• Demand for programs for key populations in Africa from countries receiving international donor assistance

      Ryan, O; Macom, J; Moses-Eisenstein, M (Taylor & Francis, 2012-12-06)
      There has been increasing attention in recent years to the HIV prevention, treatment, and care needs of key populations in Africa, in particular men who have sex with men (MSM), injection drug users (IDU), and female sex workers (FSW). While several major donors have undertaken efforts to prioritize these groups, it remains unclear which African countries are actively seeking donor support for these programs. For this analysis, we reviewed publicly available proposal and budget documentation from the US PEPFAR for fiscal years 2007 through 2010 and Rounds 1 through 10 of the Global Fund to Fight AIDS, Tuberculosis and Malaria for 40 countries in sub-Saharan Africa. Of the 164 searchable documents retrieved, nearly two-thirds contained at least one program serving FSW (65%, 107 proposals), less than one-third contained at least one program serving MSM (29%, 47 proposals), and a minority proposed programming for IDU (13%, 21 proposals). Demand for these programs was highly concentrated in a subset of countries. Epidemiological data for at least one key population was included in a majority of these proposals (63%, 67 proposals), but in many cases these data were not linked to programs.
    • Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

      C Parry; A Pithey (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2010-02-05)
      The purpose of this review was to identify and assess studies that have quantified the association between alcohol consumption and HIV infection in sub-Saharan Africa. PubMed, CAB Abstracts and article references were searched to identify studies published in English between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. Twenty-one eligible studies were described in detail and information on study characteristics extracted. All of the identified studies were conducted either in east or southern Africa, and varied substantially regarding study population andalcohol use definitions. Overall, users of alcohol and especially problem drinkers were more likely to be HIV seropositive (HIV+) than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence. The findings of this review of sub-Saharan African research strongly support an association between alcohol consumption and HIV infection. Although a causal relationship could not be established with certainty from the mainly cross-sectional studies, the negative consequences of such an association have profound implications for the burden of disease in this region. To confirm causality, futureresearch should use prospective study designs, use clearly defined  standardised measures of alcohol use (and problematic drinking)and an ‘event-specific’ approach to examine the situational links between alcohol use and HIV acquisition. Keywords: Alcohol, HIV, sexual risk, Africa.
    • Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa

      Shandir Ramlagan; Gladys Matseke; Violeta J. Rodriguez; Deborah L. Jones; Karl Peltzer; Robert A.C. Ruiter; Sibusiso Sifunda (Taylor & Francis Group, 2018-01-01)
      Disclosure of HIV status remains one of the major challenges to the effectiveness of the prevention of mother to child transmission of HIV in rural areas in South Africa. This study aimed at assessing the determinants of HIV status disclosure among HIV infected pregnant women who have disclosed their HIV status to someone, as well as among those who have disclosed to their partners. Cross-sectional data was collected from 673 HIV sero-positive pregnant women receiving antenatal care services at 12 Community Health Centers in Mpumalanga province. Results indicated that over two-thirds (72.1%) disclosed their status to someone, while just over half (58.4%) disclosed to their partners. Multivariate analysis showed that both disclosure of ones HIV status to someone and to their male partners was significantly associated with increase in antiretroviral therapy (ART) adherence, the known HIV positive status of their partner, and male involvement during pregnancy. Participants who were diagnosed HIV positive during this current pregnancy were less likely to disclose their HIV status to someone. Non-disclosure during current pregnancy highlights a need for interventions that will encourage disclosure among HIV positive women, with a particular focus on those who are newly diagnosed. The findings also need to integrate male partner involvement and partner disclosure during pregnancy.
    • Determinants of extramarital sex by men in Tanzania: A case study of Mbeya region

      Mbago, MCY; Sichona, FJ (Taylor & Francis, 2011-07-08)
      This paper attempts to identify some factors associated with extramarital sex by men in the Mbeya region of Tanzania using data from a survey conducted in 2003/2004. The choice of Mbeya region was prompted by the fact that it has been found by previous studies to be one of the regions with the highest HIV prevalence rate in Tanzania. Correlates of extramarital sex that were considered include current age, education, residence, age at first sexual intercourse, age at first marriage and sex before marriage. A bivariateanalysis of the survey data, which comprised a sample size of 568 married men aged between 15 and 62 years revealed statistically significant association between extramarital sex with current age, education, age at first intercourse and sex before marriage. The effect of these variables was tested through a multivariate logistic regression analysis and all the four independent variables were found to be statistically significant predictors of extramarital sex in Mbeya region.
    • Developing teacher self-efficacy via a formal HIV/AIDS intervention

