• Gender and HIV/AIDS impact mitigation in sub-Saharan Africa - recognising the constraints

      T Barnett; Development Studies Institute, London School of Economics and Political Science; R Grellier; Options Consultancy Services, London; J Seeley; Gender and Development at the School of Development Studies, University of East Anglia, Norwich (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-10-01)
      In discussions of gender and HIV/AIDS, attention has focused on prevention. This is a vital area. However, we argue that there is also a need to focus more attention on the resulting impact of the epidemic, because inequalities that promote the spread of infection are also hampering containment and impact mitigation. We propose a framework highlighting the gendered constraints exacerbated by the epidemic. These constraints are reviewed under the following headings: Gender-specific constraints: stemming from the specific nature of gender relations themselves, such as the availability of labour in agriculture, business and for household tasks, as well as access to services and markets, and the incidence of gendered violence. Gender-intensified disadvantages: stemming from the uneven and often inequitable distribution of resources between men and women, including cultural/religious conventions, and the social rules and norms that regulate property rights, inheritance practices and resource endowments. Gender-imposed constraints: resulting from biases and partialities of those individuals who have the authority and power to allocate resources. These include provision of credit, information, agricultural extension and health care. The differential involvement of men and women in development programmes affects access to resources, as does political participation, including involvement in the formulation of policies aimed at poverty reduction. These constraints take us beyond gender relations and sexual behaviour. But women's lives will not change in the short term. The challenges they face in mitigating the impact of HIV/AIDS will not be addressed by focusing only on their specific vulnerability to HIV/AIDS infection. Unequal gender relations and the nature of development' need to be changed too. SAHARA-J (2004) 1(2): 87-98 Keywords: gender, HIV/AIDS, impact mitigation,sub-Saharan Africa RÉSUMÉ Pendant les discussions de sexes et du VIH/SIDA, la prévention fut le centre d'intérêt. Ce dernier est un domaine primordial. Cependant, nous débattons qu'il est aussi nécessaire de se focaliser sur l'impact de l'épidémie car les inégalités qui favorisent la dissémination de l'infection ont tendance à entraver l'enraiement de l'épidémie et l'atténuation de l'impact. Nous proposons un cadre qui met en relief les contraintes de sexes aggravées par l'épidémie. Ces contraintes sont re-examinées sous les titres suivants: Des contraintes particulières aux genres: découlant de la nature particulière des relations de genres, comme la disponibilité du travail en agriculture, dans les affaires et à domicile ainsi que l'accès aux services et aux marchés et la fréquence de la violence de sexes. Les inconvénients intensifiés par le genre: découlant de la distribution irrégulière et souvent inéquitable des ressources entre les hommes et les femmes. Ceci inclue des conventions culturelles/religieuses ainsi que les règlements sociaux et des normes qui réglementent les droits aux propriétés, les pratiques de l'héritage et les dotations de ressources. Les contraintes imposées par le genre: résultant des préjudices et des partialités de ceux qui ont le droit et le pouvoir d'assigner les ressources. Ceci inclue l'approvisionnement du crédit, l'information, l'extension dans l'agriculture et les soins sanitaires. L'écart de participation des hommes et des femmes dans le développement des programmes a une incidence à l'accès aux ressources, comme c'est le cas dans la participation politique ainsi que la participation dans la mise en place d'une politique visant la réduction de la pauvreté. Ces contraintes nous amènent au delà des relations de genres et le comportement sexuel. Cependant, la vie des femmes ne changera pas du jour au lendemain. Les défis auxquels elles font face en atténuant l'effet du VIH/SIDA ne seront pas prise en charge uniquement en se focalisant sur leurs vulnérabilité particulière vis-à-vis l'infection par le VIH/SIDA. Les relations inégales de genre et la nature du développement doivent être changés également. SAHARA-J (2004) 1(2): 87-98 Mots clés : le genre, le VIH/SIDA, atténuer l'impact, le Sous-Sahara.
    • Gender and HIV/AIDS impact mitigation in sub-Saharan Africa — recognising the constraints

