• 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.
    • Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: Results from a randomized trial

      Peltzer, K; Ramlagan, Slagan; Jones, D; Weiss, SM; Fomundam, H; Chanetsa, L (Taylor & Francis, 2013-01-08)
      There is a lack of theory-based randomized controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention to improve adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to one of two conditions, a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence was measured using the Adult AIDS Clinical Trials Group adherence instrument prior to, post intervention and at follow-up. Baseline characteristics were similar for both conditions. At post-intervention, adherence information knowledge increased significantly in the intervention condition in comparison to the standard of care, while adherence motivation and skills did not significantly change among the conditions over time. There was a significant improvement in ART adherence and CD4 count and a significant reduction of depression scores over time in both conditions, however, no significant intervention effect between conditions was found. Lay healthworkers may be a useful adjunct to treatment to enhance the adherence information component of the medication adherence intervention, but knowledge may be necessary but not sufficient to increase adherence in this sample. Psychosocial informational interventions may require more advanced skill training in lay health workers to achieve superior adherenceoutcomes in comparison standard care in this resource-constrained setting.
    • Epidemiological and socio-legal overview

      Ngugi, EN; Roth, E; Mastin, T; Nderitu, MG; Yasmin, S (Taylor & Francis, 2012-12-06)
      No Abstract.
    • Equipping educators to address HIV and AIDS: A review of selected teacher education initiatives

      Holderness, WL (Taylor & Francis, 2012-12-13)
      Teacher educators, school principals and teachers are potentially well positioned to play a pivotal role in changing the course of the HIV and AIDS epidemic. The purpose of this article is to focus on a spectrum of educational initiatives in sub-Saharan Africa and South Africa which are designed to equip educators to be informed about, and to manage, HIV and AIDS in their personal and professional lives. Criteria for inclusion in the review are that the HIV and AIDS education endeavours must be operational (already functioning) and experience-based (have been experienced first-hand by the author). The review begins with a reflective account of two major undertakings: (a) an e-learning course for teacher educators in sub-Saharan Africa and (b) South Africa’s Higher Education HIV/AIDS Programme. Thereafter, the review considers a range of academic pursuits currently involving inservice school teachers and principals studying at a South African university. These include (a) two Advanced Certificates in Education; (b) doctoral studies; and (c) a new short learning programme. In reflecting on these various innovative but ‘do-able’ offerings, the article concludes that experiential and context-specific action-based learning and research into the social and educational aspects of HIV and AIDS can contribute to breaking the silence and reducing stigma while, at the same time, equipping educators to provide care and support for infected and affected learners and colleagues.Keywords: HIV and AIDS, teaching educators, schools, education initiatives, academic programmes, sub-Saharan Africa
    • Equity in access to ARV drugs in Malawi

      P R Ntata (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-11-19)
      This paper discusses the issue of equity in the distribution of ARV drugs in the Malawi health system. Malawi is one of the countries most severely affected by HIV/AIDS in southern Africa. It is also one of the poorest countries in the world.ARV drugs are expensive.The Malawi government, with assistance from the Global Fund on Tuberculosis, Malaria and HIV/AIDS, started providing free ARV drugs to eligible HIV-infected people in September 2004.The provision of free drugs brought the hope that everyone who was eligible would access them. Based on data collected through a qualitative research methodology, it was found that achieving equity in provision would face several challenges including policy, operational and socio-economic considerations. Specifically, the existing policy framework, shortage of medical personnel, access to information and inadequacy of effective community support groups are some of the key issues affecting equity. SAHARA J Vol. 4 (1) 2007: pp. 564-574
    • Establishing support groups for HIV-infected women: Using experiences to develop