      Webb, P; Gripper, A (Taylor & Francis, 2011-07-08)
      This study investigated the effects of a HIV/AIDS module on teachers’ sense of self-efficacy regarding their ability to bring about behaviours in their learners which contribute to responsible living and a reduction of the spread of HIV in their communities. The sample was 128 in-service teachers studying in nine different centres in three South African provinces in their second year of a parttime degree in education. A modified Science Teaching Efficacy Belief Instrument (STEBI) was used to generate quantitative data, while semi-structured individual and focus group interviews provided qualitative data. Statistical analyses (ANOVA and MANOVA) revealed statistically significant differences between the participants pre- and post-test self-efficacy scores. Interview data suggested that improved confidence enabled the teachers to gain a better understanding of cultural barriers to HIV/AIDS education and theimpediments to developing an effective HIV/AIDS policy in their schools. The study also highlighted the importance of leadership from school management for the successful adoption and implementation of an effective HIV/AIDS policy in schools. Enhanced confidence is noted as a motivating factor for teacher participation in community efforts to support those affected by HIV/AIDS.
    • Development of an HIV risk reduction counselling intervention for use in South African sexually transmitted infection clinics

      P Bidla; Research assistant with the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; XP Nibe; Research assistant with the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; D Cain; Research manager with the Psychology Department at the University of Connecticut; V Mathiti; Instructor of psychology at the University of the Western Cape and a research consultant with the Human Sciences Research Council, Cape Town; LC Simbayi; Research director in the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; Social Aspects of HIV/AIDS and Health, Human Sciences Research Council, Private Bag X9182, Cape Town, 8000, South Africa.; SC Kalichman; Professor in the Psychology Department at the University of Connecticut; L Shasha; Research assistant with the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; S Jooste; Research programme manager with the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; P Magubane; Research assistant with the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; Q Kekana; Research assistant with the Social Aspects of HIV/AIDS and Health research programme at the Human Sciences Research Council, Cape Town; et al. (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2005-10-13)
      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. Keywords: HIV/AIDS prevention counselling, HIV/AIDS risk reduction, clinic-based intervention, South Africa. RÉSUMÉL&#39Afrique du Sud a un besoin urgent des interventions pr&#233ventives du VIH qui pourraient &#234tre r&#233pandues utilis&#233es dans des centres m&#233dicaux et des communaut&#233s. Une br&#233ve intervention th&#233orie-bas&#233e de r&#233duction de risque du VIH par consultation qui a &#233t&#233 d&#233velopp&#233e aux &#201tats-Unis fut r&#233cemment adapt&#233e pour usage dans des centres m&#233dicaux sud-africains des infections sexuellement transmises. L&#39intervention par consultation de r&#233duction de risque qui dure 60 minutes a bien &#233t&#233 fond&#233e sur le mod&#232le Information-Motivation-Comp&#233tence Comportementales (IMB) du changement de comportement pr&#233ventive du VIH, adapt&#233e &#224 travers une s&#233rie des ateliers de collaborations interdisciplinaires. Cette communication pr&#233sente un rapport du processus de d&#233velopper et d&#39adaptation culturelle de la br&#232ve intervention par consultation de r&#233duction de risque. Le processus utilis&#233 afin d&#39adapter la consultation de r&#233duction de risque du VIH pour l&#39Afrique du Sud pourvoit un modèle potentiel pour mener les activit&#233s de transfert de technologie avec d&#39&#39autres interventions de pr&#233vention du VIH. Les nombreuses leçons tir&#233es de ce processus pourraient diriger les futurs efforts de transf&#233rer les technologies de pr&#233vention du VIH. Mots clés: développement, consultation de réduction de risque de VIH, centres médicaux des infections sexuellement transmises, l&#39Afrique du Sud.Journal of Social Aspects of HIV/AIDS Vol 2(2) 2005: 267-276
    • Development of structured support groups for HIV-positive women in South Africa

