for qualitative and univariate analysis for quantitative data. Results A total of 10 testing sessions were organized in sub-Saharan African migrant community venues in the city of Antwerp, Belgium, between December 2012 and June 2013. Overall, 18.2% of all people present (N=780) underwent HIV testing; 29.8% of them tested for HIV for the first time, 22.3% did not have a general practitioner, and 21.5% reported 2 or more sexual partners (last 3 months). Overall, 56.3% of participants chose to collect their HIV test results via the protected website. In total, 78.9% collected their results. The qualitative analysis of 137 participant observation field notes showed that personal needs and Internet literacy determined the choice of result collection method. Generally, the oral
McCurdy, Sheryl; Ratliff, Eric A.; Timpson, Sandra; Williams, Mark L.
BACKGROUND Financial compensation for participating in research is controversial, especially when participants are recruited from economically disadvantaged and/or marginalized populations such as drug users. Little is known about these participants’ own views regarding payment for research participation. OBJECTIVE The objective of the study was to elicit underserved minority drug users’ views about monetary payments for participating in research. DESIGN Semi-structured in-depth interview study of motivations for and perceptions of participation in research was used. PARTICIPANTS Thirty-seven adult, economically disadvantaged African-American crack cocaine smokers were the participants of the study. APPROACH Participants were recruited from among those taking part in three HIV prevention studies. Interviews were conducted at one of 2 research field offices located in underserved minority neighborhoods in Houston, Texas. Interviews lasting 30–45 min were recorded, transcribed, coded, and analyzed for categories and themes using both conventional and directed qualitative content analysis. This report addresses themes under the broad category of financial motivations for participating in research. RESULTS Participants viewed monetary payment for research as essential to attract participation and desirable to provide optional income. Payment for research participation was perceived as one potential income source among others. Participants considered self-determination a prerogative for themselves and others. They rejected the notion of payment for participation as encouraging drug use or as inducing risk taking. CONCLUSIONS Research regulators should consider participants’ views of their desires and capacity for autonomous decisions about financial compensation for research rather than assume participants’ diminished capacity due to poverty and/or drug use. Payment for research participation appears to be part of the “informal economy” that has been
Powell, Eleanor A; Boyce, Ceejay L; Gededzha, Maemu P; Selabe, Selokela G; Mphahlele, M Jeffrey; Blackard, Jason T
Occult hepatitis B is defined by the presence of hepatitis B virus (HBV) DNA in the absence of hepatitis B surface antigen (HBsAg). Occult HBV is associated with the development of hepatocellular carcinoma, reactivation during immune suppression, and virus transmission. Viral mutations contribute significantly to the occult HBV phenotype. Mutations in the 'a' determinant of HBsAg are of particular interest, as these mutations are associated with immune escape, vaccine escape and diagnostic failure. We examined the effects of selected occult HBV-associated mutations identified in a population of HIV-positive South Africans on HBsAg production in vitro. Mutations were inserted into two different chronic HBV backbones and transfected into a hepatocyte-derived cell line. HBsAg levels were quantified by enzyme-linked immunosorbent assay (ELISA), while the detectability of mutant HBsAg was determined using an HA-tagged HBsAg expression system. Of the seven mutations analysed, four (S132P, C138Y, N146D and C147Y) resulted in decreased HBsAg expression in one viral background but not in the second viral background. One mutation (N146D) led to a decrease in HBsAg detected as compared to HA-tag, indicating that this mutation compromises the ability of the ELISA to detect HBsAg. The contribution of occult-associated mutations to the HBsAg-negative phenotype of occult HBV cannot be determined adequately by testing the effect of the mutation in a single viral background, and rigorous analysis of these mutations is required.
Helleve, Arnfinn; Flisher, Alan J; Onya, Hans; Mukoma, Wanjiru; Klepp, Knut-Inge
This paper aims to explore South African Life Orientation teachers' perception and practice of teaching HIV/AIDS and sexuality in a cultural perspective. We aim to investigate how teachers respond to perceived cultural differences between the local community and the content of their teaching. Data were collected through interviews with teachers who taught students in grades 8 or 9 in public high schools. The teachers expressed differing viewpoints regarding the rationale for teaching about HIV/AIDS and sexuality. Many teachers saw teaching these topics as a response to declining moral standards, while others suggested that they were teaching issues that parents failed to address. The teachers were more concerned about young people's sexual behaviour than about preventing HIV/AIDS. They perceived that cultural contradictions between what was taught and local cultural values were an issue to which they needed to respond, although they differed in terms of how to respond. Some took an adaptive approach to try to avoid conflicts, while others claimed the moral neutrality of their teaching. Teaching about sexuality was perceived to be challenging in terms of language and communication norms. Teaching about HIV/AIDS was perceived as challenging because teachers often needed to convince students about the reality of AIDS.
Boekeloo, B; Geiger, T; Wang, M; Ishman, N; Quinton, S; Allen, G; Ali, B; Snow, D
African American/Black (Black) women suffer disproportionately to other women from HIV. An HIV prevention intervention combining two previous evidenced-based HIV intervention programs; “Coping with Work and Family Stress” and “Hip Hop 2 Prevent Substance Abuse and HIV”, was evaluated in a diverse sample of Black women (n=205). Study participants at 10 recruitment sites were assigned non-randomly to either the intervention or comparison group and then surveyed at baseline, immediate posttest, and 6-month follow-up. General Estimating Equation modeling revealed that participants in the comparison group reported less unprotected sex at immediate post-test and the intervention group less unprotected sex at 6-month follow-up. Despite the initial drop in reported unprotected sex in the comparison group, this study suggests that an HIV risk reduction intervention tailored to address Black women’s socio-cultural stress and enhance their coping may reduce their unprotected sex at 6-months. PMID:25645327
Seth, Puja; Wingood, Gina M.; Robinson, LaShun S.; Raiford, Jerris L.; DiClemente, Ralph J.
Background Intimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. Methods 848 African American women, 18-29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. Results IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. Discussion In an HIV intervention that did not specifically address IPV, women in the control were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs. PMID:25399033
Tufts, Kimberly Adams; Johnson, Kaprea F; Shepherd, Jewel Goodman; Lee, Ju-Young; Bait Ajzoon, Muna S; Mahan, Lauren B; Kim, Miyong T
The purpose of this systematic review was to assess the quality of interventions using mobile health (mHealth) technology being developed for and trialed with HIV-infected African American (AA) women. We aimed to assess rigor and to ascertain if these interventions have been expanded to include the broad domain of self-management. After an extensive search using the PRISMA approach and reviewing 450 records (411 published studies and 39 ongoing trials at clinicaltrials.gov), we found little completed research that tested mHealth HIV self-management interventions for AA women. At clinicaltrials.gov, we found several mHealth HIV intervention studies designed for women in general, forecasting a promising future. However, most studies were exploratory in nature and focused on a single narrow outcome, such as medication adherence. Given that cultural adaptation is the key to successfully implementing any effective self-management intervention, culturally relevant, gender-specific mHealth interventions focusing on HIV-infected AA women are warranted for the future.
Homsy, Jaco; King, Rachel; Tenywa, Joseph; Kyeyune, Primrose; Opio, Alex; Balaba, Dorothy
In many resource-poor settings of Africa, a majority of people living with HIV/AIDS depend on and choose traditional healers for psychosocial counseling and health care. If the current pan-African prevention and care efforts spurred by the HIV pandemic do not actively engage African Traditional Medicine, they will effectively miss 80%, the vast majority of the African people who, according to the World Health Organization, rely on traditional medicine for their primary health care needs. In 2001, the Ugandan nongovernmental organization, Traditional and Modern Health Practitioners Together Against AIDS and Other Diseases, in Kampala, identified the need for a concerted, systematic, and sustained effort at both local and regional levels to support and validate African Traditional Medicine on several fronts. The Eastern & Southern Africa Regional Initiative on Traditional Medicine and AIDS was borne out of this assessment. It convened a regional consultation in May 2003, which produced a series of proposed standards around six main themes related to traditional medicine and HIV/AIDS: the systematic evaluation of traditional remedies; spiritual aspects of healing; HIV prevention and care; processing and packaging of traditional remedies; protection of indigenous knowledge; and intellectual property rights related to traditional health systems. These standards, summarized in this paper, will be incorporated into programs on traditional medicine and HIV/AIDS by various implementers in the region. A number of strategies to test and implement these recommendations are also defined.
Winskell, Kate; Obyerodhyambo, Oby; Stephenson, Rob
Condoms are an essential component of comprehensive efforts to control the HIV epidemic, both for those who know their status and for those who do not. Although young people account for almost half of all new HIV infections, reported condom use among them remains low in many sub-Saharan African countries. In order to inform education and communication efforts to increase condom use, we examined social representations of condoms among young people aged 10-24 in six African countries/regions with diverse HIV prevalence rates: Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso, and Senegal. We used a unique data source, namely 11,354 creative ideas contributed from these countries to a continent-wide scriptwriting contest, held from 1(st) February to 15(th) April 2005, on the theme of HIV/AIDS. We stratified each country sample by the sex, age (10-14, 15-19, 20-24), and urban/rural location of the author and randomly selected up to 10 narratives for each of the 12 resulting strata, netting a total sample of 586 texts for the six countries. We analyzed the narratives qualitatively using thematic data analysis and narrative-based methodologies. Differences were observed across settings in the prominence accorded to condoms, the assessment of their effectiveness, and certain barriers to and facilitators of their use. Moralization emerged as a key impediment to positive representations of condoms, while humour was an appealing means to normalize them. The social representations in the narratives identify communication needs in and across settings and provide youth-focused ideas and perspectives to inform future intervention efforts.
Jemmott, John B.; Jemmott, Loretta S.; O’Leary, Ann; Ngwane, Zolani; Icard, Larry D.; Bellamy, Scarlett L.; Jones, Shasta F.; Landis, J. Richard; Heeren, G. Anita; Tyler, Joanne C.; Makiwane, Monde B.
Objectives We tested the efficacy of a school-based HIV/STD risk-reduction intervention for South African adolescents. Design A cluster-randomized controlled design, with assessments of self-reported sexual behavior collected pre-intervention and 3, 6, and 12 months post-intervention. Setting Primary schools in a large Black township and a neighboring rural settlement in Eastern Cape Province, South Africa. Participants 9 of 17 matched-pairs of schools were randomly selected. Grade 6 learners with parent/guardian consent were eligible. Interventions Two 6-session interventions based on behavior-change theories and qualitative research: HIV/STD risk-reduction intervention targeted sexual-risk behaviors; attention-matched health-promotion control intervention targeted health issues unrelated to sexual behavior. Main Outcome Measures The primary outcome was self-report of unprotected vaginal intercourse in the previous 3 months averaged over the 3 follow-ups. Secondary outcomes were other sexual behaviors. Results A total of 1,057 (94.5%) of 1,118 eligible learners (mean age = 12.4 years) participated, with 96.7% retained at the 12-month follow-up. Generalized estimating equations analyses, adjusting for clustering from 18 schools, revealed that averaged over the 3 follow-ups a significantly smaller percentage of HIV/STD risk-reduction intervention participants reported having unprotected vaginal intercourse (OR = 0.51; 95% CI, 0.30-0.85), vaginal intercourse (OR = 0.62; 95% CI, 0.42-0.94), and multiple sexual partners (OR = 0.50; 95% CI, 0.28-0.89), when adjusted for baseline prevalences, compared with health-promotion control participants. Conclusions This is the first large-scale community-level randomized intervention trial to obtain significant effects on HIV/STD sexual-risk behavior among South African adolescents in the earliest stages of entry into sexual activity. PMID:20921349
Winskell, Kate; Obyerodhyambo, Oby; Stephenson, Rob
Condoms are an essential component of comprehensive efforts to control the HIV epidemic, both for those who know their status and for those who do not. Although young people account for almost half of all new HIV infections, reported condom use among them remains low in many sub-Saharan African countries. In order to inform education and communication efforts to increase condom use, we examined social representations of condoms among young people aged 10–24 in six African countries/regions with diverse HIV prevalence rates: Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso, and Senegal. We used a unique data source, namely 11,354 creative ideas contributed from these countries to a continent-wide scriptwriting contest, held from 1st February to 15th April 2005, on the theme of HIV/AIDS. We stratified each country sample by the sex, age (10–14, 15–19, 20–24), and urban/rural location of the author and randomly selected up to 10 narratives for each of the 12 resulting strata, netting a total sample of 586 texts for the six countries. We analyzed the narratives qualitatively using thematic data analysis and narrative-based methodologies. Differences were observed across settings in the prominence accorded to condoms, the assessment of their effectiveness, and certain barriers to and facilitators of their use. Moralization emerged as a key impediment to positive representations of condoms, while humour was an appealing means to normalize them. The social representations in the narratives identify communication needs in and across settings and provide youth-focused ideas and perspectives to inform future intervention efforts. PMID:21388731
Williams, B; Campbell, C
The epidemic of HIV/AIDS is at an advanced stage in many African countries, but little attention has been given to the impact that this will have in industrial settings. Using the Southern African mining industry as a case study, the authors consider the state of the HIV epidemic and discuss programs that have been undertaken to manage HIV. They critically analyze the reasons current interventions have had little impact on HIV among mine workers, tracing the lack of success to neglect of the social and community contexts within which HIV transmission takes place, as well as the lack of attention to the psychosocial processes and mechanisms underlying disease transmission. Finally, they present an intervention that aims to address the limitations of existing industrial programs and improve the management of sexually transmitted diseases (STDs), including HIV, in a particular occupational setting through creating alliances between a wide range of community stakeholders. The intervention aims not only to reduce STDs, promote awareness of HIV risks, and distribute condoms, as existing programs have done, but also to address the broader social, cultural, and community contexts that facilitate HIV transmission.