      JP Mundell; MJ Visser (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2008-08-14)
      HIV-infected women need support to deal with their diagnosis as well as with the stigma attached to HIV. As part of their practical training, Master's-level psychology students negotiated with the staff of four clinics in townships in Tshwane, South Africa, to establish support groups for HIV+ women and offered to assist them in facilitating the groups. This study aimed to understand why the implementation of groups was successful in one clinic and not other clinics. The student reports on their experiences and interaction with clinic staff and clients were used as sources of data. Using qualitative data analysis, different dynamics and factors that could affect project implementation were identified in each clinic. The socio-ecological and systems theories were used to understand implementation processes and obstacles in implementation. The metaphor of building a bridge over a gorge was used to describe the different phases in and obstacles to the implementation of the intervention. Valuable lessons were learnt, resulting in the development of guiding principles for the implementation of support groups in community settings. Keywords: Support groups, HIV+ women, project implementation strategies, change in systems, socio-ecological theory.SAHARA J Vol. 5 (2) 2008: pp. 65-73
    • Estimates of eligibility for antiretroviral treatment (ART) and projected ART impact on AIDS mortality among South African educators

      Thomas M Rehle; Human Sciences Research Council, 69 Plein Street, Cape Town, South Africa; Olive Shisana (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2006-04-26)
      The study assessed the proportion of HIV-infected educators that need antiretroviral treatment (ART) according to current criteria, and estimated the impact of ART on AIDS mortality by modelling scenarios with and without access to ART. Specimens for HIV testing were obtained from 17 088 educators and a sub-sample of 444 venous blood specimens from HIV-positive educators was selected for a CD4 cell count analysis.The Spectrum model package was used for estimating AIDS-associated mortality and projecting the impact of ART scenarios.The results of the CD4 cell count analysis in the HIV-positive educator study population showed that 8% had fewer than 100, 22% fewer than 200, 52% fewer than 350, and 72% fewer than 500 CD4 cells/mm3. Based on the proportion of HIV-positive educators with a CD4 cell count < 200 cells/mm3 we estimated that in 2005 approximately 10 700 educators would need ART according to current SA government guidelines. For the baseline scenario without ART the number of AIDS deaths among HIV-infected educators was projected to increase from 1 992 deaths in 2000 to 5 260 in 2010.The number of projected AIDS deaths in the educator study population was estimated to be 4 414 in 2005, with almost 50% of the AIDS deaths occurring in the 35 - 44 age group.The estimates suggest that in 2005 9.1% of the HIV-infected educators, or 1.2% of the total educator population, will be dying of AIDS. By 2010, a reduction of almost 50% in AIDS deaths was estimated for the treatment scenario with 90% ART coverage, compared with the baseline scenario without treatment. The ART impact scenarios illustrate that a relatively high ART coverage would be needed to ensure a substantial impact of ART on HIV/AIDS-associated mortality.Keywords: antiretroviral treatment, CD4 cell counts,AIDS mortality, impact modelingRésuméCette étude a évalué la proportion des enseignants séropositifs qui ont besoin du traitement antirétroviral (ART) selon les critères actuels. De plus, l'étude a fait une prévision de l'impact d'ART sur la mortalité due au SIDA en présentant deux scénarios: les patients avec accès au ART et ceux sans accès. Les spécimens des essais du VIH ont été obtenu de 17 088 enseignants. En autre, avec le but de faire des analyses des comptes des cellules CD4, un sous-échantillon de 444 spécimens de sang veineux fut obtenu des enseignants séropositifs. L'ensemble de modèles Spectrum a été employé afin de faire des prévisions de mortalité liée au SIDA et aussi pour faire une projection de l'impact des scénarios d'ART. Les résultats des analyses des comptes des cellules CD4 d'une étude de population auprès des enseignants séropositifs ont montré que 8% avaient une charge virale en dessous de 100, 22% moins de 200, 52% moins de 350 et 72% moins de 500 CD4 cellules/mm3 respectivement. Etant donné la proportion des enseignants séropositifs ayant un compte des cellules CD4 moins de 200 cellules/mm3, nous avons prévu qu'en 2005 approximativement 10 700 enseignants auraient besoin d'ART suivant les directives actuelles du gouvernement sud-africain. Pour le scénario de référence sans l'ART, le taux de morts parmi les enseignants séropositifs fut prévu d'augmenter de 1 992 morts en 2000 à 5 260 morts en 2010. Le taux de morts de SIDA projeté dans l'étude de population auprès des enseignants fut prévu d'augmenter à 4 414 en 2005 avec environ 50% de morts de SIDA appartenant au groupe âgé de 35 à 44 ans. Les pronostiques suggèrent qu'en 2005, 9.1% des enseignants séropositifs, ou 1.2% de l'ensemble de la population enseignante, mourront de SIDA. D'ici 2010, une baisse d'environ 50% de morts de SIDA est prévue pour les scénarios sur traitement, avec une provision de 90% d'ART en comparaison au scénario de référence sans traitement. Les scénarios de l'impact d'ART démontrent qu'une provision relativement élevée d'ART serait nécessaire afin d'assurer un impact considérable d'ART sur la mortalité liée au VIH/SIDA.Mots clés: traitement antirétroviral, comptes des cellules CD4, mortalité de SIDA, modeler l'impact SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) Vol. 2(3) 2005: 300-310
    • Ethical and practical challenges in implementing informed consent in HIV/AIDS clinical trials in developing or resource-limited countries