      Jonathan Mundell; Kathleen Sikkema; Bridget Jeffery; Annelize de Villiers; Maretha Visser; Department of Psychology, University of Pretoria, Brooklyn, Pretoria, 0002, South Africa (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2006-04-26)
      Women living with HIV in a stigmatising community need support to cope with their HIV status. In a process of action research, a structured support group programme was designed to meet the needs of women to cope with their diagnosis and interpersonal relationships. The emphasis was on identifying their needs and developing programme material to address those needs through group participation and interaction. The programme was pilot-tested at two sites located in two townships in Tshwane, South Africa. Feedback after each session made it possible to adjust the programme to the needs of the participants. In a formative evaluation, audio-taped sessions, process notes of facilitators, and experiences of the participants were used to identify therapeutic elements, the value of the groups and the problems in the implementation process. Women reported benefit from participation in the support groups. A 10-session structured programme to be used in support groups addressing the most important needs of HIV-positive women was developed.Keywords: support groups, HIV-positive women, South AfricaRésuméLes femmes vivant avec le VIH dans une communauté stigmatisante ont besoin de soutien afin de faire face à leur statut de VIH.Au cours du processus de la recherche active, un programme de groupe de soutien structuré a été conçu avec le but de répondre aux besoins de ces femmes pour qu'elles puissent faire face au diagnostic et aux relations personnelles. L'important était d'identifier les besoins et de développer le matériel nécessaire au programme afin d'aborder ces besoins à travers la participation et l'interaction du groupe. Des essais pilotes du programme ont été fait dans deux sites situés dans deux banlieues à Tshwane, Afrique du Sud. La réaction au bout de chacune des sessions a permis une adaptation du programme aux besoins des participants. Durant l'évaluation formative les enregistrements de sessions, les notes du processus des animateurs et les expériences personnelles des participants ont été employé dans le but de relever les éléments thérapeutiques, l'importance de groupes et les problèmes émergeant de l'exécution du processus. Les femmes ont signalé que la participation aux groupes de soutien a été rentable. Un programme structuré, ayant dix sessions, a été aménagé pour être utilisé dans les groupes de soutien avec le but d'aborder les besoins les plus importants des femmes séropositives.Mots clés: groupes de soutien, femmes séropositives, Afrique du Sud SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) Vol. 2(3) 2005: 333-343
    • Diagnostic social de l\'infection à VIH/SIDA et stratégies endogènes de prévention à Gaoua, Burkina Faso

      DT Some (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-07-14)
      Despite sensitising and prevention messages, women still remain concerned about AIDS in developing countries. How do they perceive the illness and methods of prevention? The objective of this study was to assess the social diagnosis of HIV/AIDS, and endogenous strategies developed by women from Gaoua. A qualitative approach was adopted, involving four focus group discussions with women from the Lobi, Birifor, Dioula and Dagara ethnic groups. An interview guide was developed for the discussions, which were carried out in local languages, tape recorded, transcribed verbatim and analysed in detail. Specific descriptions of HIV/AIDS related to signs/symptoms were given. These were: _Kpéré tchi_ (lose weight and die) _gbè yirè_ (twig feet) _sii dan_ (end of life) _gbè milè_ (thin feet), respectively for Lobi, Birifor, Dioula and Dagara. The major signs of AIDS mentioned were weight loss, appetite for meat, good meals, curly hair, large spots on the body, high fever, diarrhoea, and redness of lips. In relation to these signs, some endogenous strategies were developed by women to protect themselves against the illness, including “observation” and hot spiced meals for a few days for a partner who was absent for a long time, as well as early marriage for young girls. The social diagnosis of HIV/AIDS by a specific group like women demonstrates the gap between perceptions of the illness and prevention messages. This could help to understand that it is important to take account of communities\' perceptions of illness in elaboration of prevention messages.En dépit de la sensibilisation et des messages reçus pour la prévention, les femmes restent encore plus que jamais concernées par le VIH/SIDA dans les pays en développement. Comment perçoivent-elles la maladie et les moyens de prévention? Le but de cette étude est d\'évaluer le diagnostic social de l\'infection à VIH/SIDA et les stratégies endogènes de prévention des femmes de Gaoua. Une approche qualitative fut adoptée. Quatre focus groups furent réalisés avec des femmes Lobi, Birifor, Dioula, Dagara. La constitution des groupes de discussion (8-12 personnes), les jours, le lieu et la place de la discussion ont été négociés avec les femmes leaders. Un guide d\'entretien fut élaboré pour la conduite des discussions. Celles-ci ont été menées dans les langues locales et ont été enregistrées, transcrites en verbatim et analysées ligne par ligne. Des dénominations spécifiques du VIH/SIDA faisant chacune référence à un signe/symptôme de la maladie ont été décrites. Les dénominations sont respectivement pour les Lobi, Birifor, Dioula et Dagara _Kpéré ci_ (maigrir et mourir) _gbè yirè_ (pieds en brindilles) _sii dan_ (fin de la vie) _gbè milè_ (pieds minces). Les principaux signes décrits du SIDA sont l\'amaigrissement, l\'appétit pour la viande, les bons repas, les cheveux frisés, de gros boutons sur le corps, la forte fièvre, la diarrhée, le rougissement des lèvres. Au regard des signes décrits et pour se protéger efficacement contre la maladie, des stratégies endogènes de prévention de la maladie sont adoptées par les femmes. Les principales sont la “mise en observation” par la consommation d\'aliments très pimentés pendant quelques jours pour un mari resté pendant longtemps absent du foyer conjugal, le mariage précoce des jeunes filles. Le diagnostic social du VIH/SIDA par un groupe spécifique tel que celui des femmes, montre le décalage qui peut exister entre les perceptions de la maladie et les messages de prévention reçus. Ceci pourrait aider à comprendre l\'échec de certaines stratégies de prévention et l\'intérêt qu\'il y a à prendre en compte les perceptions des communautés de la maladie dans l\'élaboration des messages de prévention. Keywords: Diagnostic social du VIH/SIDA, dénominations du VIH/SIDA, femmes, prévention, Burkina Faso. SAHARA J Vol. 5 (1) 2008: pp. 19-27
    • Difficult choices: Infant feeding experiences of HIV-positive mothers in northern Tanzania