Hall, Naomi M; Peterson, Jennifer; Johnson, Malynnda
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.
Cederbaum, Julie A.
Mother-daughter communication plays an influential role in adolescent development. The impact of maternal HIV infection on family communication is not clear. This study explores how living with HIV impacts sexual risk communication between mothers and daughters and whether maternal HIV status influences adolescent choices about engagement in HIV…
Drugs, Alcohol and HIV/AIDS A Consumer Guide Drugs & Alcohol What do drugs and alcohol have to do with HIV? Drug and alcohol use can ... behavior that can increase your exposure to HIV/AIDS. For example, using or sharing needles or other ...
Murry, Velma McBride; Berkel, Cady; Chen, Yi-Fu; Brody, Gene H; Gibbons, Frederick X; Gerrard, Meg
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.
Taylor, Myra; Dlamini, Siyabonga B; Meyer-Weitz, Anna; Sathiparsad, Reshma; Jinabhai, Champak C; Esterhuizen, Tonya
This community household survey undertaken in Melmoth, a rural area in KwaZulu-Natal, South Africa, investigated the influence of cumulative exposure of complementary interventions by a non-governmental organisation, LoveLife which aimed to bring changes in beliefs about HIV and AIDS prevention and treatment, and to reduce sexual risk behaviour. Amongst the 1294 respondents (15-40 years of age) increasing the number of exposures to different LoveLife interventions included use of television and radio messages, billboards, a free monthly magazine for youth, special school sports and community events, involvement of youth peer educators, and support for schools through classroom programmes and by linking clinic staff and peer educators. Cumulative exposure to LoveLife interventions resulted in more respondents believing that HIV could be prevented (p<0.005) and treated (p=0.007) and that people should test for HIV (p=0.03). Half of the respondents reported using a condom at last sex and cumulative exposure to LoveLife was associated with increased condom use (p<0.005). However, despite exposure to LoveLife, only 41.9% respondents had ever tested for HIV and cumulative exposure to LoveLife did not significantly influence respondents going to hospital for anti-retroviral treatment. The dose-response effect of cumulative LoveLife exposure appeared to have a positive influence on some beliefs and practices, but did not discriminate the extent of LoveLife exposure nor exposure to other HIV/AIDS interventions.
Dovel, Kathryn; Thomson, Kallie
Economic costs are commonly cited as barriers to women's use of antiretroviral therapy (ART) in sub-Saharan Africa; however, little is known about how changes in women's income influence economic barriers to care. We analysed in-depth interviews with 17 HIV-positive women who participated in a job-creation programme in northern Uganda and two key informant interviews with programme staff to examine lingering economic barriers to care experienced after programme enrollment. We found that participants continued to experience economic barriers even after receiving a steady income and improving their economic status. Two themes emerged: first, limited resources in health facilities (e.g. drug and staff shortages) led participants to view ART utilisation as a primarily economic endeavour where clients made informal payments for prompter service or sought treatment in private facilities where ART was readily available; second, increased economic status among participants increased expectations of economic reciprocity among participants' social networks. Financial obligations often manifested themselves in the form of caring for additional dependents, limiting the resources women could allocate toward their HIV treatment. When paired with limited resources in health facilities, increased financial obligations perpetuated the economic barriers experienced by participants. Job-creation programmes should consider how health institutions interact with participants' financial obligations to influence women's access to HIV services.
Mpontshane, Nontobeko; Broeck, Jan Van den; Chhagan, Meera; Luabeya, Kany Kany Angelique; Johnson, Ayesha; Bennish, Michael L.
Little is known about dietary diversity of children residing in areas of high HIV prevalence. This study examined dietary diversity in 381 children ages 6−24 mo in rural South Africa. Twenty-eight (7.3%) children and 170 mothers (44.6%) were HIV infected. Home visits were conducted weekly and a detailed history of dietary intake obtained. A dietary diversity score was computed based on the weekly consumption of 8 food classes. Low dietary diversity was defined as falling within the lowest quartile of the diversity scale. There were 22,772 child weeks of observation: 1369 for HIV-infected children, 8876 for HIV-uninfected children born to HIV-infected mothers, and 12,527 for HIV-uninfected children born to HIV-uninfected mothers. Low dietary diversity was more common in HIV-infected children [crude odds ratio (OR), 2.59; 95% CI, 1.52 to 4.41) compared with children born to HIV-uninfected mothers. In a multiple logistic regression analysis adjusting for socioeconomic and health status, HIV-infected children had lower dietary diversity (conditional OR, 1.76; 95% CI, 1.06 to 2.94) than HIV-uninfected children. HIV-infected children consumed less in 6 of 8 food classes compared with HIV-uninfected children, with the 2 exceptions being breast milk and formula milk. In rural South Africa, HIV-infected children's diets are significantly less diverse than those of HIV-uninfected children. This may be a factor contributing to increased morbidity and poorer survival in these children. PMID:18716173
15 years ago, most business, labor, government, and nongovernment representatives would have had only a small idea of what AIDS was, and let alone why it should concern them. However, companies have since lost top managers, workers have lost colleagues, and considerable time, energy, and emotion have been spent upon issues of illness and loss. Entire families have collapsed, as companies struggle against a background of chronic poverty. The HIV/AIDS pandemic has forced a reconsideration of whether disease prevention and health promotion are business concerns. AIDS causes illness, disability, and death to workers, as well as severe economic and emotional disruptions to their families. It also increases the cost of doing business. As South Africa faces a large epidemic, business must take prompt and incisive action against AIDS. A list of 10 workplace principles is presented and a 3-stage process recommended to ensure optimal workplace HIV/AIDS/STD and tuberculosis policies and programs.
Background Advanced HIV infection can result in lipoatrophy and wasting, even in the absence of ongoing opportunistic infections, suggesting that HIV may directly affect adipose tissue amount and distribution. Methods We assessed the relationship of fat (measured using anthropometry, DEXA, MRI scans) or markers related to glucose and lipid metabolism with viral load in a cross-sectional sample of 83 antiretroviral-naïve HIV-1-infected South African women. A multivariable linear model was fitted to log10VL to assess the combined effect of these variables. Results In addition to higher T cell activation, women with viral load greater than the population median had lower waist circumference, body mass index and subcutaneous abdominal fat, as well as lower serum leptin. We demonstrate that leptin serum levels are inversely associated with viral replication, independent of the amount of adipose tissue. This association is maintained after adjusting for multiple variables associated with disease progression (i.e., cellular activation and innate immunity effector levels). Conclusions Our results demonstrate that serum leptin levels are inversely associated with viral replication, independent of disease progression: we postulate that leptin may affect viral replication. PMID:20822522
Borgdorff, Hanneke; Tsivtsivadze, Evgeni; Verhelst, Rita; Marzorati, Massimo; Jurriaans, Suzanne; Ndayisaba, Gilles F; Schuren, Frank H; van de Wijgert, Janneke HHM
Cervicovaginal microbiota not dominated by lactobacilli may facilitate transmission of HIV and other sexually transmitted infections (STIs), as well as miscarriages, preterm births and sepsis in pregnant women. However, little is known about the exact nature of the microbiological changes that cause these adverse outcomes. In this study, cervical samples of 174 Rwandan female sex workers were analyzed cross-sectionally using a phylogenetic microarray. Furthermore, HIV-1 RNA concentrations were measured in cervicovaginal lavages of 58 HIV-positive women among them. We identified six microbiome clusters, representing a gradient from low semi-quantitative abundance and diversity dominated by Lactobacillus crispatus (cluster R-I, with R denoting ‘Rwanda') and L. iners (R-II) to intermediate (R-V) and high abundance and diversity (R-III, R-IV and R-VI) dominated by a mixture of anaerobes, including Gardnerella, Atopobium and Prevotella species. Women in cluster R-I were less likely to have HIV (P=0.03), herpes simplex virus type 2 (HSV-2; P<0.01), and high-risk human papillomavirus (HPV; P<0.01) and had no bacterial STIs (P=0.15). Statistically significant trends in prevalence of viral STIs were found from low prevalence in cluster R-I, to higher prevalence in clusters R-II and R-V, and highest prevalence in clusters R-III/R-IV/R-VI. Furthermore, only 10% of HIV-positive women in clusters R-I/R-II, compared with 40% in cluster R-V, and 42% in clusters R-III/R-IV/R-VI had detectable cervicovaginal HIV-1 RNA (Ptrend=0.03). We conclude that L. crispatus-dominated, and to a lesser extent L. iners-dominated, cervicovaginal microbiota are associated with a lower prevalence of HIV/STIs and a lower likelihood of genital HIV-1 RNA shedding. PMID:24599071
Background The implementation and utilization of programmes for the prevention of mother-to-child transmission (PMTCT) of HIV in most low income countries has been described as sub-optimal. As planners and service providers, the views of health workers are important in generating priorities to improve the effectiveness of the PMTCT programme in Uganda. We explored the lessons learnt by health workers involved in the provision of PMTCT services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. Methods A qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (2 district officials and 2 officials from TASO). Data were analyzed using the content thematic approach. Study themes and sub-themes were identified following multiple reading of interview transcripts. Relevant quotations have been used in the presentation of study findings. Results The key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers. Conclusions The voices of health workers in this study revealed that it is imperative for government, civil society organizations and donors that the PMTCT programme addresses the challenges of shortage of critical PMTCT supplies, continuous health worker training and follow-up and support for mothers
Dols, Joke A M; Reid, Gregor; Kort, Remco; Schuren, Frank H J; Tempelman, Hugo; Bontekoe, Tj Romke; Korporaal, Hans; Van der Veer, E M; Smit, Pieter W; Boon, Mathilde E
Vaginal lactobacilli assessed by PCR-based microarray and PCR-based genotyping of HPV in South African women at risk for HIV and BV. Vaginal lactobacilli can be defined by microarray techniques in fixed cervical samples of South African women. Cervical brush samples suspended in the coagulant fixative BoonFix of one hundred women attending a health centre for HIV testing in South Africa were available for this study. In the Ndlovu Medical Centre in Elandsdoorn, South Africa, identification of 18 hr-HPV genotypes was done using the INNO-LiPA method. An inventory of lactobacilli organisms was performed using microarray technology. On the basis of the Lactobacillus and Lactobacillus biofilm scoring, the cases were identified as Leiden bacterial vaginosis (BV) negative (BV-; n = 41), Leiden BV intermediate (BV±; n = 25), and Leiden BV positive (BV+; n = 34). Fifty-one women were HIV positive and 49 HIV negative. Out of the 51 HIV positive women, 35 were HPV infected. These 51 HIV positive women were frequently infected with HPV16 and HPV18. In addition, HPV35, HPV52, HPV33, and HPV66 were often detected in these samples. Lactobacillus salivarius and Lactobacillus iners were the most prevalent lactobacilli as established by the microarray technique. In women with HPV infection, the prevalence of Lactobacillus crispatus was significantly reduced. In both HIV and HPV infection, a similar (but not identical) shift in the composition of the lactobacillus flora was observed. We conclude that there is a shift in the composition of vaginal lactobacilli in HIV-infected women. Because of the prominence of HPV35, HPV52, HPV33, and HPV66, vaccination for exclusively HPV16 and HPV18 might be insufficient in South African HIV+ women.