      Janet Seeley; Rachel Grellier; Tony Barnett (Taylor & Francis Group, 2004-08-01)
      In discussions of gender and HIV/AIDS, attention has focused on prevention. This is a vital area. However, we argue that there is also a need to focus more attention on the resulting impact of the epidemic, because inequalities that promote the spread of infection are also hampering containment and impact mitigation. We propose a framework highlighting the gendered constraints exacerbated by the epidemic. These constraints are reviewed under the following headings: Gender-specific constraints: stemming from the specific nature of gender relations themselves, such as the availability of labour in agriculture, business and for household tasks, as well as access to services and markets, and the incidence of gendered violence. Gender-intensified disadvantages: stemming from the uneven and often inequitable distribution of resources between men and women, including cultural/religious conventions, and the social rules and norms that regulate property rights, inheritance practices and resource endowments. Gender-imposed constraints: resulting from biases and partialities of those individuals who have the authority and power to allocate resources. These include provision of credit, information, agricultural extension and health care. The differential involvement of men and women in development programmes affects access to resources, as does political participation, including involvement in the formulation of policies aimed at poverty reduction.These constraints take us beyond gender relations and sexual behaviour. But women's lives will not change in the short term. The challenges they face in mitigating the impact of HIV/AIDS will not be addressed by focusing only on their specific vulnerability to HIV/AIDS infection. Unequal gender relations and the nature of ‘development’ need to be changed too.
    • Gender differences in university students' HIV/AIDS-related knowledge and sexual behaviours in Malawi: a pilot study

      Pierson RT Ntata; Adamson S Muula; Seter Siziya; Edrinnie E Kayambazinthu (Taylor & Francis Group, 2008-12-01)
      A cross-sectional study was conducted among first-year university students in Malawi to determine distributions of HIV/AIDS related knowledge, and sexual behaviours. A total of 314 (199 male and 115 female) students were eligible to participate, and of these 221 (70.4%) participated in the survey. Generally, levels of HIV/AIDS-related knowledge were similar between sexes. Overall, 68.9% of students of both sexes felt that they knew enough about HIV/AIDS. Altogether, 83.3% of students reported that they knew where to access HIV testing on campus, but only 19.0% reported that they knew their HIV status. Some 60.3% of students who had never been tested intended to have an HIV test. A history of having ever been tested was not associated with sex. Most (68.4%) students felt that they were not at risk of acquiring HIV infection. Overall, 66.8% of students knew where to get a condom on campus, and 38.7% stated that they knew exactly how to use it. About half (52.6%) of the students used a condom at last vaginal sexual intercourse. Having multiple sex partners in the last 12 months was reported by 40.4% of students.
    • Gender differences in university students\' HIV/AIDS-related knowledge and sexual behaviours in Malawi: a pilot study

      EE Kayambazinthu; AS Muula; PRT Ntata; S Siziya (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2009-01-07)
      A cross-sectional study was conducted among first-year university students in Malawi to determine distributions of HIV/AIDSrelated knowledge, and sexual behaviours. A total of 314 (199 male and 115 female) students were eligible to participate, and of these 221 (70.4%) participated in the survey. Generally, levels of HIV/AIDS-related knowledge were similar between sexes. Overall, 68.9% of students of both sexes felt that they knew enough about HIV/AIDS. Altogether, 83.3% of students reported that they knew where to access HIV testing on campus, but only 19.0% reported that they knew their HIV status. Some 60.3% of students who had never been tested intended to have an HIV test. A history of having ever been tested was not associated with sex. Most (68.4%) students felt that they were not at risk of acquiring HIV infection. Overall, 66.8% of students knew where to get a condom on campus, and 38.7% stated that they knew exactly how to use it. About half (52.6%) of the students used a condom at last vaginal sexual intercourse. Having multiple sex partners in the last 12 months was reported by 40.4% of students. Keywords: University students, HIV/AIDS-related knowledge, sexual behaviours, Malawi.SAHARA-J Vol. 5 (4) 2008: pp. 201-205
    • Gender differences regarding barriers and motivators of HIV status disclosure among HIV-positive service users