      A Blystad; K M Moland; S C Leshabari (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-11-19)
      Infant feeding represents a great challenge in the prevention of mother-to-child transmission of HIV (pMTCT). The international guidelines informing infant feeding counselling suggest feeding methods that reduce the risk of HIV transmission, and discourage mixed feeding (combining breastfeeding with other fluids and solids).The feasibility and the social acceptability of the recommended feeding methods are hotly debated currently.Through the documentation of HIV-positive women\'s experiences, this article aims to provide empirically grounded knowledge on the relevance of the proposed feeding methods. Drawing upon cultural theory and a view of infant feeding practices as socially and culturally embedded, the article discusses the so-called ‘informed choice\' of infant feeding method among women enrolled in the pMTCT programme at Kilimanjaro Christian Medical Centre in northern Tanzania.The study is based on interviews and follow-up of 20 HIV-positive mothers during the last part of pregnancy, delivery and the first six months after birth.The article details four of these cases describing the challenges linked to exclusive breastfeeding, cow\'s milk feeding and formula feeding.The study demonstrates the gap between intentions and infant feeding practice in a context where the social expectations to breastfeed are high, and where kin and neighbours are part of the decision-making team surrounding infant feeding. It highlights the tension between the competing concerns of the medical and social risks involved in the choice of infant feeding method, and documents that the feeding options may be difficult to adhere to, whether a mother chooses exclusive breastfeeding or replacement feeding. SAHARA J Vol. 4 (1) 2007: pp. 544-555
    • Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho

      Koto, Masebeo Veronica; Maharaj, Pranitha (Taylor & Francis, 2016-06-03)
      Sub-Saharan Africa is most affected by the AIDS pandemic and Lesotho is no exception. In many countries, healthcare workers are at the forefront of the fight against AIDS. This study explores the difficulties facing healthcare workers in Lesotho using a combination of qualitative methods – focus group discussions and in-depth interviews. The findings suggest that healthcare workers are afraid of contracting HIV from their patients and this affects their delivery of services. In addition, the results revealed that poor infrastructure and shortage of supplies at the facilities hinder healthcare workers from performing their duties effectively. The other concern was the heavy workload and severe time constraints which puts enormous stress on healthcare workers. Stigma and discrimination emerged as major problems for healthcare workers. Addressing the challenges facing healthcare workers is essential in effectively managing the AIDS pandemic facing the continent.Keywords: difficulties, healthcare workers, AIDS, Lesotho
    • Disability and health outcomes – from a cohort of people on long-term anti-retroviral therapy

      Hellen Myezwa; Jill Hanass-Hancock; Adedayo Tunde Ajidahun; Bradley Carpenter (Taylor & Francis Group, 2018-01-01)
      Human-immunodeficiency virus (HIV)/Acquired immunodeficiency Syndrome (AIDS) remains a major health problem in South Africa – even after two decades since the introduction of antiretroviral therapy (ART). Long-term survival with HIV is associated with new health-related issues and a risk of functional limitation/disability. The aim of this study was to assess functional limitation associated with HIV/AIDS among people living with HIV (PLHIV) in South Africa. This study is a cross-sectional survey using a cohort in an urban area in Gauteng province, South Africa. Data were collected using questionnaires through an interview process. The information collected included aspects such as demographics, livelihood, the state of mental and physical health, adherence and disability. A total of 1044 participants with an average age of 42 ± 12 years were included in the study, with 51.9% of the participants reporting functional limitations (WHODAS ≥ 2). These were reported mainly in the domains of participation (40.2%) and mobility (38.7%). In addition, adherence to ART, symptoms of poor physical health and depression were strongly associated with their functional limitations/disability. HIV as a chronic disease is associated with functional limitations that are not adequately addressed and pose a risk of long-term disability and negative adherence outcomes. Therefore, wellness for PLHIV/AIDS needs to include interventions that can prevent and manage disability.
    • Disability and health outcomes – from a cohort of people on long-term antiretroviral therapy