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
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
Matthews, Alicia K; Conrad, Megan; Kuhns, Lisa; Vargas, Maria; King, Andrea C
This study examined the feasibility, acceptability, and outcomes of a culturally tailored smoking cessation intervention for HIV-positive African American male smokers. Eligible smokers were enrolled in a seven-session group-based treatment combined with nicotine patch. The mean age of participants was M=46 years. The majority were daily smokers (71%), smoked a mentholated brand (80%), and averaged 8.6 (standard deviation [SD]=8.1) cigarettes per day. Baseline nicotine dependency scores (M=5.8) indicated a moderate to high degree of physical dependence. Of the 31 participants enrolled, the majority completed treatment (≥3 sessions; 68%), 1-month follow-up (74%), and 3-month follow-up (87%) interviews. Program acceptability scores were strong. However, adherence to the patch was low, with 39% reporting daily patch use. The majority of participants (80%, n=24) made a quit attempt. Furthermore, over the course of the intervention, smoking urge, cigarettes smoked, nicotine dependence, withdrawal symptoms, and depression scores all significantly decreased. Follow-up quit rates at 1 and 3 months ranged from 6% to 24%, with treatment completers having better outcomes. This first of its kind intervention for HIV-positive African American male smokers was feasible, acceptable, and showed benefit for reducing smoking behaviors and depression scores. Smoking cessation outcomes were on par with other similar programs. A larger trial is needed to address limitations and to confirm benefits.
Alexander, Carla S; Memiah, Peter; Henley, Yvonne B; Kaiza-Kangalawe, Angela; Shumbusho, Anna Joyce; Obiefune, Michael; Enejoh, Victor; Stanis-Ezeobi, Winifred; Eze, Charity; Odion, Ehekhaye; Akpenna, Donald; Effiong, Amana; Miriti, Kenneth; Aduda, Samson; Oko, John; Melaku, Gebremedhin D; Baribwira, Cyprien; Umutesi, Hassina; Shimabale, Mope; Mugisa, Emmanuel; Amoroso, Anthony
To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been successfully treated. Initial legislation cited palliative care as an essential aspect of this plan but overall health strengthening became critical to sustainability of programming and funding priorities shifted to assure staffing for care delivery sites; laboratory and pharmaceutical infrastructure; data collection and reporting; and financial management as individual countries are being encouraged to assume control of in-country funding. Given infrastructure requisites, individual care delivery beyond ART management alone has received minimal funding yet care remains necessary for durable viral suppression and overall quality of life for individuals. Technical assistance staff of one implementing partner representing seven African countries met to clarify domains of palliative care compared with the substituted term "care and support" to understand potential gaps in on-going HIV care. They prioritized care needs as: 1) mental health (depression and other mood disorders); 2) communication skills (age-appropriate disclosure of HIV status); 3) support of care-providers (stress management for sustainability of a skilled HIV workforce); 4) Tied Priorities: symptom management in opportunistic infections; end-of-life care; spiritual history-taking; and 5) Tied Priorities: attention to grief-related needs of patients, their families and staff; and management of HIV co-morbidities. This process can inform health policy as funding transitions to new priorities.
McNealy, Kim R.; Al-Khattab, Halima; Carter-Harris, Lisa; Oruche, Ukamaka Marian; Naanyu, Violet; Draucker, Claire Burke
Background AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics. Methods Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population. Results The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy. Conclusions The three phases of sexual learning interact to shape
Bryan, Angela; Robbins, Reuben N; Ruiz, Monica S; O'Neill, Dennis
Prisons and prison inmates present important targets for HIV/AIDS prevention interventions. Inmates often have histories of high-risk behavior that place them in danger of contracting HIV/AIDS, and rates of HIV/AIDS tend to be much higher in this population. The goal of this study was to assess the effectiveness of a prison-based HIV/AIDS intervention to change attitudes toward HIV prevention, norms supporting HIV prevention, perceived behavioral control (i.e., self-efficacy) for HIV prevention behaviors, and intentions to engage in HIV prevention behaviors postrelease. The intervention also had the goal of encouraging inmates to become HIV/AIDS peer educators. The intervention appeared most successful at influencing beliefs and behaviors related to peer education and somewhat successful at influencing beliefs and intentions related to condom use. Analyses also showed some significant differences in effectiveness by race/ethnicity. Results are discussed from the perspectives of both research and practice with regard to prison-based HIV prevention efforts.
Mda, Siyazi; van Raaij, Joop M A; MacIntyre, Una E; de Villiers, François P R; Kok, Frans J
Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n=154) and appetite measurement (n=48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumonia (9.0 ± 2.5 vs. 5.9 ± 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of HIV-uninfected children (18.6 ± 5.8 vs. 25.2 ± 7.4). The eating rates (g min(-1) ) of HIV-infected children were also slower (17.6 ± 6.2 vs. 10.1 ± 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.
McKee, Laura; Jones, Deborah J; Roland, Erin; Coffelt, Nicole; Rakow, Aaron; Forehand, Rex
This study was designed to examine interactions between psychosocial risk (i.e., maternal depressive symptoms) and protective (i.e., child coping skills and mother-child relationship quality) correlates of depressive symptoms among inner-city African American children of mothers with and without HIV/AIDS. Two primary hypotheses were tested: (a) whether these correlates interact differently in HIV-infected and noninfected samples and (b) whether child coping skills and a positive mother-child relationship interact to protect children from developing depressive symptoms in the context of maternal HIV infection. Results indicated that (a) a positive mother-child relationship, but not child coping skills, was protective in the HIV-infected sample when maternal depressive symptoms were high and (b) the combination of a positive mother-child relationship and child coping skills was associated with the lowest level of child depressive symptoms in the HIV-infected sample. These findings highlight the differential importance of various risk and protective mechanisms for HIV-infected and noninfected African American samples and, as such, have preventative implications for children of HIV-infected women.
Hoover, Matthew A.; Green, Harold D.; Bogart, Laura M.; Wagner, Glenn J.; Mutchler, Matt G.; Galvan, Frank H.; McDavitt, Bryce
We examined how functional social support, HIV-related discrimination, internalized HIV stigma, and social network structure and composition were cross-sectionally associated with network members’ knowledge of respondents’ serostatus among 244 HIV-positive African Americans in Los Angeles. Results of a generalized hierarchical linear model indicated people in respondents’ networks who were highly trusted, well-known to others (high degree centrality), HIV-positive, or sex partners were more likely to know respondents’ HIV serostatus; African American network members were less likely to know respondents’ serostatus, as were drug-using partners. Greater internalized stigma among respondents living with HIV was associated with less knowledge of their seropositivity within their social network whereas greater respondent-level HIV discrimination was associated with more knowledge of seropositivity within the network. Additional research is needed to understand the causal mechanisms and mediating processes associated with serostatus disclosure as well as the long-term consequences of disclosure and network members’ knowledge of respondents’ serostatus. PMID:25903505
Hoover, Matthew A; Green, Harold D; Bogart, Laura M; Wagner, Glenn J; Mutchler, Matt G; Galvan, Frank H; McDavitt, Bryce
We examined how functional social support, HIV-related discrimination, internalized HIV stigma, and social network structure and composition were cross-sectionally associated with network members' knowledge of respondents' serostatus among 244 HIV-positive African Americans in Los Angeles. Results of a generalized hierarchical linear model indicated people in respondents' networks who were highly trusted, well-known to others (high degree centrality), HIV-positive, or sex partners were more likely to know respondents' HIV serostatus; African American network members were less likely to know respondents' serostatus, as were drug-using partners. Greater internalized stigma among respondents living with HIV was associated with less knowledge of their seropositivity within their social network whereas greater respondent-level HIV discrimination was associated with more knowledge of seropositivity within the network. Additional research is needed to understand the causal mechanisms and mediating processes associated with serostatus disclosure as well as the long-term consequences of disclosure and network members' knowledge of respondents' serostatus.
de la Fuente, Luis; Bravo, María José; Toro, Carlos; Brugal, M Teresa; Barrio, Gregorio; Soriano, Vicente; Vallejo, Fernando
Objectives To evaluate changes in the prevalence of HIV infection among young heroin users in three Spanish cities, and their association with harm reduction programmes (HRPs). Methods Two cross sectional studies. The 1995 study included 596 users; half were street recruited and half were recruited at drug treatment centres. The 2001–03 study included 981 street recruited users. Face to face interviews were conducted using a structured questionnaire. Samples for HIV testing (saliva in 1995 and dried blood spot in 2001–03) were collected. Results The proportion who had ever injected (IDUs) decreased in all three cities. HIV prevalence in IDUs decreased by half in Barcelona (44.1% to 20.8%) and Seville (44.2% to 22.2%), but remained constant in Madrid (36.8% and 34.9%). This difference was attributable to a decrease in HIV prevalence in long term IDUs in Barcelona and Seville, but not in Madrid. The crude odds ratio for HIV prevalence in Madrid compared with Barcelona in long term IDUs was 2.3 (95%CI 1.4 to 3.7), increasing to 3.1 (95%CI 1.5 to 6.2) after adjusting for sociodemographic and risk factors. HIV prevalence in short term IDUs was similar in all cities. In 1992 Barcelona already had 20 heroin users in methadone maintenance programmes (MMPs) per 10 000 population aged 15–49 years; Seville reached this rate in 1994, and Madrid, not until 1998. Conclusions The prevalence of HIV infection did not decrease in long term injectors in Madrid. The delayed implementation of HRPs, especially MMPs, may be the most plausible hypothesis. This finding should shed light on decision making in countries in a similar epidemiological and sociological situation. PMID:16698987
Dickson-Gomez, Julia; Owczarzak, Jill; Lawrence, Janet St.; Sitzler, Cheryl; Quinn, Katherine; Pearson, Broderick; Kelly, Jeffrey A.; Amirkhanian, Yuri A.
African American men who have sex with men (AAMSM) are disproportionately burdened by new and existing HIV infections. In spite of this, few HIV prevention interventions have been developed that meet the specific needs of AAMSM and that are culturally appropriate and build on strengths and resources. In this paper, we examine constructed families, including those who belong to houses and those who do not, from a three city sample of 196 AAMSM. Results show that the majority of AAMSM who belong to constructed families do not participate in houses or balls. Both house and non-house affiliated constructed families are important sources of social support among AAMSM. Participants reported limited success in spreading HIV messages at ball events, but talk about HIV within their constructed families. Social network approaches to HIV prevention may capitalize on existing social ties within constructed families to promote safer sexual behaviors. PMID:24980248
Manirankunda, Lazare; Loos, Jasna; Alou, Therese Assebide; Colebunders, Robert; Nostlinger, Christiana
This study explored perceptions, needs, and barriers of sub-Saharan African migrants in relation to HIV voluntary counseling and testing (VCT). Using an inductive qualitative methodological approach, data were obtained from focus group discussions. Results showed that participants were in principle in favor of VCT. However, they indicated that…
Mashburn, Andrew J.; Peterson, John L.; Bakeman, Roger; Miller, Robin L.; Clark, Leslie F.
This study examined the influence of demographic characteristics, risk behaviors, knowledge, and psychosocial variables on HIV testing among a sample (n = 551) of young African-American men who have sex with men (MSM) from three cities--Atlanta (n = 241), Birmingham (n = 174), and Chicago (n = 136). Among the entire sample of young men, age,…
Sales, J. M.; DiClemente, R. J.; Davis, T. P.; Sullivan, S.