      Deribe, K; Woldemichael, K; Njau, BJ; Yakob, B; Biadgilign, S; Amberbir, A (Taylor & Francis, 2011-07-07)
      There are inconsistent findings about the relation between gender and HIV status disclosure. We conducted a facility-based crosssectional study, using qualitative and quantitative data collection methods, to explore gender differences in HIV-positive status disclosure among service users in south-west Ethiopia. Among 705 participants, an equal number of men and women (94.6% men v. 94.3%, women) indicated that they had disclosed their result to someone, and the majority (90.9% men v. 90.7% women) to their current main partner. ‘It is customary to tell my partner everything’ was the most frequently cited reason for disclosing (62.5% menv. 68.5% women). Reasons for non-disclosure varied by gender: men were concerned about their partner’s worry and exposure of their own unfaithfulness. Women feared physical violence, and social and economic pressure in raising their children. Factors that influenced disclosure also indicated gender variation. For men, disclosure of HIV results to a sexual partner was positively associated with knowing the partner’s HIV status and discussion about HIV testing prior to seeking services, while for women it was associated with knowing the partner’s HIV status, advanced disease stage, having no more than primary education, being married, and perceiving the current relationship as long-lasting. There was no significant difference in the proportion of HIV status disclosure among men and women. However, the contextual barriers and motivators of disclosure varied by gender. Therefore it is important that clinicians, counsellors, and health educators underscore the importance of gender-specific interventions in efforts to dispel barriers to HIV status disclosure.
    • Gender differences regarding barriers and motivators of HIV status disclosure among HIV-positive service users

      Kebede Deribe; Kifle Woldemichael; Bernard Joseph Njau; Bereket Yakob; Sibhatu Biadgilign; Alemayehu Amberbir (Taylor & Francis Group, 2010-07-01)
      There are inconsistent findings about the relation between gender and HIV status disclosure. We conducted a facility-based cross-sectional study, using qualitative and quantitative data collection methods, to explore gender differences in HIV-positive status disclosure among service users in south-west Ethiopia. Among 705 participants, an equal number of men and women (94.6% men v. 94.3%, women) indicated that they had disclosed their result to someone, and the majority (90.9% men v. 90.7% women) to their current main partner. ‘It is customary to tell my partner everything’ was the most frequently cited reason for disclosing (62.5% men v. 68.5% women). Reasons for non-disclosure varied by gender: men were concerned about their partner's worry and exposure of their own unfaithfulness. Women feared physical violence, and social and economic pressure in raising their children. Factors that influenced disclosure also indicated gender variation. For men, disclosure of HIV results to a sexual partner was positively associated with knowing the partner's HIV status and discussion about HIV testing prior to seeking services, while for women it was associated with knowing the partner's HIV status, advanced disease stage, having no more than primary education, being married, and perceiving the current relationship as long-lasting.There was no significant difference in the proportion of HIV status disclosure among men and women. However, the contextual barriers and motivators of disclosure varied by gender. Therefore it is important that clinicians, counsellors, and health educators underscore the importance of gender-specific interventions in efforts to dispel barriers to HIV status disclosure.
    • Health care users’ knowledge, attitudes and perceptions of HIV self-testing at selected gateway clinics at eThekwini district, KwaZulu-Natal province, South Africa

      Gumede, Sibongiseni Daphney; Sibiya, Maureen Nokuthula (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2018-09-27)
      Progress in promoting knowledge of HIV status has been made globally, but half of all people living with HIV are still unaware of their HIV status. It is argued the new innovative HIV selftesting strategy could increase the uptake of HIV testing among the people. The aim of the study was to assess outpatients’ health care user’s knowledge, attitudes and perceptions towards HIV self-testing (HIVST) at selected Gateway clinics at eThekwini District, KwaZulu-Natal Province, South Africa. The objectives of the study were to determine health care users’ knowledge of HIVST, assess health care users’ attitudes and perceptions towards HIVST and establish if there is any relationship between knowledge, attitudes and perceptions of healthcare users towards HIVST. A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three purposefully selected Addington, R. K. Khan and Prince Mshiyeni Memorial Hospital Gateway clinics at eThekwini Health District. A convenience sampling of 442 respondents were sampled from the three study sites. Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they could use it if it can be made freely available to the public and be properly regulated. Generally, health care users indicated positive attitudes towards HIV self-testing. Nevertheless, issues of lack of pre and post-test counselling, false negative results and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated in South Africa.Keywords: HIV self-testing; oral HIV testing; South Africa
    • Health care users’ knowledge, attitudes and perceptions of HIV self-testing at selected gateway clinics at eThekwini district, KwaZulu-Natal province, South Africa