      K Mystakidou; I Panagiotou; S Katsaragakis; E Parpa; E Tsilika (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2010-01-20)
      Background/rationale: Ethical issues regarding HIV/AIDS human research in the developing world remain under continuous evaluation; a critical area of concern includes informed consent. This paper reviews several of the most important ethical and practical aspects of informed consent in HIV research in developing countries. Enhancement of overall understanding of such key issues might promote higher ethical standards of future research.Objectives: The major objective was to address informed consent in human research in non-Western societies, and specifically in HIV clinical trials of affected adults. Secondary end-points included the consent complexities in HIV research involving vulnerable patient populations in resource-limited nations, such as children, adolescents and women.Methods: A systematic review of the published literature using MEDLINE and EMBASE from 1998 until December 2008 was performed, using the search terms ‘HIV/AIDS’, ‘informed consent’, ‘clinical trials’, ‘developing world’.Results: Ethical complexities such as participants’ diminished autonomy, coercion or monetary inducement, language difficulties, illiteracy or lack of true understanding of the entire study, cultural barriers mainly due to communitarianism and social diversities were identified in the 44 studies reviewed. Informed consent of vulnerable patient populations must be tailored to their sex and developmental age, while counselling is fundamental. Children and adolescents’ assent must be ensured. Local language is to be used, while trusted community leaders and local cultural representatives may convey information.Discussion: Despite the heterogeneity of studies, similarities were  identified. Providing adequate and comprehensive information and assessing the true understanding of the research represent fundamental prerequisites. Potential solutions to the critical areas of concern include peer counselling and meetings with local community leaders or local cultural representatives. Conclusions: International investigators of HIV human research should bear in mind these ethical issues and their potential solutions, when trying to ensure ethical research conduct, based on a truly informed and culturally relevant consent.
    • Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study

      J. Daniel Kelly; Raphael Frankfurter; Gregoire Lurton; Sulaiman Conteh; Susannah F. Empson; Fodei Daboh; Brima Kargbo; Thomas Giordano; Joia Mukherjee; M. Bailor Barrie (Taylor &amp; Francis Group, 2018-01-01)
      Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24 months and adherence to ART over a three-month time period. Participants who received community-based ART had significantly higher retention than those receiving standard of care. At 12 months, retention rates for community-based ART and standard of care were 61.5% and 31.9%, respectively (p &lt; .01). At 24 months, retention rates for community-based ART and standard of care were 73.1% and 44.0%, respectively (p &lt; .01). Significant differences in levels of adherence were observed when comparing community-based ART against persons receiving standard of care (p &lt; .05). No differences in adherence levels were observed between groups of people receiving various frequencies of home visits. Our pilot programme in Koidu City provides new evidence that community-based ART has the potential to improve retention and adherence outcomes for HIV-infected persons, regardless of the frequency of home visits. Overcoming the barriers to HIV care requires a comprehensive, patient-centred approach that may include clinic-based and community-based interventions.
    • Evaluation of the Nigerian national antiretroviral (ARV) treatment training programme