Human immunodeficiency virus (HIV) interventions can significantly reduce risky sexual behaviors among vulnerable populations. However, not everyone exposed to an intervention will reduce their sexual risk behavior. This qualitative study sought to identify factors associated with young African American females' lack of increase in condom use…
Davantes Heckman, Bernadette
Context: Acquired immunodeficiency syndrome (AIDS) prevalence rates are increasing rapidly in rural areas of the United States. As rural African Americans are increasingly affected by human immunodeficiency virus (HIV), it is important to identify psychosocial factors unique to this group so that AIDS mental health interventions can be culturally…
Robinson, Beatrice E.; Galbraith, Jennifer S.; Lund, Sharon M.; Hamilton, Autumn R.; Shankle, Michael D.
We describe the process of adapting a community-level, evidence-based behavioral intervention (EBI), Community PROMISE, for HIV-positive African American men who have sex with men (AAMSM). The Centers for Disease Control and Prevention (CDC) Map of the Adaptation Process (MAP) guided the adaptation process for this new target population by two…
MacMaster, Samuel A.; Jones, Jenny L.; Rasch, Randolph F. R.; Crawford, Sharon L.; Thompson, Stephanie; Sanders, Edwin C., II
Objective: This article provides an evaluation of a federally funded faith-based program that serves African Americans who use heroin and cocaine and are at risk for HIV/AIDS in Nashville, Tennessee. Methods: Data were collected from 163 individuals at baseline and 6- and 12-month follow-up interviews. A subset of participants (n = 51) completed…
Ritchwood, Tiarney D.; Hughes, James P.; Jennings, Larissa; MacPhail, Catherine; Williamson, Brian; Selin, Amanda; Kathleen, Kahn; Gómez-Olivé, F. Xavier; Pettifor, Audrey
Objective Sexual liaisons between older men and younger women have been linked to greater risk of HIV acquisition. This study aims to: 1) identify psychosocial and behavioral factors associated with age-discordant (partner ≥ 5 years older) versus age-concordant partnerships (−1
van Dyk, A C
HIV/AIDS in Africa places a tremendous burden on the nursing profession. Hospitals are inundated with very sick and dying AIDS patients and nurses often find that their role as healers has shifted to a great extent to that of caregivers, counsellors and educators. AIDS also calls for nurses to go beyond the strict Western-based bio-medical model to be able to help and understand patients who come from a traditional African background. This article discusses relevant aspects of the traditional African worldview by explaining what health, sickness and sexuality mean in traditional Africa. Traditional African perceptions of the causes of illness (God, ancestors, witches, pollution and germs), perceptions of sexuality, the importance of having children, cultural beliefs inhibiting the usage of condoms, the importance of community life, as well as the controversial issue of confidentiality in Africa are discussed. The implications for AIDS care and counselling in Africa are explored and suggestions on how to use traditional beliefs and customs to the advantage of AIDS education, are offered.
Goyer, K C; Gow, Jeff
Prisoners in South Africa face problems of overcrowding, violence and poor nutrition. Added to this burden in recent times is the increased threat from HIV. The HIV epidemic has been relatively late in coming to South Africa but infection rates are now 20% in the adult population. However, there is no data available on the level of HIV infection in the prison population. Overseas studies suggest that the characteristics of prisoners place them at much greater risk of HIV infection. Factors which contribute to increased levels of HIV infection include poor health care facilities, lack of condoms and lack of disinfectants. Current policies and practices on HIV in prison attempt to balance the constraints of limited resources with the need to preserve prisoner human rights. The outcomes include: mass testing not freely available, HIV education is limited, and early release of prisoners with advanced AIDS is not allowed. Constraints on the implementation of effective HIV prevention strategies include: bureaucratic inefficiency, lack of resources, and a reluctance by prison authorities to address the issue of HIV in prison. These problems can possibly be overcome by addressing the issue from both management and prisoner perspectives. On the management side, increased resources, increased training of prison officials, and increased political commitment to address the issue are required. Outside partnerships are probably required for an effective response. Prisoners require better nutrition, better living conditions, better health care, freely available condoms and disinfectants.
Khan, Maria R; El-Bassel, Nabila; Golin, Carol E; Scheidell, Joy D; Adimora, Adaora A; Coatsworth, Ashley M; Hu, Hui; Judon-Monk, Selena; Medina, Katie P; Wohl, David A
Incarceration is thought to influence HIV transmission by disrupting partnerships that provide support and protect against sex risk-taking. Current correctional facility-based family-strengthening programs focus on marital partnerships, a minority of inmates' partnerships. Research on the sex partnerships of incarcerated African-American men and the types of partnerships most likely to protect against HIV-related sex risk is limited. Improved understanding can inform expansion of correctional facility-based family-strengthening programs to a greater proportion of protective partnerships and HIV risk reduction programs to partnerships vulnerable to sex risk. Project DISRUPT is a cohort study of African-American men being released from prison in North Carolina who were in committed heterosexual partnerships at prison entry. Using baseline survey data (N = 189), we conducted latent class analysis (LCA) to identify subgroups of participants with distinct relationship profiles and measured associations between relationship characteristics and multiple partnerships of inmates and their partners in the six months before incarceration. LCA indicated a two-class solution, with relationships distinguished by satisfaction/stability (satisfied/stable class: 58.0%; dissatisfied/unstable class: 42.0%); each class had comparable relationship length and levels of marriage and cohabitation. Dissatisfied/unstable relationships were associated with multiple partnerships among participants (AOR 2.93, 95% CI 1.50, 5.72) and partners (AOR 4.95, 95% CI 1.68, 14.58). Satisfaction indicators-versus length, marriage, or cohabitation-were the strongest independent correlates of inmates' and partners' multiple partnerships. Pre-incarceration economic deprivation, mental disorder symptoms, substance use, and violence in relationships were associated with dissatisfaction/instability. Prison-based programs designed to maintain healthy partnerships, strengthen relationship skills, and reduce
St. Lawrence, Janet S.; Kelly, Jeffrey A.; Dickson-Gomez, Julia; Owczarzak, Jill; Amirkhanian, Yuri A.; Sitzler, Cheryl
Contemporary antiretroviral therapy (ART) can produce viral suppression of HIV, maintain health, and prevent onward HIV transmission from infected persons to their sexual partners, giving rise to the concept of treatment as prevention. Successful implementation of test-and-treat strategies rests on the early detection of HIV infection through voluntary counseling and testing (VCT) followed by entry and retention in care, ART initiation and adherence, and subsequent viral suppression. In the United States, African American men who have sex with men (MSM) bear a disproportionate burden of HIV and have high rates of undetected and untreated HIV infection. However, little research has examined racial minority MSM’s views about HIV testing. In this study, in-depth interviews were conducted with 96 key informants knowledgeable about racial minority MSM as well as 100 African American MSM community members in Milwaukee, Cleveland, and Miami. Most men in the sample were aware of the availability of testing and knew testing locations, but many voiced great personal ambivalence about being tested, feared knowing their HIV status, expressed concern about stigma and loss of confidentiality, and held beliefs indicative of medical mistrust. Participants did not spontaneously cite benefits of being tested, risk reduction behavior changes made as a consequence of testing, nor the benefits of testing to get early medical care for HIV infection. There is a gap between the public health field’s perception of testing benefits and the beliefs about testing held by racial minority MSM in this sample. To increase the desired outcomes from VCT for minority MSM, VCT promotion should address the concerns of African American MSM and underscore the benefits of early entry into medical care. PMID:26010312
Tobin, K; Kuramoto, SJ; German, D; Fields, E; Spikes, PS; Patterson, J; Latkin, C
Unity in Diversity was a randomized controlled trial of a culturally tailored HIV prevention intervention for African American men who have sex with men (AA MSM). The intervention condition was six group-based sessions and one individual session. The control condition was a single-session HIV prevention review. Participants were aged 18 years or older, identified as African American/black race, reported having at least two sex partners in the prior 90 days (at least one of whom must be a male partner), unprotected anal sex with male partner in the prior 90 days and willing to test for HIV. Retention exceeded 95% at 3 month follow-up. Results of multivariate logistic regression analysis adjusting for baseline risk, HIV status and health insurance indicate intervention efficacy in decreasing the number of male sex partners and marginal effects on condom use with male partners and HIV negative/unknown partners. Specifically, intervention condition was associated with increased odds of zero male sex partners (AOR=3.03, 95%CI=1.26–7.28), condom use with male partners (AOR=2.64, 95%CI=0.95–7.36) and HIV negative/unknown status partners (AOR=3.19, 95%CI=0.98–10.38) at follow-up. These results contribute to the limited number of culturally appropriate models of HIV prevention intervention that are urgently needed for African American men who have sex with men to address their persistently high rates of HIV. PMID:22984216
Responsive to perceived high risk of HIV infection by sexually active youth, several South African sexual health-promotion campaigns have used media targeting mothers, instructing them on how sex should be talked about with their children to 'risk-proof' them. A Foucauldian approach to the normative apparatus of family-sexuality-risk finds mothers positioned as pivots between 'public' (health, economy, culture) and 'private' (family, childrearing, sex) apparatuses, tasked with appropriately socialising a new generation of sexually responsible, HIV-free citizens. This paper uses a reading of interactive discourse from (racially and gender) mixed groups of parents who, as professionals and postgraduate students in a university context, discussed their own childrearing practices in response to a particular didactic media text about sex-communication. In a way different from traditional media-reception studies, this discourse analytic reading of parents' engagement with risk-expertise examines how mothers especially are persuaded (or not) to adopt particular childrearing practices in the context of an HIV epidemic. Using a Foucauldian argument about subject positioning, this paper examines how the parents positioned themselves in relation to the expertise offered in the stimulus material, as well as how they positioned one another during the group discussions. The analysis explores the partial buy-in to expert Western psychological techniques concerning talking with children about sex openly and often, and how this appropriation is negotiated in contextual family situations that are gendered, raced, classed and acculturated.
Ramiah, Ilavenil; Reich, Michael R
This paper examines the processes for building highly collaborative public-private partnerships for public health, with a focus on the efforts to manage the complex relationships that underlie these partnerships. These processes are analyzed for the African Comprehensive HIV/AIDS Partnerships (ACHAP), a 5-year partnership (2001-2005) between the government of Botswana, Merck & Co., Inc. (and its company foundation), and the Bill & Melinda Gates Foundation. ACHAP is a highly collaborative initiative. The ACHAP office in Botswana engages intensively (on a daily basis) with the government of Botswana (an ACHAP partner and ACHAP's main grantee) to support HIV/AIDS control in that country, which had an adult prevalence of 38.5% HIV infection in 2000 when ACHAP was being established. The paper discusses the development of ACHAP in four stages: the creation of ACHAP, the first year, the second and third years, and the fourth year. Based on ACHAP's experiences over these four years, the paper identifies five lessons for managing relationships in highly collaborative public-private partnerships for public health.
Kass, Nancy E; Ali, Joseph; Hallez, Kristina
Objectives Our primary aim was to evaluate the impact of US National Institutes of Health (NIH)-funded bioethics training programmes (Fogarty bioethics training programmes, FBTPs) that trained individuals from Africa over the programme's first 10 years to examine changes between pretraining and post-training in individual achievement and to document any associations between individual, training programme and post-training accomplishments. Design We surveyed trainees from the 10 bioethics programmes funded by NIH Fogarty International Center from 2000 to 2011 that included African trainees. McNemar's and Wilcoxon signed rank-sum tests were used to analyse pre–post levels of general and bioethics-related professional achievement. Likelihood of specific post-training achievement outcomes was measured using logistic regression including demographic, pretraining and intratraining variables. Setting 10 different FBTPs that trained individuals from Africa from 2000 to 2011. Participants Of 253 eligible respondents, 171 completed the survey (response rate 67.6%). Primary outcome measures Pre–post comparisons of professional achievement indicators (eg, serving in leadership roles, teaching, publishing manuscripts); likelihood of specific post-training achievement outcomes. Results Post-training, respondents were significantly more likely to report serving in a leadership role, being an investigator on a research grant, serving on international committees, serving as a mentor, and publishing manuscripts than at pretraining. Post-training, significantly greater numbers of respondents reported bioethics-related achievements including being a bioethics instructor, serving on an Institutional Review Board (IRB), being an investigator on a bioethics grant and publishing bioethics-related manuscripts than pretraining. Controlling for other factors, there were no significant differences by gender in the post-training success of these participants in terms of leadership roles
Seth, Puja; Wingood, Gina M.; Robinson, LaShun S.; DiClemente, Ralph J.