      Myezwa, Hellen; Hanass-Hancock, Jill; Ajidahun, Adedayo Tunde; Carpenter, Bradley (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2018-05-30)
      Human-immunodeficiency virus (HIV)/Acquired immunodeficiency Syndrome (AIDS) remains a major health problem in South Africa – even after two decades since the introduction of antiretroviral therapy (ART). Long-term survival with HIV is associated with new health-related issues and a risk of functional limitation/disability. The aim of this study was to assess functional limitation associated with HIV/AIDS among people living with HIV (PLHIV) in South Africa. This study is a cross-sectional survey using a cohort in an urban area in Gauteng province, South Africa. Data were collected using questionnaires through an interview process. The information collected included aspects such as demographics, livelihood, the state of mental and physical health, adherence and disability. A total of 1044 participants with an average age of 42 ± 12 years were included in the study, with 51.9% of the participants reporting functional limitations (WHODAS ≥ 2). These were reported mainly in the domains of participation (40.2%) and mobility (38.7%). In addition, adherence to ART, symptoms of poor physical health and depression were strongly associated with their functional limitations/disability. HIV as a chronic disease is associated with functional limitations that are not adequately addressed and pose a risk of long-term disability and negative adherence outcomes. Therefore, wellness for PLHIV/AIDS needs to include interventions that can prevent and manage disability.Keywords: HIV, disability, depression, South Africa, adherence, antiretroviral
    • Disclosure of HIV status between parents and children in Uganda in the context of greater access to treatment

      Kyaddondo, D; Wanyenze, RK; Kinsman, J; Hardon, A (Taylor & Francis, 2013-10-11)
      While disclosure of HIV sero-status is encouraged in the management of the HIV and AIDS epidemic, it remains a challenge, especially among family members. This article examines the moral dilemmas and pragmatic incentives surrounding disclosure of HIV status in contemporary Uganda. Our findings are based on 12 in-depth interviews, 2 focus-group discussions, 6 key informant interviews with AIDS activists, and open-ended responses derived from 148 HIV-positive persons in a quantitative survey. The study was conducted in 2008–2009 in Kampala, Mpigi, and Soroti districts in Uganda. We found both parents and adult children facing dilemmas in disclosure, whether it was parents revealing their own HIV status to their children or the status of their perinatally infected children, or young people infected through sexual intercourse telling their parents. For both groups, there is fear of blame, stigma, discrimination, and shame and guilt related to unsafe sex, while young people also fear loss of privileges. On the other hand, there are practical imperatives for disclosure in terms of gaining access to care, treatment, and material resources. Faced with these dilemmas, HIV-positive people and their families require professional counselling to help them work through the emotional challenges encountered and identify mechanisms of support and coping.Keywords: disclosure, morality, family, Uganda
    • Drug trafficking, use, and HIV risk: The need for comprehensive interventions

      Mbwambo, J; McCurdy, SA; Myers, B; Lambdin, B; Kilonzo, GP; Kaduri, P (Taylor & Francis, 2012-12-06)
      The rapid increase in communication and transportation between Africa and other continents as well as the erosion of social fabric attended by poverty, ethnic conflicts, and civil wars has led to increased trafficking and consumption of illicit drugs. Cannabis dominates illicit trade and accounts for as much as 40% of global interdiction. Due to escalating seizures in recent years, the illicit trade in heroin and cocaine has become a concern that has quickly spread from West Africa to include Eastern and Southern Africa in the past 10 years. All regions of Africa are characterized by the use of cannabis, reflecting its entrenched status all over Africa. Most alarming though is the use of heroin, which is now being injected frequently and threatens to reverse the gain made in the prevention of HIV/AIDS. The prevalence of HIV infection and other blood-bornediseases among injection drug users is five to six times that among the general population, calling for urgent intervention among this group. Programs that aim to reduce the drug trafficking in Africa and needle syringe programs as well as medication-assisted treatment (MAT) of heroin dependence while still in their infancy in Africa show promise and need tobe scaled up.
    • Early infant male circumcision for human immunodeficiency virus prevention: knowledge and attitudes of women attending a rural hospital in Swaziland, Southern Africa