      Sibongiseni Daphney Gumede; Maureen Nokuthula Sibiya (Taylor & Francis Group, 2018-01-01)
      Progress in promoting knowledge of HIV status has been made globally, but half of all people living with HIV are still unaware of their HIV status. It is argued the new innovative HIV self-testing strategy could increase the uptake of HIV testing among the people. The aim of the study was to assess outpatients’ health care user’s knowledge, attitudes and perceptions towards HIV self-testing (HIVST) at selected Gateway clinics at eThekwini District, KwaZulu-Natal Province, South Africa. The objectives of the study were to determine health care users’ knowledge of HIVST, assess health care users’ attitudes and perceptions towards HIVST and establish if there is any relationship between knowledge, attitudes and perceptions of health care users towards HIVST. A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three purposefully selected Addington, R. K. Khan and Prince Mshiyeni Memorial Hospital Gateway clinics at eThekwini Health District. A convenience sampling of 442 respondents were sampled from the three study sites. Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they could use it if it can be made freely available to the public and be properly regulated. Generally, health care users indicated positive attitudes towards HIV self-testing. Nevertheless, issues of lack of pre and post-test counselling, false negative results and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated in South Africa.
    • Health-related quality of life and associated factors in adults living with HIV in Rwanda

      Biraguma, Juvenal; Mutimura, Eugene; Frantz, José M. (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2018-09-27)
      In Rwanda, as in other sub-Saharan African (SSA) countries, life expectancy of people living with HIV (PLWH) has increased dramatically as a result of combined antiretroviral therapy (cART). People living with HIV can now live longer but with increasing rates of non-communicable diseases (NCDs). Thus, prevention of NCD comorbidities in PWLHI is crucial to maintain and gain health-related benefits and to maximise the health-related quality of life (HRQOL) in the long-term management of PLWH. This study determines the association between physical and mental health-related dimensions of quality of life (QOL) with behavioural and biological risk factors, after controlling socio-demographic and HIV-related factors in adults living with HIV in Rwanda. A cross-sectional study using the WHO STEPwise approach and Kinyarwanda version of the MOS-HIV Health Survey, risk factors for NCDs and HRQOL were analysed for 794 PLWH, both HIV+ on ART and ART-naïve. Multiple regression analysis was used to examine the relationship between CMD risk factors and physical health and mental health summary scores. A total of 794 participants were interviewed. The mean age of the sample was 37.9 (±10.8) years and the majority of the participants were women (n = 513; 64.6%). About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits while 26.1% reported being physically inactive. 18.4% were overweight 43.4% had abdominal obesity, i.e. waist-hip-ratio (WHR) ≥0.95 in males and 0.85 in females. High blood pressure (HBP), i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. The results reveal that mean physical health summary and mental health summary score values were 63.96 ± 11.68 and 53.43 ± 10.89, respectively. While participants indicated that tobacco users and those who had abdominal obesity reported poor mental HRQOL, physical inactivity and hypertension have a negative impact on physical HRQOL. In addition, certain sociodemographic and HIV-related variables – specifically being unmarried, lack of HIV disclosure and low CD4 count (less 350 cell counts /mm3) – were associated with significantly lower mental and physical dimensions of quality of life. The results of this study reveal that behavioural and biological risk factors for NCDs were significantly associated with a lower HRQOL. These research findings also suggest that the assessment of the association between behavioural and biological risk factors for NCDs and a HRQOL provides opportunities for targeted counselling and secondary prevention efforts, so that health care providers can implement strategies that have a significant impact on the HRQOL.Keywords: Non-communicable diseases; risk factors; HIV; healthrelated quality of life; physical health; Rwanda
    • Health-related quality of life and associated factors in adults living with HIV in Rwanda