The impact of alcohol use on the efficacy of an HIV/STI intervention designed for young African-American women in predicting STIs was examined. Eight hundred forty-eight African-American women, 18–29 years, were randomly assigned to either the HIV/STI intervention or a control condition. Participants were assessed on alcohol use and provided two vaginal swab specimens for STI testing. Women in the intervention who consumed alcohol were less likely to test STI-positive than women in the control and abstainers (AOR = 2.47, 95 % CI = 1.01–6.22). STI risk factors may vary across different populations. Further research on heavy drinking and HIV intervention efficacy is needed. PMID:23979497
Kisler, Kimberly A.; Williams, John K.
Background HIV prevention has rarely explored the impact of childhood sexual abuse (CSA) across health domains among African American men who have sex with men and women (MSMW). Early sexual experiences may influence perceptions of gender roles, sexual identity, and risks for HIV/AIDS. The attribute of masculinity is commonly associated with strength and success. However, a legacy of racism and oppression may pose challenges for African American men in achieving gender-based milestones. Instead, proxies for success may include masculinity constructs with hypersexual posturing and prowess that contradict sexual health messages. Methods Two groups, each meeting twice for 90-minutes, of HIV-positive African American MSMW participated in discussions focusing on masculinity and sexual experiences. Participants were bisexual HIV-positive African American men who engaged in unprotected sex and had histories of CSA. Discussions were recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. Results Participant mean age was 40.5 years (n=16). Majority had a high school education (69%), half were unemployed, and almost two-thirds earned less than $20,000 annually. Three themes, each with two subthemes, emerged that described the sociocultural context for engaging in high-risk sexual behaviors, and included: 1) the importance of inhabiting a “traditional” masculine gender role with: a) general and b) sexual masculine traits; 2) the influence of conceptions of masculinity on sexual identity with the associations: a) between being gay and being effeminate and b) between being gay and being HIV-positive, and; 3) CSA experiences with: a) appraisal of CSA and b) early sexual experiences as rites of passage. Conclusion Attempts to be masculine may contribute to high-risk sexual behaviors. Research needs to explore how early sexual experiences shape perceptions of masculinity and masculinity's influence on receiving
Batist, Elizabeth; Brown, Benjamin; Scheibe, Andrew; Baral, Stefan D; Bekker, Linda-Gail
Introduction Men who have sex with men (MSM) in Cape Town's townships remain in need of targeted HIV-prevention services. In 2012, a pilot community-based HIV-prevention programme was implemented that aimed to reach MSM in five Cape Town townships, disseminate HIV-prevention information and supplies, and promote the use of condoms and HIV services. Methods Convenience sampling was used to recruit self-identified MSM who were 18 years old or older in five Cape Town townships. The six-month pilot programme trained five community leaders who, along with staff, provided HIV-prevention information and supplies to MSM through small-group meetings, community-based social activities and inter-community events. After the completion of the pilot programme, in-depth interviews and focus group discussions (FGDs) were conducted with a subset of conveniently sampled participants and with each of the community leaders. Qualitative data were then analyzed thematically. Results Overall, 98 mostly gay-identified black MSM consented to participate, 57 community-based activities were facilitated and 9 inter-community events were conducted. Following their enrolment, 60% (59/98) of participants attended at least one pilot activity. Of those participants, 47% (28/59) attended at least half of the scheduled activities. A total of 36 participants took part in FGDs, and five in-depth interviews were completed with community leaders. Participants reported gaining access to MSM-specific HIV-prevention information, condoms and water-based lubricant through the small-group meetings. Some participants described how their feelings of loneliness, social isolation, self-esteem and self-efficacy were improved after taking part. Conclusions The social activities and group meetings were viable strategies for disseminating HIV-prevention information, condoms and water-based lubricant to MSM in this setting. Many MSM were also able to receive social support, reduce social isolation and improve their
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
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 a model for
HIV/AIDS are affecting increasingly complex, more diverse populations, particularly communities of color. Despite National prevention efforts designed to speak to marginal experience, these communities continue to be disproportionately affected, especially in rural areas of the country which are difficult to access with communication about HIV. A…
Balkus, Jennifer E.; Brown, Elizabeth R.; Hillier, Sharon L.; Coletti, Anne; Ramjee, Gita; Mgodi, Nyaradzo; Makanani, Bonus; Reid, Cheri; Martinson, Francis; Soto-Torres, Lydia; Karim, Salim S. Abdool; Chirenje, Zvavahera M.
Objective To assess the effect of oral and injectable contraceptive use compared to non-hormonal contraceptive use on HIV acquisition among Southern African women enrolled in a microbicide trial. Study Design Prospective cohort study using data from women enrolled in HIV Prevention Trials Network (HPTN) protocol 035. At each quarterly visit, participants were interviewed about self-reported contraceptive use and sexual behaviors and underwent HIV testing. Cox proportional hazards regression was used to assess the effect of injectable and oral hormonal contraceptive use on HIV acquisition. Results The analysis included 2,830 participants, of whom 106 became HIV infected (4.07 per 100 person-years.) At baseline, 1,546 (51%) participants reported using injectable contraceptives and 595 (21%) reported using oral contraceptives. HIV incidence among injectable, oral and non-hormonal contraceptive method users was: 4.72, 2.68 and 3.83 per 100 person-years, respectively. Injectable contraceptive use was associated with a non-statistically significant increased risk of HIV acquisition (adjusted hazard ratio [aHR] = 1.17; 95% confidence interval [CI] 0.70, 1.96), while oral contraceptive use was associated with a non-statistically significant decreased risk of HIV acquisition (aHR=0.76; 95% CI 0.37,1.55). Conclusion In this secondary analysis of randomized trial data, a marginal, but non-statistically significant, increase in HIV risk among women using injectable hormonal contraceptives was observed. No increased HIV risk was observed among women using oral contraceptives. Our findings support the World Health Organization’s recommendation that women at high risk for acquiring HIV, including those using progestogen-only injectable contraception, should be strongly advised to always use condoms and other HIV prevention measures. PMID:26519646
Bates, Annwen E
The article takes a hermeneutic approach to exploring a selection of visual representations of the African body in relation to the issue of HIV and AIDS in Africa. In particular, it argues that the trope of 'deficiency' ('lack'), wherein Africa is constructed as dirty, degenerate, decaying and dying, continues in visual representations aimed at a northern or UK audience. In contrast, examples of public health material aimed at a South African audience present a postcolonial counter-discourse where the African body is empowered rather than deficient. These two assumptions and their accompanying visuals parallel two differing narratives about HIV and AIDS in Africa. The article explores the ideological underpinnings of those narratives in four sections: 1) Paper-thin facts presents certain attitudes about Africa and the African body that have come into currency in relation to colonialism; 2) A matter of mor(t)ality examines the relationship between morality and the mortality of the African body; 3) The legacies endure analyses selected images aimed at a potential donor, UK audience with reference to the ideologies proposed in the previous sections; and 4) Wearing the T-shirt engages with the proposed counter-discourse and its visual representations, as evident in a selection of South African public health material.
Strathdee, Steffanie A; Arredondo, Jaime; Rocha, Teresita; Abramovitz, Daniela; Rolon, Maria Luisa; Patiño Mandujano, Efrain; Rangel, Maria Gudelia; Olivarria, Horcasitas Omar; Gaines, Tommi; Patterson, Thomas L; Beletsky, Leo
Introduction Policing practices are key drivers of HIV among people who inject drugs (PWID). This paper describes the protocol for the first study to prospectively examine the impact of a police education programme (PEP) to align law enforcement and HIV prevention. PEPs incorporating HIV prevention (including harm reduction programmes like syringe exchange) have been successfully piloted in several countries but were limited to brief pre–post assessments; the impact of PEPs on policing behaviours and occupational safety is unknown. Objectives Proyecto ESCUDO (SHIELD) aims to evaluate the efficacy of the PEP on uptake of occupational safety procedures, as assessed through the incidence of needle stick injuries (NSIs) (primary outcome) and changes in knowledge of transmission, prevention and treatment of HIV and viral hepatitis; attitudes towards PWID, adverse behaviours that interfere with HIV prevention and protective behaviours (secondary outcomes). Methods/analysis ESCUDO is a hybrid type I design that simultaneously tests an intervention and an implementation strategy. Using a modified stepped-wedge design involving all active duty street-level police officers in Tijuana (N=∼1200), we will administer one 3 h PEP course to groups of 20–50 officers until the entire force is trained. NSI incidence and geocoded arrest data will be assessed from department-wide de-identified data. Of the consenting police officers, a subcohort (N=500) will be randomly sampled from each class to undergo pre-PEP and post-PEP surveys with a semiannual follow-up for 2 years to assess self-reported NSIs, attitudes and behaviour changes. The impact on PWIDs will be externally validated through a parallel cohort of Tijuana PWIDs. Ethics/dissemination Research ethics approval was obtained from the USA and Mexico. Findings will be disseminated through open access to protocol materials through the Law Enforcement and HIV Network. Trial registration number NCT02444403. PMID:26260350
Kingori, Caroline; Esquivel, Camila LeMaster; Hassan, Qorsho; Elmi, Abdul; Mukasa, Bakali; Reece, Michael
African-born immigrants and refugees have HIV infection rates six times higher than any other minority groups in the United States. Despite the increase in the population size and diversity of Somali immigrants and refugees in the United States, Somalis are one of the medically underserved population subgroups in this region. The lack of aggregate HIV infection rates among African-born immigrants, for example, Somali refugees, is a cause for alarm and calls for more research to be conducted in this subgroup. The purpose of this article was to examine contextually relevant HIV prevention strategies that will enhance HIV prevention among Somali immigrant/refugee young adults in the United States. Using the grounded theory approach, a convenience sample of 27 immigrant/refugee young adults was recruited in central Ohio. Recommendations for potential HIV prevention strategies emerged under two main categories: (1) internal community resources and (2) external platforms. Study findings support a collaborative approach involving community leaders (parents, elders, religious leaders) and educational (schools), media, and healthcare settings to tailor HIV prevention strategies that meet the needs of the priority group.
Boyes, Mark E; Cluver, Lucie D
South African children and adolescents living in HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms. Poverty and HIV/AIDS-related stigma are additional risk factors for these negative mental health outcomes. Community level factors, such as poverty and stigma, are difficult to change in the short term and identifying additional potentially malleable mechanisms linking familial HIV/AIDS with mental health is important from an intervention perspective. HIV/AIDS-affected children are also at increased risk of bullying victimization. This longitudinal study aimed to determine whether prospective relationships between familial HIV/AIDS and both anxiety symptoms and depressive symptoms operate indirectly via bullying victimization. Adolescents (M = 13.45 years, 56.67 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up one year later (n = 3,401, 96.70 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces, and door-to-door sampling included all households with a resident child/adolescent. Familial HIV/AIDS at baseline assessment was not directly associated with mental health outcomes 1 year later. However, significant indirect effects operating via bullying victimization were obtained for both anxiety and depression scores. Importantly, these effects were independent of poverty, HIV/AIDS-related stigma, and baseline mental health, which highlight bullying victimization as a potential target for future intervention efforts. The implementation and rigorous evaluation of bullying prevention programs in South African communities may improve mental health outcomes for HIV/AIDS-affected children and adolescents and this should be a focus of future research and intervention.
Haberer, Jessica; Celum, Connie; Mugo, Nelly; Ware, Norma C.; Cohen, Craig R.; Tappero, Jordan W.; Kiarie, James; Ronald, Allan; Mujugira, Andrew; Tumwesigye, Elioda; Were, Edwin; Irungu, Elizabeth; Baeten, Jared M.
