• Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal, South Africa

      Ngidi, Ndumiso Daluxolo; Moyo, Sibusiso; Zulu, Thobile; Adam, Jamila Khatoon; Krishna, Suresh Babu Naidu (Taylor & Francis, 2016-08-22)
      Background: The incidence of HIV and AIDS continues to be a source of great concern within universities in South Africa. Furthermore, university students constitute an important community in the intervention against the HIV/AIDS epidemic. Students in the age group of 15–24 years are at a greater risk of HIV infection than any other group in the country; yet, little is known about why they continue to engage in risky sexual practices. Objectives: This study was designed to explore the sexual behaviour of students in a metropolitan Durban University of Technology in KwaZulu-Natal to understand the social factors underlying their risk of HIV infection. Methods: This is a qualitative study that used cluster sampling where the population was stratified by campus and faculty. The study population was selected using a standard randomization technique. This was a part of a multi-phased research project aimed at providing a sero-prevalence baseline and an analysis of risk-taking behaviour at a Durban University of Technology in the eThekwini Metropolitan Municipality area. Results: The study highlights peer pressure among students as an influence in promoting high-risk sexual behaviour. Within this context, the findings revealed that university students lack the ability to negotiate risk-aware decisions especially regarding sexual relationships. Conclusion: This study draws attention to the perspectives of African university students regarding their risk-taking sexual practices and selected factors which influence such behaviour. The findings are not exhaustive in exploring contextual antecedents that shape students’ sexual practices. However, they provide an important basis in understanding key factors which expose students to HIV infections. The study provides insights into opportunities for further studies as well as preventative implications.Keywords: HIV/AIDS, prevention, risky sexual behaviour, sexual relationships, university students
    • Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drugusing populations in Cape Town, Durban and Pretoria, South Africa

      S Dewing; P Petersen; R Needle; C Parry; T Carney (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2009-01-07)
      This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known ‘hotspots\' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues relate to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug- intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations. Keywords: Drug use, sexual risk behaviour, HIV/AIDS, South Africa.SAHARA-J Vol. 5 (3) 2008: pp. 113-119
    • Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drugusing populations in Cape Town, Durban and Pretoria, South Africa

      Charles Parry; Petal Petersen; Tara Carney; Sarah Dewing; Richard Needle (Taylor & Francis Group, 2008-09-01)
      This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known ‘hotspots’ for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.
    • Reaching the hearts and minds of illiterate women in the Amhara highland of Ethiopia: Development and pre-testing of oral HIV/AIDS prevention messages

      Gebeyehu W Bogale; Henk Boer; Erwin R Seydel (Taylor & Francis Group, 2010-07-01)
      In the style of radio programmes, we developed three episodes of audio HIV prevention education for illiterate women in Ethiopia. We used social-oriented presentation formats, such as discussion between women on HIV prevention, and expert-oriented presentation formats, such as an interview with a male doctor. The aim of this study was to assess the relation between evaluation of presentation formats and overall liking of episodes, which is important for persuasive effects. Thirty women from rural Amhara listened to the episodes and, after listening, female data collectors interviewed the women on evaluation of presentation formats, overall liking of episodes, identification with the characters and convincingness. Evaluation of social-oriented presentation formats was strongly related to overall liking of episodes, but evaluation of expert-oriented presentation formats was not. This relation was mediated through convincingness and not through identification. We conclude that social-oriented presentation formats make messages more convincing and, consequently, improve overall liking and persuasive impact.
    • Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions

      C.D.H. Parry; T. Carney; P. Petersen Williams (Taylor & Francis Group, 2017-01-01)
      Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.
    • Relationship between socio-economic characteristics of older adults’ women and family planning use in Botswana