      Juvenal Biraguma; Eugene Mutimura; José M Frantz (Taylor & Francis Group, 2018-01-01)
      In Rwanda, as in other sub-Saharan African (SSA) countries, life expectancy of people living with HIV (PLWH) has increased dramatically as a result of combined antiretroviral therapy (cART). People living with HIV can now live longer but with increasing rates of non-communicable diseases (NCDs). Thus, prevention of NCD comorbidities in PWLHI is crucial to maintain and gain health-related benefits and to maximise the health-related quality of life (HRQOL) in the long-term management of PLWH. This study determines the association between physical and mental health-related dimensions of quality of life (QOL) with behavioural and biological risk factors, after controlling socio-demographic and HIV-related factors in adults living with HIV in Rwanda. A cross-sectional study using the WHO STEPwise approach and Kinyarwanda version of the MOS-HIV Health Survey, risk factors for NCDs and HRQOL were analysed for 794 PLWH, both HIV+ on ART and ART-naïve. Multiple regression analysis was used to examine the relationship between CMD risk factors and physical health and mental health summary scores. A total of 794 participants were interviewed. The mean age of the sample was 37.9 (±10.8) years and the majority of the participants were women (n = 513; 64.6%). About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits while 26.1% reported being physically inactive. 18.4% were overweight 43.4% had abdominal obesity, i.e. waist-hip-ratio (WHR) ≥0.95 in males and 0.85 in females. High blood pressure (HBP), i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. The results reveal that mean physical health summary and mental health summary score values were 63.96 ± 11.68 and 53.43 ± 10.89, respectively. While participants indicated that tobacco users and those who had abdominal obesity reported poor mental HRQOL, physical inactivity and hypertension have a negative impact on physical HRQOL. In addition, certain socio-demographic and HIV-related variables – specifically being unmarried, lack of HIV disclosure and low CD4 count (less 350 cell counts /mm3) – were associated with significantly lower mental and physical dimensions of quality of life. The results of this study reveal that behavioural and biological risk factors for NCDs were significantly associated with a lower HRQOL. These research findings also suggest that the assessment of the association between behavioural and biological risk factors for NCDs and a HRQOL provides opportunities for targeted counselling and secondary prevention efforts, so that health care providers can implement strategies that have a significant impact on the HRQOL.
    • Hearing community voices: grassroots perceptions of an intervention to support health volunteers in South Africa

      C Campbell; S Maimane; Y Nair; A Gibbs (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2009-01-07)
      With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS – as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, we conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities – at the end of this 3-year period. These discussions aimed to elicit local people's perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long term, due to lack of support for volunteers both within and outside of the community. We conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors. Keywords: Evaluation, home-based care, volunteers, task shifting, participation, stipends, leadership.SAHARA-J Vol. 5 (4) 2008: pp. 162-177
    • Hearing community voices: grassroots perceptions of an intervention to support health volunteers in South Africa

      Catherine Campbell; Yugi Nair; Sbongile Maimane; Andy Gibbs (Taylor & Francis Group, 2008-12-01)
      With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS – as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, we conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities – at the end of this 3-year period. These discussions aimed to elicit local people's perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long term, due to lack of support for volunteers both within and outside of the community. We conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors.
    • High levels of psychosocial readiness for ART in an African population at the onset of treatment

      B Wolff; M Mbonye; S Jaffar; B Amuron; A Coutinho; R Nkabala; H Grosskurth (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2010-02-05)
      Adherence at the earliest stages of treatment is likely to be influenced by prior illness trajectories and future expectations, best captured (and addressed) before treatment begins. We examined the influence of illness trajectories and treatment expectations on psychosocial readiness to start antiretroviral therapy (ART) in Jinja, Uganda. In-depth interviews were conducted between October 2005 and April 2006 with 41 members of an AIDS support organisation on their first day of treatment. Transcribed texts were translated, coded and analysed thematically using NVIVO-7 software. Results indicated that acute fear of death and progressive withdrawal from social, economic and sexual roles narrowed focus on survival, while efficacy-enhancing experiences with septrin prophylaxis and trust in counsellors reinforced belief in HIV diagnosis and importance of adherence. Most enjoyed supportive home environments after disclosing their serostatus. Lack of money for food and transport was anticipated as the main barriers to future adherence, particularly among women. Integrating strong counselling support with ART provision helped channel the power of shared illness experience into positive motivation to adhere at the onset of treatment.Keywords: HIV, antiretroviral therapy, adherence, qualitative, Africa.
    • High levels of psychosocial readiness for ART in an African population at the onset of treatment