      Jarrett, P; Kliner, M; Walley, J (Taylor & Francis, 2014-10-08)
      Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world at 26% of the adult population. Medical male circumcision (MMC) has been shown to reduce the risk of acquiring HIV from  heterosexual sex by up to 60% and the Government of Swaziland has been promoting adult male circumcision. Infant circumcision commenced in 2013 so it is important to understand the knowledge and views of women as potential mothers, around infant circumcision for medical purposes to inform the development of the service. This study interviewed 14 women of reproductive age attending the outpatient department of Good Shepherd Mission Hospital (GSMH), a rural district hospital, on their knowledge of and attitudes to early infant male circumcision (EIMC). Participants were highly knowledgeable about the health benefits of medical circumcision, although  knowledge of the comparative risks and benefits of EIMC to adult circumcision was poor. All participants would have a son circumcised; the preferred age varied from early infancy to adolescence. Complications and pain were the main barriers whilst religious and cultural reasons were mentioned both for and against circumcision. A variety of family members are important in the decision to circumcise a young boy. Acceptability of medical circumcision was high in this study, but concerns about safety, pain, autonomy and cultural factors reduce the acceptability of infant circumcision more specifically. It will be important to provide accurate, culturally sensitive information about infant circumcision to mothers, fathers and grandparents using existing hospital and  community services provided at GSMH and throughout Swaziland. Where possible services for MMC should be available to males of all ages so that families and young men may choose the most favourable age for circumcision.Keywords: circumcision, HIV, sub-Saharan AfricaLe Swaziland a la fre´quence la plus e´leve´e du VIH du monde avec 26% de la population adulte touche´e. On a montre´ que la circoncision peut re´duire le risque de contracter le VIH des rapports he´te´rosexuelles de jusqu’a` 60%, et le gouvernement du Swaziland promeut la circoncision me´dicale masculine. Le programme de la circoncision d’enfants commencera en 2013. Vu que la circoncision d’enfants est imminent, il est ainsi  important d’e´valuer les connaissances et les attitudes de femmes en tant que me`res, au niveau de la  circoncision afin d’informer le de´veloppement du service. Au cours de cette e´tude, des entretiens ont e´te´ mene´s avec quatorze jeunes femmes de l’aˆge reproductif qui allaient au service des consultations externes l’hopital de la mission Good Shepherd (GSMH), un hoˆpital rural, sur leurs attitudes et leurs connaissances de la circoncision d’enfants pour les raisons me´dicales. Les participantes s’y connaissaient sur les avantages de la circoncision me´dicale pour la sante´, quoique les connaissances des risques et des avantages de la circoncision d’enfants maˆles compare´s a` la circoncision adulte fussent faibles. Toutes les participantes choisiraient de circoncire leur fils; l’aˆge pre´fe´re´ pour cela e´tait divers, de l’enfance jusqu’a` l’adolescence. Les obstacles principaux cite´s e´taient la douleur et les complications, tandis que les facteurs culturels et religieux e´taient cite´s comme des raisons en faveur ainsi que des raisons contre la circoncision. Nombreux sont les membres de la famille implique´s dans la de´cision de circoncire un enfant. L’acceptabilite´ de la circoncision me´dicale e´tait forte parmi ces participantes mais les pre´occupations de la se´curite´, la douleur, l’autonomie et les facteurs culturels re´duisent l’acceptabilite´ de la circoncision d’enfants maˆles spe´cifiquement. Il sera donc impe´ratif de fournir des informations sur la circoncision pre´cises et sensibles a` la culture du Swaziland pour les me`res, les pe`res et les grands-parents en utilisant les services hoˆpitaux et communautaires de´ja` fournis a l’hoˆpital de GSMH et partout dans le Swaziland. Lorsque cela est possible la circoncision masculine me´dicale devrait eˆtre disponible pour les hommes de tous aˆges afin que les familles et les jeunes hommes puissent choisir l’aˆge le plus favourable pour la circoncision.Mots cle´s: Circoncision, VIH, Afrique sub-saharienne
    • Editorial review: Male circumcision, gender and HIV prevention in sub-Saharan Africa: a (social science) research agenda

      C I Niang; K Peltzer; C Chimbwete; H Boiro; L Okeke; A S Muula; K Bowa (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-01-22)
      No Abstract.SAHARA J Vol. 4 (3) 2007: pp. 658-667
    • Effect of a multicomponent behavioural PMTCT cluster randomised controlled trial on HIV stigma reduction among perinatal HIV positive women in Mpumalanga province, South Africa