      R A Audu; M Osagbemi; O M Jolayemi; R A Audu; C B Uwakwe; M O Folayan; P Okonkwo; O Odutolu; World Bank/UNAIDS Global HIV/AIDS Monitoring and Evaluation Team (GAMET); Harvard AIDS Prevention Initiative in Nigeria (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-02-28)
      There is an understanding that greater availability of HIV treatment for the 40.3 million people currently infected with HIV is a humanitarian imperative that could prolong the lives of millions, restore economic productivity, and stabilise societies in some of the world's hardest-hit regions. The Nigerian government recognises that the country has the third highest burden of infection, with people living with HIV estimated to total 4.0 million, and so in 2002 commenced the implementation of one of Africa's largest antiretroviral (ARV) treatment programmes. A successful ARV programme requires that all components of a functional management system be put in place for effective and efficient functioning. This would include logistics, human resources, financial planning, and monitoring and evaluation systems, as well as sustainable institutional capacities. The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained, and utilisation thereof. Recommendations are made for improved training effectiveness and for specific national policy on training, to meet the demand for scaling up therapy to the thousands who need ARV. Keywords: ARV, training, evaluation, HIV, health care providerJournal of Social Aspects of HIV/AIDS Research Initiatve Vol. 3 (3) 2006: pp. 488-502
    • ‘Every teacher is a researcher!’: Creating indigenous epistemologies and practices for HIV prevention through values-based action research

      Wood, L (Taylor &amp; Francis, 2012-12-13)
      Since gender is an undisputed driver of HIV infection, teachers concerned with HIV prevention education should ideally encourage critical awareness of and culturally sensitive practices around gender inequalities. Many interventions and programmes have been developed for teachers to enable them to do this, however most have met with limited success. This article proceeds from the viewpoint that for HIV-prevention interventions to be sustainable and effective, teachers should be actively engaged in their design, implementation and evaluation. It outlines how teachers in an HIV prevention programme utilised an action research design to explore their own gender constructs as a necessary first step to the creation of more gender-sensitive school climates and teaching practices. This values-based self-enquiry moved the teachers to action on two levels: first, to adopt a more gendersensitive approach in their own personal and professional lives and second, to take action to challenge gender inequalities within their particular educational contexts. Evidence is presented to justify the claim that action research of this genre helps teachers to generate indigenous epistemologies and practices that not only are effective in creating sustainable and empowering learning environments for HIV prevention education, but also for teaching and learning in general.Keywords: HIV and AIDS prevention, gender education, action research, self-reflection, critical awareness, values-based self-enquiry
    • Expanding the prevention armamentarium portfolio: A framework for promoting HIV-Conversant Communities within a complex, adaptive epidemiological landscape

      Burman, CJ; Aphane, M; Mtapuri, O; Delobelle, P (Taylor &amp; Francis, 2015-05-05)
      The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples’ HIV-related navigational skill sets—while simultaneously opening a ‘chronic situation’ schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by the facilitation of path creations and pattern management implementation techniques. These constructs are underpinned by a ‘middle-ground’ prevention approach which is designed to bridge the prevention ‘fault line’, enabling a multi-ontology conceptualisation of the challenge to be developed. The article concludes that stepping outside of the ‘ordered’ epistemological parameters of the existing prevention ‘messaging’ mind-set towards a more systemic approach that emphasises agency, structure and social practices as a contribution to ‘ending AIDS by 2030’ is worthy of further attention if communities are to engage more adaptively with the dynamic HIV landscape in South Africa.Keywords: chronic schemas, complex adaptive epidemiological landscape, disruptive innovation, pattern management, safe-fail probes
    • Experience of stigma and discrimination and the implications for healthcare seeking behavior among people living with HIV/AIDS in resource-limited setting