      Brent Wolff; Martin Mbonye; Alex Coutinho; Barbara Amuron; Robert Nkabala; Shabbar Jaffar; Heiner Grosskurth (Taylor & Francis Group, 2009-12-01)
      Adherence at the earliest stages of treatment is likely to be influenced by prior illness trajectories and future expectations, best captured (and addressed) before treatment begins. We examined the influence of illness trajectories and treatment expectations on psychosocial readiness to start antiretroviral therapy (ART) in Jinja, Uganda. In-depth interviews were conducted between October 2005 and April 2006 with 41 members of an AIDS support organisation on their first day of treatment. Transcribed texts were translated, coded and analysed thematically using NVIVO-7 software. Results indicated that acute fear of death and progressive withdrawal from social, economic and sexual roles narrowed focus on survival, while efficacy-enhancing experiences with septrin prophylaxis and trust in counsellors reinforced belief in HIV diagnosis and importance of adherence. Most enjoyed supportive home environments after disclosing their serostatus. Lack of money for food and transport was anticipated as the main barriers to future adherence, particularly among women. Integrating strong counselling support with ART provision helped channel the power of shared illness experience into positive motivation to adhere at the onset of treatment.
    • HIV counselling and testing utilisation and attitudes of male inmates in a South African prison

      Motshabi, LC; Pengpid, S; Peltzer, K (Taylor & Francis, 2012-08-27)
      The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction, their experiences and expectations, and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre, South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34, 95%CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison, while age, educational level, population group, marital status, length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50%) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services, ranging from 79% (fair to very good) for ‘the way he/she received you’ to 62% ‘clarified all your concerns’. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctionalcentres especially with regard to VCT services.
    • HIV counselling and testing utilisation and attitudes of male inmates in a South African prison

      Lelaka C Motshabi; Supa Pengpid; Karl Peltzer (Taylor & Francis Group, 2011-09-01)
      The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction, their experiences and expectations, and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre, South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200 male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34, 95%CI: 0.23 – 0.50) was inversely associated with HIV testing acceptance in prison, while age, educational level, population group, marital status, length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50%) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services, ranging from 79% (fair to very good) for ‘the way he/she received you’ to 62% ‘clarified all your concerns’. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctional centres especially with regard to VCT services.
    • HIV fatalism and engagement in transactional sex among Ugandan fisherfolk living with HIV

      Katelyn M. Sileo; Laura M. Bogart; Glenn J. Wagner; William Musoke; Rose Naigino; Barbara Mukasa; Rhoda K. Wanyenze (Taylor & Francis Group, 2019-01-01)
      HIV fatalism, or the belief that HIV acquisition and mortality is out of one's control, is thought to contribute to HIV risk in fishing populations in East Africa. The objective of this cross-sectional study was to investigate the association between fatalism and sexual risk behaviours (unprotected sex, engagement in transactional sex), beyond the influence of other known HIV risk factors (e.g. food insecurity, mobility), and identify demographic, psychosocial, and structural correlates of HIV fatalism. Ninety-one men and women living in fishing villages on two islands in Lake Victoria, Uganda completed an interviewer-administered questionnaire after testing HIV-positive during home or community-based HIV testing between May and July 2015. Multivariate logistic regression was used to test the association between HIV fatalism and transactional sex and multivariate linear regression was used to identify demographic, psychosocial, and structural correlates of HIV fatalism. HIV fatalism was significantly associated with a greater likelihood of transactional sex (AOR = 3.07, 95% CI = 1.02–9.23, p = 0.04), and structural barriers to HIV care (e.g. distance to clinic) were significantly associated with HIV fatalism (β = 0.26, SE = 0.12, p = 0.04). Our findings highlight HIV fatalism as a contributor to transactional sex in Ugandan fishing communities, and as a product of broader social and contextual factors, suggesting the potential need for structural HIV interventions in this setting.
    • HIV in (and out of) the clinic: Biomedicine, traditional medicine and spiritual healing in Harare