Background: Intimate partner violence (IPV) is associated with higher HIV incidence, reduced condom use, and poor adherence to antiretroviral therapy and other medications. IPV may also affect adherence to pre-exposure prophylaxis (PrEP). Methods: We analyzed data from 1785 HIV-uninfected women enrolled in a clinical trial of PrEP among African HIV serodiscordant couples. Experience of verbal, physical, or economic IPV was assessed at monthly visits by face-to-face interviews. Low PrEP adherence was defined as clinic-based pill count coverage <80% or plasma tenofovir levels <40 ng/mL. The association between IPV and low adherence was analyzed using generalized estimating equations, adjusting for potential confounders. In-depth interview transcripts were examined to explain how IPV could impact adherence. Results: Sixteen percent of women reported IPV during a median of 34.8 months of follow-up (interquartile range 27.0–35.0). Overall, 7% of visits had pill count coverage <80%, and 32% had plasma tenofovir <40 ng/mL. Women reporting IPV in the past 3 months had increased risk of low adherence by pill count (adjusted risk ratio 1.49, 95% confidence interval: 1.17 to 1.89) and by plasma tenofovir (adjusted risk ratio 1.51, 95% confidence interval: 1.06 to 2.15). Verbal, economic, and physical IPV were all associated with low adherence. However, the impact of IPV diminished and was not statistically significant 3 months after the reported exposure. In qualitative interviews, women identified several ways in which IPV affected adherence, including stress and forgetting, leaving home without pills, and partners throwing pills away. Conclusions: Women who reported recent IPV in the Partners PrEP Study were at increased risk of low PrEP adherence. Strategies to mitigate PrEP nonadherence in the context of IPV should be evaluated. PMID:27243900
Grewe, Mary E.; Taboada, Arianna; Dennis, Alexis; Chen, Elizabeth; Stein, Kathryn; Watson, Sable; Barrington, Clare; Lightfoot, Alexandra F.
Theatre-based interventions have been used in health promotion activities among young people to address HIV and sexual health. In this study, we explored the experience of undergraduate student performers participating in a theatre-based HIV prevention and sexual health education intervention for high school students in the USA. Undergraduate students enrolled in a credit-bearing course to learn about HIV and sexual health, participatory theatre and health education techniques. We analysed students’ reflective essays written throughout the semester to identify any changes and the intervention processes that promoted these changes. Students experienced five interrelated forms of transformation: (1) increased knowledge about HIV and sexual health; (2) changes in attitude and communication about sex; (3) artistic growth; (4) emotional growth; and (5) clarification of career goals and future plans. Intervention processes that contributed to these transformations included improvisation, guided writing exercises, the creation of a close-knit cohesive group, and interactions with a group of HIV-positive speakers. Theatre-based, peer-led sexual health programmes can provide a transformative experience for undergraduate student performers. The transformative effects are linked to specific activities and processes of the intervention and require examination in future research. PMID:26085813
Lanier, Latrona; DeMarco, Rosanna
The challenges that face African American women living with HIV are immense. African American women continue to be disproportionately infected and affected by this chronic and life-threatening infection in a complex context of individual experience, interactions with the environment, formal and informal support systems, and cultural belief systems. This article identifies the Theory of Silencing the Self (STS) and a widely known model, the Social Ecological Model (SEM), as a synthesized explanatory framework in helping nurses understand how to address research questions and clinical care that is congruent with the experience of African American women living with HIV infection. In synthesizing the components of these two frameworks, an explanation of the relationship between disempowerment and depression in this population will be uncovered as a key component to making relationships at the individual, family, and community level better. Helping African American women living with HIV infection to explore and address how choosing to be silent across their life systems will advance healthcare adherence as we currently know it to improved self-management of a chronic, gender-specific, culturally-bound experience of depression.
Billings, Douglas W; Leaf, Samantha L; Spencer, Joy; Crenshaw, Terrlynn; Brockington, Sheila; Dalal, Reeshad S
The aim of this study was to develop and test a cost-effective, scalable HIV behavioral intervention for African American women. Eighty-three African American women were recruited from a community health center and randomly assigned to either the web-based Safe Sistah program or to a delayed HIV education control condition. The primary outcome was self-reported condom use. Secondary measures assessed other aspects of the gender-focused training included in Safe Sistah. Participants completed self-report assessments prior to randomization, 1- and 4-months after their program experience. Across the entire study period, women in the experimental condition significantly increased their condom use relative to controls (F = 5.126, p = 0.027). Significant effects were also found for sexual communication, sex refusal, condom use after alcohol consumption, and HIV prevention knowledge. These findings indicate that this web-based program could be an important component in reducing the HIV disparities among African American women.
Desmond, Michelle; Andrasik, Michele; Rasberry, Tonya; Lambert, Nina; Cohn, Susan E.; Simoni, Jane
Abstract Observational studies have examined the prevalence and impact of internalized stigma among African American women living with HIV, but there are no intervention studies investigating stigma reduction strategies in this population. Based on qualitative data previously collected, we adapted the International Center for Research on Women's HIV Stigma Toolkit for a domestic population of African American women to be consistent with Corrigan's principles of strategic stigma change. We implemented the intervention, led by an African American woman living with HIV, as a workshop across two afternoons. The participants discussed issues “triggered” by videos produced specifically for this purpose, learned coping mechanisms from each other, and practiced them in role plays with each other. We pilot tested the intervention with two groups of women (total N=24), measuring change in internalized stigma with the Stigma Scale for Chronic Illness before and after workshop participation. Sixty-two percent of the participants self-reported acquiring HIV through heterosexual sexual contact, 17% through intravenous drug use, 4% in utero, and 13% did not know the route of transmission. The intervention was feasible, enthusiastically accepted by the women, and led to decreased stigma from the start of the workshop to the end (p=0.05) and 1 week after (p=0.07) the last session of workshop. Findings suggest the intervention warrants further investigation. PMID:22984780
Danielson, Carla Kmett; McCauley, Jenna L.; Gros, Kirstin Stauffacher; Jones, Andrea M.; Barr, Simone C.; Borkman, April L.; Bryant, Brittany G.; Ruggiero, Kenneth J.
African-American adolescent girls are at disproportionate risk for HIV infection. Although numerous evidence-based risk-reduction interventions exist, dissemination and implementation resources remain limited, and prevention services remain notably inaccessible to the very populations at highest risk for HIV infection. Internet delivery of HIV risk-reduction programming has promise as a mechanism for extending the reach of existing prevention efforts and overcoming barriers associated with traditional service delivery. This article: (1) details the development process for the creation of SiHLEWeb, a web-adapted version of an evidence-based, culturally-informed HIV prevention program traditionally delivered to female African-American adolescents via an in-person group format; and (2) presents findings from quantitative and qualitative usability testing conducted among 18 African-American girls (13–18). Results suggest that users found the website improved knowledge and learning, was helpful, efficient to use, and generally attractive. Users reported some concerns about website navigation. Implications for internet delivery of health prevention programming are discussed. PMID:25167865
Billings, Douglas W.; Leaf, Samantha L.; Spencer, Joy; Crenshaw, Terrlynn; Brockington, Sheila; Dalal, Reeshad S.
The aim of this study was to develop and test a cost-effective, scalable HIV behavioral intervention for African American women. Eighty-three African American women were recruited from a community health center and randomly assigned to either the web-based Safe Sistah program or to a delayed HIV education control condition. The primary outcome was self-reported condom use. Secondary measures assessed other aspects of the gender-focused training included in Safe Sistah. Participants completed self-report assessments prior to randomization, 1- and 4-months after their program experience. Across the entire study period, women in the experimental condition significantly increased their condom use relative to controls (F = 5.126, p = 0.027). Significant effects were also found for sexual communication, sex refusal, condom use after alcohol consumption, and HIV prevention knowledge. These findings indicate that this web-based program could be an important component in reducing the HIV disparities among African American women. PMID:25616838
Parathyras, John; Gebhardt, Stefan; Hillermann-Rebello, Renate; Grobbelaar, Nelis; Venter, Mauritz; Warnich, Louise
South Africa, like many other Southern African countries, has one of the highest HIV infection rates in the world and many individuals consequently receive antiretroviral therapy (ART). However, knowledge regarding (i) the prevalence of functional single nucleotide polymorphisms (SNPs) in pharmacologically relevant genes, and (ii) variance in pharmacotherapy both within and between different populations and ethnic groups is limited. The aim of this study was to determine whether selected polymorphisms in cytochrome P450 (CYP) genes (CYP2B6 and CYP3A4) and the multidrug-resistance 1 (ABCB1) gene underlie altered antiretroviral (ARV) drug response in two South African populations. DNA samples from 182 HIV-positive individuals of Mixed-Ancestry and Xhosa ethnicity on ART were genotyped for the A-392G SNP in CYP3A4, the G516T and A785G SNPs in CYP2B6, and the T-129C, C1236T, G2677T/A and C3435T SNPs in ABCB1. Univariate two-way analysis of variance (ANOVA) testing revealed no apparent effect of ethnicity on immune recovery (in terms of CD4-cell count) in response to ART. Univariate one-way ANOVA testing revealed a discernible effect of genotype on immune recovery in the cases of the T-129C (P=0.03) and G2677A (P<0.01) polymorphisms in the ABCB1 gene. This study serves as a basis for better understanding and possible prediction of pharmacogenetic risk profiles and drug response in individuals and ethnic groups in South Africa.
Whiteley, Laura B; Brown, Larry K; Swenson, Rebecca R; Valois, Robert F; Vanable, Peter A; Carey, Michael P; DiClemente, Ralph; Salazar, Laura F; Romer, Daniel
Minority adolescents are affected disproportionately by HIV and STIs, and the Internet is a popular venue to meet sex partners. Little is known about the risks of this behavior for minority adolescents. The majority of studies that have examined sexual risk behavior online or STI/HIV prevention programs online have been among adult MSM. In this study, data from 1,045 African American youth found that 6% met sex partners online and in chat rooms. Odds ratios, adjusting for gender, found this behavior was associated with alcohol (AOR = 2.33, 95% CI [1.1, 4.7]) and drug use (AOR = 3.45, 95% CI [1.9, 6.1]), unprotected vaginal (AOR = 4.71, 95% CI [1.9, 8.4]) and anal sex (AOR = 4.77, 95% CI [1.3,17.1]) in the last 90 days, more lifetime vaginal (AOR = 3.65, 95% CI [2.0, 6.8]) and anal sex (AOR = 2.74, 95% CI [1.5, 4.8]), greater sexual sensation seeking (AOR = 2.92, 95% CI [1.5, 5.7]) and greater depression (AOR = 2.06, 95% CI [1.2, 3.6]. A final multiple logistic regression analyses found that male gender (AOR = 3.13, 95% CI [1.7, 5.8]), drug use at last sex (AOR = 2.41, 95% CI [1.3, 4.5]), lifetime history of vaginal (AOR = 2.90, 95% CI [1.5, 5.5]) and anal sex (AOR = 2.09, 95% CI [1.2, 3.6]), and cocaine use (AOR = 8.53, 95% CI [2.7, 27.3]) were independently associated with having sex with a partner met online. Meeting sex partners online is associated with a variety of risks among African American youth; however, the Internet may be an opportunity for intervention.
Rehle, Thomas; Johnson, Leigh; Hallett, Timothy; Mahy, Mary; Kim, Andrea; Odido, Helen; Onoya, Dorina; Jooste, Sean; Shisana, Olive; Puren, Adrian; Parekh, Bharat; Stover, John
Background The interpretation of HIV prevalence trends is increasingly difficult as antiretroviral treatment programs expand. Reliable HIV incidence estimates are critical to monitoring transmission trends and guiding an effective national response to the epidemic. Methods and Findings We used a range of methods to estimate HIV incidence in South Africa: (i) an incidence testing algorithm applying the Limiting-Antigen Avidity Assay (LAg-Avidity EIA) in combination with antiretroviral drug and HIV viral load testing; (ii) a modelling technique based on the synthetic cohort principle; and (iii) two dynamic mathematical models, the EPP/Spectrum model package and the Thembisa model. Overall, the different incidence estimation methods were in broad agreement on HIV incidence estimates among persons aged 15-49 years in 2012. The assay-based method produced slightly higher estimates of incidence, 1.72% (95% CI 1.38 – 2.06), compared with the mathematical models, 1.47% (95% CI 1.23 – 1.72) in Thembisa and 1.52% (95% CI 1.43 – 1.62) in EPP/Spectrum, and slightly lower estimates of incidence compared to the synthetic cohort, 1.9% (95% CI 0.8 – 3.1) over the period from 2008 to 2012. Among youth aged 15-24 years, a declining trend in HIV incidence was estimated by all three mathematical estimation methods. Conclusions The multi-method comparison showed similar levels and trends in HIV incidence and validated the estimates provided by the assay-based incidence testing algorithm. Our results confirm that South Africa is the country with the largest number of new HIV infections in the world, with about 1 000 new infections occurring each day among adults aged 15-49 years in 2012. PMID:26230949
The Relationship Between Online Social Network Use, Sexual Risk Behaviors, and HIV Sero-Status Among a Sample of Predominately African American and Latino Men Who have Sex with Men (MSM) Social Media Users.