      Peltzer, Karl; Babayigit, Suat; Rodriguez, Violeta J.; Jean, Jenny; Sifunda, Sibusiso; Jones, Deborah L. (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2018-08-27)
      Background: We evaluate the impact a multicomponent, behavioural, prevention of mother to child transmission (PMTCT), cluster randomised controlled trial on HIV stigma reduction among perinatal HIV infected women in rural South Africa.Methods: In a cluster randomised controlled trial, twelve community health centres (CHCs) in Mpumalanga Province, South Africa, were randomised; pregnant women living with HIV enrolled received either: A Standard Care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n =357), or an Enhanced Intervention (EI) condition of SC PMTCT plus the ‘Protect Your Family’ intervention (EI; 6 CHCs; n =342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions; those in the EI, four antenatal and two postnatal group PMTCT sessions, including stigma reduction, led by trained lay health workers. Maternal PMTCT, HIV knowledge and HIV related stigma were assessed. The impact of the EI was ascertained on stigma reduction (baseline, 12 months postnatally). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention.Results: In all, 699 women living with HIV were recruited during pregnancy (8–24 weeks), and assessments were completed prenatally at baseline and at 12 months (59.5%) postnatally. Baseline scores of overall HIV related stigma and the four scale factors (personalised stigma, disclosure concerns, negative self-image, and concern public attitudes) decreased at follow-up in the intervention group, while baseline scores of overall stigma and three scale factors (personalised stigma, negative self-image, and concern public attitudes) increased at follow-up in the control group. Using longitudinal analyses, Model 1, which included time-invariant predictors of stigma assessed over the two time periods of baseline and 12 months, increases in stigma from baseline to 12 months were associated with being unemployed, having been diagnosed with HIV before the current pregnancy, and alcohol use. In Model 2, which included time-varying predictors, lower stigma scores were associated with participation in the intervention, greater male partner involvement, and consistent condom use.Conclusion: The enhanced PMTCT intervention, including stigma reduction, administered by trained lay health workers had a significant effect on the reduction of HIV related stigma. Trial registration: clinicaltrials.gov: number NCT02085356.Keywords: Randomized controlled trial; behavioural intervention; stigma; Prevention of Mother to Child Transmission of HIV (PMTCT); South Africa
    • Effect of a multicomponent behavioural PMTCT cluster randomised controlled trial on HIV stigma reduction among perinatal HIV positive women in Mpumalanga province, South Africa

      Karl Peltzer; Suat Babayigit; Violeta J. Rodriguez; Jenny Jean; Sibusiso Sifunda; Deborah L. Jones (Taylor & Francis Group, 2018-01-01)
      Background: We evaluate the impact a multicomponent, behavioural, prevention of mother to child transmission (PMTCT), cluster randomised controlled trial on HIV stigma reduction among perinatal HIV infected women in rural South Africa. Methods: In a cluster randomised controlled trial, twelve community health centres (CHCs) in Mpumalanga Province, South Africa, were randomised; pregnant women living with HIV enrolled received either: A Standard Care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n =357), or an Enhanced Intervention (EI) condition of SC PMTCT plus the ‘Protect Your Family’ intervention (EI; 6 CHCs; n =342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions; those in the EI, four antenatal and two postnatal group PMTCT sessions, including stigma reduction, led by trained lay health workers. Maternal PMTCT, HIV knowledge and HIV related stigma were assessed. The impact of the EI was ascertained on stigma reduction (baseline, 12 months postnatally). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention. Results: In all, 699 women living with HIV were recruited during pregnancy (8–24 weeks), and assessments were completed prenatally at baseline and at 12 months (59.5%) postnatally. Baseline scores of overall HIV related stigma and the four scale factors (personalised stigma, disclosure concerns, negative self-image, and concern public attitudes) decreased at follow-up in the intervention group, while baseline scores of overall stigma and three scale factors (personalised stigma, negative self-image, and concern public attitudes) increased at follow-up in the control group. Using longitudinal analyses, Model 1, which included time-invariant predictors of stigma assessed over the two time periods of baseline and 12 months, increases in stigma from baseline to 12 months were associated with being unemployed, having been diagnosed with HIV before the current pregnancy, and alcohol use. In Model 2, which included time-varying predictors, lower stigma scores were associated with participation in the intervention, greater male partner involvement, and consistent condom use. Conclusion: The enhanced PMTCT intervention, including stigma reduction, administered by trained lay health workers had a significant effect on the reduction of HIV related stigma. Trial registration: clinicaltrials.gov: number NCT02085356
    • Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection

      Larry Obi; University of Venda, South Africa; Supa Pengpid; National School of Public Health, University of Limpopo, South Africa; Jude Igumbor; School of Health Sciences, University of Venda, South Africa (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-02-08)
      HIV and AIDS incidence among infants in South Africa is on the increase.The uptake of prevention of motherto- child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services.This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area, South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics, level of exposure to clinic-based HEI, salient beliefs and behavioural intention on PMTCT.The major findings included that approximately 85% of the participants had heard of PMTCT.There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally, the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing, normative belief of regular ANC visit and nevirapine use.The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women, and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated. Keywords: PMTCT, HIV/AIDS, health education intervention, vertical transmission, nevirapine, behavioural intention, theory of planned behaviour. Résumé Le cas de VIH/SIDA augmente parmi les bébés en Afrique du Sud. L'assimilation des interpositions de prévention de transmission mère á enfant (PMTCT) est souvent vu d'être dépendante de croyances et de besoins éducatifs de ceux qui ont besoin des services PMTCT. Cette étude a pour but de vérifier l'effet des interpositions de l'éducation sanitaire clinique-basées (HEI) sur l'intention comportementale de PMTCT auprès de 300 femmes enceintes originaires de 4 services de santé primaire dans les bassins de captation de l'hôpital Tshilidzini, en Afrique du Sud. Un barème d'entretien a été utilisé pour obtenir des informations concernant les caractéristiques démographiques des participants, le niveau d'être exposé aux HEI clinique-basées, les croyances principales et l'intention comportementale sur les PMTCT. Les résultats principaux ont démontré qu'approximativement 85% de participants avaient déjà entendu parlé de PMTCT. Il y a eu une association très étroite entre la fréquence de visites antenatales et le niveau d'être exposé à l'information de PMTCT. L'utilisation du préservatif avait les résultats de croyances principales les plus bas. La croyance de commande était la croyance la plus commune qui contribue à l'intention comportementale. En général, l'association entre les croyances principales des PMTCT et l'intention comportementale était faible. Les HEI clinique-basées avaient un impact sur l'intention comportementale du dépistage de VIH, la croyance normative des visites antenatales régulières et la prise du nevirapine. La contribution primordiale des sources alternatives d'informations sur les PMTCT comme la radio et la télévision a été observée. Rehausser les initiatives vers le développement des femmes et la coordination meilleure de HEI qui existent à travers une meilleure mise en oeuvre de la stratégie de l'éducation sanitaire pourraient renforcer l'actuelle intention modérée des PMTCT dans le lieu en question. Mots clés: PMTCT,VIH/SIDA, interposition de l'éducation sanitaire, infection verticale, nevirapine, intention comportementale, théorie d'un comportement prévu.
    • Effects of adolescent exposure to behaviour change interventions on their HIV risk reduction in Northern Malawi: a situation analysis

      M. Mwale; A. S. Muula (Taylor & Francis Group, 2018-01-01)
      Understanding adolescents’ translation of HIV and AIDS-related behaviour change interventions (BCI) knowledge and skills into expected behavioural outcomes helps us appreciate behaviour change dynamics among young people and informs evidence-based programming. We explored the effects of adolescents’ exposure to BCI on their HIV risk reduction in selected schools in Nkhatabay and Mzimba districts and Mzuzu city in Northern Malawi. The study used questionnaires as instruments. Data were collected between January and April 2017. Adolescent boys and girls [n = 552], ages 11–19 were randomly sampled to participate. Data analysis was through multiple regression and content analysis. Respondents included 324 female [58.7%] and 228 male [41.3%]. Multiple regression analysis indicated that exposure to BCI did not affect risk reduction in the study area. The best stepwise model isolated sexual experience ([Beta = .727, p = .0001, p < .05]) as having the strongest correlation with the dependent variable – risk reduction. BCI exposure was stepwise excluded ([Beta = −.082, p = .053, p > .05]). There was therefore no evidence against the null hypothesis of no relationship between adolescent exposure to BCI and their HIV risk reduction. Overall there was limited BCI knowledge and skills translation to behavioural risk reduction. The study points to the need to evaluate and redesign adolescent BCI in line with current behavioural dynamics among young people in Malawi. The findings have been used to inform the design and programming of a model to be tested for feasibility through a quasi-experiment in the second phase of our project.