      O'Brien, S; Broom, A (Taylor & Francis, 2014-10-08)
      Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in  various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The  co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative  interviews with 60 people from poor urban areas in Harare, we explore the experiences of people living with and affected by HIV. Specifically, we sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. Second, we observe the dramatic and overwhelmingly beneficial impact of  Antiretroviral Therapy and conclude through Zimbabwean’s own stories that limitations around delivery and wider structural inequalities impede its potential. Lastly, we explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert  contestation. This paper aimed to add to our knowledge of the relationships between traditional medicine and spiritual healing in  connection with biomedicine and how this may influence HIV treatment and prevention.Keywords: antiretroviral therapy, HIV/AIDS, qualitative sociology, spiritual healing, traditional medicine, ZimbabweLes experiences contemporaines du virus humain de deficience immunologique VIH sont determinees par des rencontres cliniques et culturelles avec la maladie. Dans les pays sub-Sahariens comme le Zimbabwe, le VIH est soigne´ de manie`re tre`s diffe´rente selon des contextes the´rapeutiques varie´s y compris les experts en me´decine biome´dicale, les gue´risseurs traditionnels et les gue´risseurs par la foi. L’existence coˆte a` coˆte de ces pratiques soule`ve des questions importantes concernant l’efficacite´ et les limites de la me´dicalisation et des pratiques de gue´rison alternatives afin de promouvoir la gue´rison du VIH. Dans cette e´tude faisant appel a` des interviews qualitatives en profondeur avec 60 personnes provenant de secteurs urbains appauvris a` Harare, nous explorons les expe´riences des personnes qui vivent avec et qui sont affecte´es par le VIH. Surtout nous avons essaye´ de documenter d’interroger et de reflechir sur leurs perceptions et expe´riences de la biome´dicine par rapport a la medicine traditionnelle et des gue´risseurs par la foi. Leurs comptes rendus indiquent que les pratiques traditionnelles et les croyances spirituelles continuent a` influencer de fac¸on significative la fac¸on dans laquelle le VIH est compris et les types d’aide et de soins que les gens recherchent. Deuxiemement, nous observons l’impacte drammatique et be´ne´fique de la The´rapie Antire´troviale (TAR) et concluons selons les rapports du Zimbabwe que les limites de livraison et que des ine´galite´s de structure  re´pandues empeˆchent l’accomplissement de leur potentiel. En dernier lieu, nous explorons certaines  implications pratiques de la Clinique biome´dicale (et autres pratiques ‘alternatives’ de gue´rison) comme etant  comprises en tant que champs ide´ologiques et experts en contestation. Le but de cet article est de renforcer  notre connaissance de la relation entre la gue´rison traditionnelle et la gue´rison par la foi en rapport avec la  biome´dicine et comment cela peut influencer le traitement et la pre´vention du VIH.Mots cle´s: the´rapie antire´troviale, gue´risseurs par la foi, gue´rison traditionnelle, sociologie qualitative, VIH/SIDA, Zimbabwe
    • HIV knowledge and health-seeking behavior in Zambe´ zia Province, Mozambique

      Audet, CM; Sidat, M; Blevins, M; Moon, TD; Vergara, A; Vermund, SH (Taylor & Francis, 2012-08-27)
      HIV prevalence rates in Zambe´zia Province were estimated to be 12.6% in 2009. A number of educational campaigns have been aimed at improving HIV transmission and prevention knowledge among community members in an effort to reduce infection rates. These campaigns have also encouraged people to seek health care at clinical sites, instead of employing traditional healers to cure serious illness. The impact of these programs on the rural population has not been well documented. To assess the level of knowledge about HIV transmission and prevention and health-seeking behavior, we interviewed 349 people in 2009 using free response and multiple choice questionnaires. Over half reported first seeking treatment at a government health clinic; however, the majority of participants had visited a traditional healer in the past. Knowledge regarding prevention and transmission of HIV was primarily limited to the sexual origins of infection and the protective advantages of condom use.Increased educational level and having learned about HIV from a community health worker were associated with higher HIV prevention and transmission knowledge. Traditional healers and community health-care workers were both conduits of health information to our study participants. HIV education and use of clinical services may be facilitated by partnering more closely with these groups.