Chiu, ChingChe J; Young, Sean D
Social networking technologies have emerged as potential platforms to reach HIV(+) MSM in HIV interventions. This study sought to compare use of online social networking sites (SNSs) and sexual risk behaviors between HIV(+) and HIV(-) individuals among a sample of predominately African American and Latino SNS-using MSM. A total of 112 MSM Facebook users were recruited online and offline and completed an online survey. We performed regression models to assess the association between HIV status, SNS use, and sexual risk behaviors. After adjusting for age, race, and employment status, being HIV positive was significantly associated with a greater number of sexual partners (ARR = 2.84, p = 0.0017) and lower comfort levels of discussing HIV/STI status on SNSs (AOR: 0.23, p = 0.011). Findings suggest that HIV status is associated with sexual risk behaviors and SNS use among SNS-using MSM. We discuss the implications for online HIV prevention.
International consultation on the criminalization of HIV transmission: 31 October-2 November 2007, Geneva, Switzerland. Joint United Nations Programme on HIV/AIDS (UNAIDS) Geneva, United Nations Development Programme (UNDP), New York, 2007.
Since the beginning of the HIV epidemic, some jurisdictions have applied criminal law to the transmission of HIV. In 2002, UNAIDS issued a policy options paper on this issue. In light of renewed calls for the application of criminal law to HIV transmission and concerns raised in this regard by the UNAIDS Reference Group on HIV and Humans Rights and others, UNDP and the UNAIDS Secretariat decided to bring together a number of legal experts and other concerned stakeholders to discuss this issue in the context of an effective human rights and public health response to HIV. The discussion would inform a UNAIDS/UNDP policy brief on this subject. It was clarified that the consultation would focus primarily on HIV transmission through sexual contact, although it was noted that concerns exist in relation to applying criminal law to HIV transmission in other contexts. This Bookshelf article consists of excerpts from the report of the meeting.
Kubicek, Katrina; Beyer, William; Weiss, George; Kipke, Michele D.
Objectives HIV rates for African American young men who have sex with men (AAYMSM) have reached as much as 14.7%, compared to 2.5% and 3.5% among Caucasian and Latino YMSM. However, there remains a lack HIV prevention interventions for this population. This study describes the use of Photovoice in the adaptation process of an evidence-based intervention (Adult Identity Mentoring) to make it developmentally and culturally appropriate for AAYMSM. Methods Thirty-six AAYMSM (ages 18–24) participated in weekly working group sessions to conduct a community, youth and data-driven adaptation process. Photovoice was used as a technique to facilitate guided discussions on topics that were identified for the new curriculum. Results Through Photovoice discussions, we identified a new focus for the adapted intervention, Young Men’s Adult Identity Mentoring (YM-AIM): development and maintenance of healthy intimate relationships. This new focus and resulting curriculum are rooted in the voices and perceptions of the target population. Conclusions Including youth was integral to the adaptation process and the use of techniques such as Photovoice helped ensure that the resulting adaptation was relevant to the target population. PMID:21460254
Kerrigan, Deanna; Andrinopoulos, Katherine; Johnson, Raina; Parham, Patrice; Thomas, Tracey; Ellen, Jonathan M
This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with fifty African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention.
Wadley, Antonia L; Mitchell, Duncan; Kamerman, Peter R
Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.
Scott-Sheldon, Lori A. J.; Carey, Kate B.; Carey, Michael P.; Cain, Demetria; Simbayi, Leickness C.; Kalichman, Seth C.
Background Shebeens in South Africa are settings in which alcohol use and sexual behavior often co-occur. The prevalence of alcohol use disorder (AUD), and the association between AUD, situations and settings, and sexual risk behavior, in shebeens remains unknown. Methods Men (n = 763; mean age = 30; 98% Black African) were recruited from townships in Cape Town, South Africa and completed a self-administered survey that assessed alcohol use, sexual risk behaviors, and situations and settings of alcohol use. The Alcohol Use Disorder and Associated Disabilities Interview Schedule DSV-IV Version (AUDADIS-IV) was used to identify the likelihood of AUD. Bivariate regression analyses assessed whether screening for AUD predicted sexual risk behaviors. Multivariate regression analyses examined whether AUD and/or situations/settings predicted risk behaviors. Results Nearly two-thirds of men (62%) endorsed sufficient criteria for AUD; 25%, 17%, and 20% were classified as having a mild, moderate, or severe AUD, respectively. AUD was associated with HIV risk such that men with AUD reported more unprotected sex than men without AUD. Analyses indicated that (a) individual (i.e., AUD) and (b) settings (i.e., frequency of having sex with a partner in a shebeen, tavern, or bottle store) interacted to predict unprotected sex. Conclusions The prevalence of AUD among shebeen patrons was high and was associated with unprotected sex. Findings suggest the need to integrate both individual and situational/setting factors to prevent HIV among patrons of shebeens. PMID:24854966
Robinson, Allysha C.; Knowlton, Amy R.
Objective Research suggests gender differences exist in achieving undetectable viral load (UVL) among persons living with HIV (PLHIV), and that social and behavioral health factors may play a role. Method Data were from African-American PLHIV in the BEACON study. Participants completed self-report surveys and gave biomarker data. Poisson regression with robust standard errors was implemented. Results Men with moderate religious activity had 1.3 times the likelihood of UVL as men with low religious activity (p<.10; N=199). Men with 1-2 mental illness diagnoses had 1.3 times the likelihood of UVL as men with none (p<.05). Women using 1-2 substances had 28% lower likelihood of UVL than non-using women (N=122; p<.10). Finally, women with frequent doctor-patient communication had 35% higher likelihood of UVL as women with less doctor-patient communication (p<.05). Conclusions Results suggest that social support, substance use, and mental illness function differently among men and women. Healthcare professionals should employ gender-specific interventions to address and improve HIV health outcomes. PMID:26143248
Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity. PMID:27672513
Lubinga, E; Maes, A A; Jansen, C J M
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 about a deliberately puzzling HIV and AIDS poster that cautioned the target group to be faithful to one sexual partner. We measured their comprehension of the poster and beliefs about the message, before and after the conversations. Overall, actual comprehension (AC) was low, and we observed a large discrepancy between actual and perceived comprehension. In general, conversations did not improve AC. It proved to be even more probable that a correct interpretation before a conversation turned into an incorrect interpretation than the other way around. However, having a well-informed conversation partner increased the chance of acquiring adequate subsequent comprehension. We found, in general, that conversations did not decrease undesirable beliefs. One important undesirable belief even became reinforced after the conversations. Conversations among peers might be valuable in health campaigns, but our study shows that intended positive effects do not automatically follow.
Mitchell, Mary M; Nguyen, Trang Q; Maragh-Bass, Allysha C; Isenberg, Sarina R; Beach, Mary Catherine; Knowlton, Amy R
Among disadvantaged persons living with HIV/AIDS (PLHIV), patient-provider engagement, which has been defined as patient-provider relationships that promote the use of health care services and are characterized by active listening and supportive decision making, has been associated with antiretroviral therapy (ART) maintenance and viral suppression. However, chronic pain, depression, and substance use, all of which are prevalent in this population, can reduce the quality of patient-provider engagement. We hypothesized a model in which chronic pain, depression, and substance use would be associated with poorer patient-provider engagement, which would be positively associated with adherence, with the latter associated positively with viral suppression. We analyzed data from the BEACON study, which included surveys from 383 PLHIV who were primarily African American, on ART, and had histories of drug use. Due to six missing cases on the chronic pain variable, we used data from 377 respondents in a structural equation model. Chronic pain and depressive symptoms were significantly associated with poorer patient-provider engagement, while substance use was associated with better engagement. Patient-provider engagement in turn was associated with better ART adherence, which was associated with higher viral suppression. Results suggest the role of chronic pain in poor patient-physician engagement in this population, which has potential implications for quality of HIV patient care and health outcomes. Findings suggest the need for attention to patient-provider engagement in PLHIV.
Dale, Sannisha K; Bogart, Laura M; Galvan, Frank H; Wagner, Glenn J; Pantalone, David W; Klein, David J
In a sample of HIV-positive African-American men who have sex with men (MSM), we examined neighborhood factors that may contextualize perceived discrimination from three intersecting stigmatized characteristics: race, HIV status, and sexual orientation. HIV-positive African-American MSM (N = 162, mean age = 44, SD = 8) provided information on neighborhood-related stressors and discrimination experiences related to being Black, HIV-positive, or perceived as gay. Residential ZIP codes and US Census data were used to determine neighborhood poverty rates. Regressions, controlling for socio-demographics, indicated that (1) higher neighborhood poverty was significantly related to more frequent experiences with hate crimes (Gay-related: b = 1.15, SE = .43, p < .008); and (2) higher neighborhood-related stressors were significantly related to more frequent discrimination (Black-related: b = .91, SE = .28, p = .001; gay-related: b = .71, SE = .29, p = .01; and HIV-related: b = .65, SE = .28, p = .02) and hate crimes (Gay-related: b = .48, SE = .13, p = .001; and Black-related: b = .28, SE = .14, p = .04). For HIV-positive African-American MSM, higher neighborhood poverty and related stressors are associated with experiencing more discrimination and hate crimes. Interventions for this group should promote individual- and neighborhood-level socioeconomic empowerment and stigma reduction.
Kantor, Rami; DeLong, Allison; Balamane, Maya; Schreier, Leeann; Lloyd, Robert M; Injera, Wilfred; Kamle, Lydia; Mambo, Fidelis; Muyonga, Sarah; Katzenstein, David; Hogan, Joseph; Buziba, Nathan; Diero, Lameck
Introduction Antiretroviral resistance leads to treatment failure and resistance transmission. Resistance data in western Kenya are limited. Collection of non-plasma analytes may provide additional resistance information. Methods We assessed HIV diversity using the REGA tool, transmitted resistance by the WHO mutation list and acquired resistance upon first-line failure by the IAS–USA mutation list, at the Academic Model Providing Access to Healthcare (AMPATH), a major treatment programme in western Kenya. Plasma and four non-plasma analytes, dried blood-spots (DBS), dried plasma-spots (DPS), ViveSTTM-plasma (STP) and ViveST-blood (STB), were compared to identify diversity and evaluate sequence concordance. Results Among 122 patients, 62 were treatment-naïve and 60 treatment-experienced; 61% were female, median age 35 years, median CD4 182 cells/µL, median viral-load 4.6 log10 copies/mL. One hundred and ninety-six sequences were available for 107/122 (88%) patients, 58/62 (94%) treatment-naïve and 49/60 (82%) treated; 100/122 (82%) plasma, 37/78 (47%) attempted DBS, 16/45 (36%) attempted DPS, 14/44 (32%) attempted STP from fresh plasma and 23/34 (68%) from frozen plasma, and 5/42 (12%) attempted STB. Plasma and DBS genotyping success increased at higher VL and shorter shipment-to-genotyping time. Main subtypes were A (62%), D (15%) and C (6%). Transmitted resistance was found in 1.8% of plasma sequences, and 7% combining analytes. Plasma resistance mutations were identified in 91% of treated patients, 76% NRTI, 91% NNRTI; 76% dual-class; 60% with intermediate-high predicted resistance to future treatment options; with novel mutation co-occurrence patterns. Nearly 88% of plasma mutations were identified in DBS, 89% in DPS and 94% in STP. Of 23 discordant mutations, 92% in plasma and 60% in non-plasma analytes were mixtures. Mean whole-sequence discordance from frozen plasma reference was 1.1% for plasma-DBS, 1.2% plasma-DPS, 2.0% plasma-STP and 2.3% plasma
Jemmott, L. S.; Jemmott, J. B.; Ngwane, Z.; Icard, L.; O’Leary, A.; Gueits, L.; Brawner, B.