      Alemu, T; Biadgilign, S; Deribe, K; Escudero, HR (Taylor &amp; Francis, 2013-10-10)
      Background: Stigma and discrimination can limit access to care and treatment services. Stigma hides HIV from the public, resulting in reduced pressure for behavioral change. For effective behavior change, empirically grounded and theory-based behavioral change approaches are fundamental as a prevention interventions directed on decreasing stigma and discrimination. The objective of the study was to assess the experience of stigma and discrimination on the psychosocial and health care seeking behavior of people living with HIV/AIDS (PLHIV) in Arba Minch, Ethiopia.Methods: This study uses qualitative methods involving focus-group discussions and in-depth interviews conducted in Arba Minch town and nearby Kebeles. Our sample consisted of PLHIV and other key informants who were purposively selected. Data were analyzed manually using thematic content analysis framework.Results: It appears that the magnitude of stigma and discrimination in the area has decreased to a considerably lower level, however, the problem’s severity is still being influenced by various factors including: current residence, disclosure status and level of community’s awareness about HIV/AIDS. Care and support services provided to PLHIV were well accepted by the respondents and the majority of them were willing to make use of any service available. Health information messages that have been disseminated to the public through mass media since the start of the epidemic in 1984 and AIDS cases in 1986 have played a significant role regarding the current prevailing problem of stigma and discrimination of PLHIV.Conclusion: Stigma and discrimination have come to a level that can be tolerated by most PLHIV that live in this region, especially those who have disclosed their HIV status and were living in urban areas. This calls for a strategy that improves the rates of serostatus disclosure after HIV counseling and testing and strengthens and integrates activities in the task of expanding care and support activities.Keywords: HIV/AIDS, stigma, discrimination, EPPM, Ethiopia
    • Experiences of HIV-related stigma among HIV-positive older persons in Uganda – a mixed methods analysis