One of the worst HIV/AIDS epidemics in the world is occurring in South Africa, where heterosexual exposure is the main mode of HIV transmission. Young people 15–24 years of age, particularly women, account for a large share of new infections. Accordingly, there is an urgent need for behavior-change interventions to reduce the incidence of HIV among adolescents in South Africa. However, there are few such interventions with proven efficacy for South African adolescents, especially young adolescents. A recent cluster-randomized controlled trial of the ‘Let Us Protect Our Future!’ HIV/STD risk-reduction intervention for Grade 6 South African adolescents (mean age = 12.4 years) found significant decreases in self-reported sexual risk behaviors compared with a control intervention. This article describes the intervention, the use of the social cognitive theory and the reasoned action approach to develop the intervention, how formative research informed its development and the acceptability of the intervention. Challenges in designing and implementing HIV/STD risk-reduction interventions for young adolescents in sub-Saharan Africa are discussed. PMID:23962491
Kange'ethe, Simon Murote
The research study done at the Kanye village of Botswana was qualitative in design and exploratory in nature. While the broad goal aimed at assessing the contributions of caregivers in the Kanye CHBC programme, this article aims at evaluating the traditional Healers' contribution as providers of care to HIV/AIDS patients and other chronically ill persons. The study conveniently involved all the 140 registered caregivers in the Kanye programme, but with only 82 caregivers turning up for focus group discussions. The caregivers were grouped in 10 focus group discussions, and all of the 5 CHBC nurses were subjected to one-on-one interviews. Both the focus group discussions and one-on-one interviews with the nurses used two slightly different interview schedules as data collection instruments. The study findings revealed that traditional healers are important players in caregiving of persons with various ailments but their role, position and contribution in the battle against HIV/AIDS is fast waning with time. The government has been challenged to map out strategies of collaboration between the two systems as traditional healers can complement the services of biomedical practitioners in this era of HIV/AIDS.
Bloch, Evan M; Shah, Avani; Kaidarova, Zhanna; Laperche, Syria; Lefrere, Jean-Jacques; van Hasselt, James; Zacharias, Peter; Murphy, Edward L
Background and Objectives Serologic screening for the major transfusion transmissible viruses (TTV) is critical to blood safety and has been widely implemented. However, actual performance as measured by proficiency testing has not been well studied in Sub-Saharan Africa. Therefore, we conducted an external quality assessment of laboratories engaged in transfusion screening in the region. Materials and Methods Blinded test panels, each comprising 25 serum samples that were pedigreed for HIV, HBsAg, HCV and negative status, were sent to participating laboratories. The panels were tested using the laboratories’ routine donor screening methods and conditions. Sensitivity and specificity were calculated and multivariable analysis was used to compare performance against mode of testing, country and infrastructure. Results A total of 12 African countries and 44 laboratories participated in the study. The mean (range) sensitivities for HIV, HBsAg and HCV were 91.9% (14.3-100), 86.7% (42.9-100) and 90.1% (50-100), respectively. Mean specificities for HIV, HBsAg and HCV were 97.7%, 97% and 99.5% respectively. After adjusting for country and infrastructure, rapid tests had significantly lower sensitivity than enzyme immunoassays (EIA) for both HBsAg (p<0.0001) and HCV (p<0.05). Sensitivity also varied by country and selected infrastructure variables. Conclusion While specificity was high, sensitivity was more variable and deficient in a substantial number of testing laboratories. These findings underscore the importance of proficiency testing and quality control, particularly in Africa where TTV prevalence is high. PMID:25052195
Introduction Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level. Programme approach We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Médecins Sans Frontières, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008. Discussion and Evaluation Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. Conclusion Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates
Mosam, Anisa; Sathar, Mahomed A; Dawood, Halima; Cassol, Edana; Esterhuizen, Tonya M; Coovadia, Hoosen M
In 38 African AIDS patients initiating generic HAART, GB virus C (GBV-C) RNA-positive patients retained GBV-C viraemia during 52 weeks of HAART, had a faster decline in HIV viral load (P = 0.03), fewer opportunistic infections (14.3 versus 50%, P = 0.18), and suffered no serious adverse events (none versus 61%, P = 0.008) compared with patients without GBV-C. GBV-C co-infection may be associated with a beneficial effect on African AIDS patients treated with generic HAART.
O’Leary, Ann; Jemmott, John B.; Stevens, Robin; Rutledge, Scott Edward; Icard, Larry D.
The present study sought to replicate effects of the number of syndemic psychosocial health conditions on sexual risk behavior and HIV infection among a sample of high-risk African American men who have sex with men (MSM) and to identify resilience factors that may buffer these effects. We used baseline data from an HIV risk-reduction trial to examine whether a higher number of syndemic conditions was associated with higher rates of self-reported sexual risk behavior and HIV infection. Using logistic regression models, we tested for interactions between number of syndemic conditions and several potential resilience factors to identify buffering effects. Replicating previous studies, we found significant associations between numbers of syndemic conditions and higher rates of sexual risk behavior and HIV infection. Surprisingly, we also replicated a previous finding (Stall et al., 2003) that the effects of syndemic burden on HIV status fell off at the highest levels of syndemic conditions. Among a variety of potential resilience factors, two--optimism and education--buffered the syndemic effect on HIV prevalence. This is, to our knowledge, the first paper to identify resilience factors buffering against syndemic effects among MSM. It also constitutes a significant contribution to the literature regarding prevention among black MSM. These results point to the need to identify HIV-positive black MSM and provide effective treatment for them and to develop interventions addressing both syndemic and resilience factors. PMID:24705710
Arnold, Emily A; Sterrett-Hong, Emma; Jonas, Adam; Pollack, Lance M
The House Ball Community (HBC) is an understudied network of African American men who have sex with men and transgender women, who join family-like houses that compete in elaborate balls in cities across the United States. From 2011 to 2012, we surveyed 274 recent attendees of balls in the San Francisco Bay Area, focusing on social networks, social support, and HIV-related behaviours. Participants with a high percentage of alters who were supportive of HIV testing were significantly more likely to have tested in the past six months (p = .02), and less likely to have engaged in unprotected anal intercourse (UAI) in the past three months (p = .003). Multivariate regression analyses of social network characteristics, and social support, revealed that testing in the past six months was significantly associated with social support for safer sex, instrumental social support, and age. Similarly, UAI in the past three months was significantly associated with social support for safer sex, homophily based on sexual identity and HIV status. HIV-related social support provided through the HBC networks was correlated with recent HIV testing and reduced UAI. Approaches utilising networks within alternative kinship systems, may increase HIV-related social support and improve HIV-related outcomes.
Arrey, Agnes Ebotabe; Bilsen, Johan; Lacor, Patrick; Deschepper, Reginald
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. PMID:25781906
O'Leary, Ann; Jemmott, John B; Stevens, Robin; Rutledge, Scott Edward; Icard, Larry D
The present study sought to replicate effects of the number of syndemic psychosocial health conditions on sexual risk behavior and HIV infection among a sample of high-risk African American men who have sex with men (MSM) and to identify resilience factors that may buffer these effects. We used baseline data from an HIV risk-reduction trial to examine whether a higher number of syndemic conditions was associated with higher rates of self-reported sexual risk behavior and HIV infection. Using logistic regression models, we tested for interactions between number of syndemic conditions and several potential resilience factors to identify buffering effects. Replicating previous studies, we found significant associations between numbers of syndemic conditions and higher rates of sexual risk behavior and HIV infection. Surprisingly, we also replicated a previous finding (Stall et al., Am J Public Health, 93(6):939-942, 2003) that the effects of syndemic burden on HIV status fell off at the highest levels of syndemic conditions. Among a variety of potential resilience factors, two-optimism and education-buffered the syndemic effect on HIV prevalence. This is, to our knowledge, the first paper to identify resilience factors buffering against syndemic effects among MSM. It also constitutes a significant contribution to the literature regarding prevention among black MSM. These results point to the need to identify HIV-positive black MSM and provide effective treatment for them and to develop interventions addressing both syndemic and resilience factors.
Rida, Wasima; Haddad, Lisa B.; Kamali, Anatoli; Karita, Etienne; Lakhi, Shabir; Kilembe, William; Allen, Susan; Inambao, Mubiana; Yang, Annie H.; Latka, Mary H.; Anzala, Omu; Sanders, Eduard J.; Bekker, Linda-Gail; Edward, Vinodh A.; Price, Matt A.
Background: Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. Methods: From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy. Results: Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different. Conclusions: In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted. PMID:27893488
Cross, Michael; Naidoo, Devika
The paper scrutinises the dynamics and the nature of peer review in the programme evaluation and accreditation process within the context of diverse individual and institutional legacies in South Africa. It analyses the peer review process and highlights the contestation at political, policy and epistemological levels. The paper argues that,…
The equity and transformation challenge for women and black academics at universities in Post-Apartheid South Africa is enormous. Despite a marked increase in equity development programmes since the 1996 Employment Equity legislation, fewer women than expected have advanced through the academic ranks. An indigenous mentoring model for…
Arrey, Agnes Ebotabe; Bilsen, Johan; Lacor, Patrick; Deschepper, Reginald
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 consideration
Newman Owiredu, Morkor; Newman, Lori; Nzomo, Theresa; Conombo Kafando, Ghislaine; Sanni, Saliyou; Shaffer, Nathan; Bucagu, Maurice; Peeling, Rosanna; Mark, Jennifer; Diop Toure, Isseu
The World Health Organization's (WHO) Strategic Framework for the Elimination of New HIV Infections among Children in Africa by 2015 identifies important synergies for the elimination of mother-to-child transmission of HIV and syphilis in terms of prevention interventions, implementation logistics and service delivery, monitoring and evaluation systems, and need for sustained political commitment. The WHO advocates the use of an integrated, rights-based dual approach with partnerships and collaboration to make the best use of available resources. Through a consultative approach, six countries in the African Region committed to dual elimination and developed and implemented action plans for this purpose. Where interest and commitment are high, this may also be possible and effective in other African countries.
St. Lawrence, Janet S.; And Others
Randomly assigned 246 African American adolescents either to an educational program or to an 8-week intervention that combined education with behavior skills training. Results indicate that, compared with the education program, youth in behavioral skills training lowered their infection risk to a greater degree, maintained risk reduction changes…
Eyre, Stephen L.; Flythe, Michelle; Hoffman, Valerie; Fraser, Ashley E.
In this study, we used an exploratory methodology to determine what cultural models African American emerging adults use to understand infidelity/cheating. Cultural models are defined as "cognitive schema[s] that [are] intersubjectively shared by a social group" (D'Andrade, 1987, p. 112). We interviewed 144 participants ages 19-22 from three…
Tran, Bach Xuan; Ohinmaa, Arto; Duong, Anh Thuy; Nguyen, Long Thanh; Vu, Phu Xuan; Mills, Steve; Houston, Stan; Jacobs, Philip
We analysed the cost-effectiveness and budget impact of the methadone maintenance treatment (MMT) programme in HIV prevention and treatment among injection drug users (DUs) in Vietnam. The costs and health outcomes of providing MMT for opioid-dependent DUs versus non-MMT were estimated using a decision analytical model. Probabilistic sensitivity analysis using Monte Carlo simulation was conducted to justify uncertainties of model parameters simultaneously. The incremental cost-effectiveness ratio (ICER) of MMT in HIV prevention was US$3324 per one averted HIV case. The decision model showed that the cost-effectiveness ratio of MMT and non-MMT strategies was US$480 and US$204 per 1 quality-adjusted life year (QALY), equivalent to 0.43 and 0.18 times the gross domestic product per capita (GDPpc). The ICER for MMT versus non-MMT strategy was US$1964, approximately 1.76 times the GDPpc/QALY, classifying MMT as a cost-effective intervention. At the willingness to pay threshold of three times the GDPpc, the probability of MMT and non-MMT strategies being cost-effective was 80.3 and 19.7%, respectively. The budget impact of scaling up MMT from 2011 to 2015 will be US$97 million for 65% coverage or US$49 million for treating 80,000 DUs. The results indicated that MMT was cost-effective in HIV prevention and treatment among DUs who were opioid dependent.
van Niekerk, H; Silberbauer, M J; Hohls, B C
Determination of data adequacy for detection of long-term salinity changes was an important task in the revision of the South African National Chemical Monitoring Programme (NCMP). The NCMP has been running for more than 30 years with