      Kuteesa, MO; Wright, S; Seeley, J; Mugisha, J; Kinyanda, E; Kakembo, F; Mwesigwa, R; Scholten, F (Taylor &amp; Francis, 2014-10-08)
      There is limited data on stigma among older HIV-infected adults in sub-Saharan Africa. We describe the experiences of stigma and disclosure in a cohort of HIV-positive older people in Uganda. Using data from the Wellbeing of Older Peoples’ Study of Kalungu (rural site) and Wakiso district (peri-urban site) residents, we measured self-reported stigma levels for 183 respondents (94 on antiretroviral therapy (ART); 88, not on ART) using a stigma score generated using three questions on stigma perceptions where 0 meant no stigma at all and 100 was maximum stigma. Based on two questions on disclosure, an overall score was computed. High disclosure was assigned to those who often or very often disclosed to the family and were never or seldom afraid to disclose elsewhere. We examined the experiences of HIV stigma of 25 adults (52% females) using semi-structured, open-ended interviews and monthly oral diaries over one year. Mean age of the respondents was 70 years (range 60–80 years) and 80% of all respondents were enrolled in ART. Interview transcripts were analysed using thematic content analysis. Overall, 55% of respondents had a high disclosure score, meaning they disclosed easily, and 47% had a high stigma score. The stigma scores were similar among those with high and low disclosure scores. In multivariate analyses with disclosure and stigma scores as dependent variables none of the respondents’ characteristics had a significant effect at the 5% level. Qualitative data revealed that stigma ranges from: (1) perceptions (relatively passive, but leading to behaviour such as gossip, especially if not intended maliciously); to (2) discriminatory behaviour (active or enacted stigma; from malicious gossip to outright  discrimination). Despite the relatively high levels of disclosure, older people suffer from high levels of stigma of various forms apart from HIVrelated stigma. Efforts to assess for different forms of stigma at an individual level deserve greater attention from service providers and researchers, and must be context specific.Keywords: disclosure, discrimination, HIV, older peopleLes donne´es sont limite´es quant a` la stigmatisation chez les adultes infecte´s par le VIH en Afrique sub-saharienne. Nous tentons ici de pre´senter les expe´riences de la stigmatisation et la divulgation chez une cohorte des personnes aˆge´es se´ropositives en Ouganda. A l’aide des donne´es tire´es d’une e´tude sur le bien-eˆtre des personnes aˆge´es mene´e aupre`s des habitants de Kalungu (site en milieu rural) et de Wakiso (site en milieu pe´riurbain), nous avons mesure´ les niveaux de stigmatisation de´clare´s par les 183  re´pondants eux-meˆmes (dont 94 e´taient sous les traitements antire´troviraux; 88 pas sous les traitements antire´troviraux). Les re´sultats ´taient obtenus a` partir de trois questions sur les perceptions de stigmatisation et en utilisant une e´chelle de 0 a` 100, ou` 0 signifie aucune stigmatisation et 100, une stigmatisation  maximale. A la base de deux questions sur la divulgation, on a fait des calculs pour obtenir une note globale. Une note e´leve´e pour la divulgation e´tait attribue´e a` ceux qui annonc¸aient souvent ou tre`s souvent leur se´ropositivite´ a` leurs familles et n’avaient jamais peur ou n’avaient gue`re peur de divulguer cette information par ailleurs. On a examine´ les expe´riences de la stigmatisation lie´e au VIH chez 25 adultes (dont 52% du sexe fe´minin) au moyen d’entrevues semi-structure´es et a` questions ouvertes ainsi que les rapports oraux portant sur les expe´riences personnelles d’une anne´e. Les re´pondants avaient un aˆge moyen de 70 ans (la gamme e´tait de 60–80 ans). 80% de ces re´pondants e´taient place´s sous traitement antire´troviral (ARV). Les transcriptions des entrevues ont e´te´ analyse´es a` partir d’une analyse the´matique. Dans l’ensemble, 55% des re´pondants ont obtenu une note e´leve´e pour la divulgation, c’est-a`-dire qu’ils ont divulgue´  facilement leur se´ropositivite´ a` d’autres, tandis que 47% ont obtenu une note e´leve´ de stigmatisation. Les notes au niveau de stigmatisation e´taient semblables chez les re´pondants ayant les notes e´leve´es et chez ceux ayant les notes peu e´leve´es pour la divulgation. Au niveau des analyses multi-varie´es, avec les notes pour la divulgation et pour la stigmatisation comme variables de´pendantes, aucune des caracte´ristiques des re´pondants n’a eu d’effet significatif au seuil de 5%. Les donne´es qualitatives ont indique´ que la stigmatisation varie entre : (1) les perceptions (relativement passives mais entraıˆnant les comportements tels que les comme´rages notamment s’ils ne sont pas mal intentionne´es); et (2) les comportements  discriminatoires (stigmatisation active ou effective; allant des me´disances a` la discrimination pure). Malgre´ les niveaux relativement e´leve´s de divulgation, les personnes aˆge´es souffrent des niveaux e´leve´s de stigmatisation se manifestant sous formes varie´es outre la stigmatisation lie´e au VIH. Les efforts pour e´valuer les formes diffe´rentes de stigmatisation au niveau individuel me´ritent une plus grande attention de la part des prestataires de services et des chercheurs. Cette communication met en exergue la ne´cessite´ de de´ployer les efforts qui sont adapte´s a` chaque contexte culturel spe´cifique dans le but d’atte´nuer la stigmatisation chez les personnes aˆge´es maintenant et dans l’avenir.Mots cle´s: divulgation, discrimination, VIH, personnes aˆge´es
    • Experiences of orphan care in Amach, Uganda: assessing policy implications

      O B Rekdal; C Oleke; A Blystad; K M Moland (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-11-19)
      Uganda is estimated to have around two million orphans constituting approximately 19% of all the children in the country.This paper presents findings from a study on the experiences of orphan care among Langi people of Amach sub-county in Lira District, northern Uganda, and discusses their policy implications.The study utilised the following methods in data collection: eight months of ethnographic fieldwork; 21 in-depth interviews with community leaders; 45 with heads of households caring for orphans; 35 with orphans; and five focus group discussions.The findings revealed that the Langi people have an inherently problematic orphan concept, which contribute toward discriminatory attitudes and practices against orphans.The clan based decision-making to care for orphans, the category of kin a particular orphan ends up living with, the sex and age of the orphan, as well as the cessation of the ‘widow-inheritance\' custom emerged as prominent factors which impact on orphan care. Thus there is the need to draw upon such local knowledge in policy making and intervention planning for orphans.The paper concludes with a discussion of potential approaches to alleviating the current orphan challenges among the Langi people.SAHARA J Vol. 4 (1) 2007: pp. 532-543