      Njoku Ola Ama; John O. Olaomi (Taylor & Francis Group, 2021-01-01)
      Older adults (50 years and over) are still sexually active and therefore vulnerable to unplanned pregnancy, infection of STIs and HIV, yet there are no programmes in place to cater for their family planning needs. The objective of the study is to show how some socio-economic characteristics of older adults influence their family planning (FP) use. The study used a stratified random sampling design where four health districts (two urban and two rural) were purposively selected and the sample size of 444 older adult women allocated to the districts using proportional allocation to size. Snowball technique was used in identifying respondents. The multinomial logistic regression analysis reveals that while age, marital status, educational qualification, employment status, menopausal status, district and desire for another child jointly significantly predict FP use, only menopausal status and desire for another child individually significantly (p < 0.01) predict FP use. Older adult women who desired another child were significantly (p < 0.01) 7.5 times more likely to use family planning (FP) methods than those who do not want another child. The postmenopausal older adult women were less likely to use FP methods than those in their premenopausal state (OR = 0.13). Women with no schooling were less likely to use FP methods than those with degree/professional qualifications. Single and married women were less likely to use FP methods than the divorced/widowed/separated. The study recommends the promotion of education and training on FP use among the older adult women that will take into consideration their menopausal status and desire for another child. The training should be home-based.
    • Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/AIDS Research: Innovations in access to prevention, treatment and care in HIV/AIDS, Kisumu, Kenya, 29 April - 3 May 2007

      G Setswe; M Banyini; S Sedumedi; K Peltzer; J Seager; S Maile; D Gomis; I van der Linde; D Skinner (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2007-11-19)
      About 520 delegates from all over Africa and 21 countries attended the conference. This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from the three countries were classified as best practice interventions. Of the 83 abstracts that were accepted at the conference, only 7 (8.4%) were dealing with antiretroviral therapy (ART).There has been tremendous effort by various organisations to provide information about prevention of HIV/AIDS. Information received by adolescents has been effective in increasing their knowledge, but without positive sexual behaviour change.The conference noted the contribution of gender discrimination and violence to the HIV epidemic and the different risks that men and women face in relation to the epidemic. Social scientists need to study the deep cultural meanings attached to male circumcision among different ethnic groups to be able to guide the debate on the latest biomedical findings on the protective effect of circumcision against HIV. Palliative care and support is crucial for coping among people living with HIV/AIDS (PLWHA) in order to deal with medical and psychological issues. Results from several countries have helped researchers to explore alternative ways of examining poverty in the context of HIV and AIDS. Policy frameworks which are likely to succeed in combating HIV/AIDS need to be updated to cover issues of access, testing, disclosure and stigma. In general, the conference was successful in identifying innovations in access to prevention, treatment and care in HIV/AIDS. SAHARA J Vol. 4 (2) 2007: pp. 640-651
    • Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/AIDS Research: Innovations in access to prevention, treatment and care in HIV/AIDS, Kisumu, Kenya, 29 April–3 May 2007

      G. Setswe; K. Peltzer; M. Banyini; D. Skinner; J. Seager; S. Maile; S. Sedumedi; D. Gomis; I. van der Linde (Taylor & Francis Group, 2007-08-01)
      About 520 delegates from all over Africa and 21 countries attended the conference. This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from the three countries were classified as best practice interventions. Of the 83 abstracts that were accepted at the conference, only 7 (8.4%) were dealing with antiretroviral therapy (ART). There has been tremendous effort by various organisations to provide information about prevention of HIV/AIDS. Information received by adolescents has been effective in increasing their knowledge, but without positive sexual behaviour change.The conference noted the contribution of gender discrimination and violence to the HIV epidemic and the different risks that men and women face in relation to the epidemic. Social scientists need to study the deep cultural meanings attached to male circumcision among different ethnic groups to be able to guide the debate on the latest biomedical findings on the protective effect of circumcision against HIV. Palliative care and support is crucial for coping among people living with HIV/AIDS (PLWHA) in order to deal with medical and psychological issues. Results from several countries have helped researchers to explore alternative ways of examining poverty in the context of HIV and AIDS. Policy frameworks which are likely to succeed in combating HIV/AIDS need to be updated to cover issues of access, testing, disclosure and stigma. In general, the conference was successful in identifying innovations in access to prevention, treatment and care in HIV/AIDS.
    • Report and policy brief: 2nd Annual Conference on Social Aspects of HIV/AIDS Research, Cape Town, 9 - 12 May 2004

      DFID(UK), CIDA(Canada); L C Simbayi; The Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, Private Bag 9182, Cape Town, 8000, South Africa; C I Niang; Institut des Sciences de I'Environnement,faculté des Sciences, Université Cheikh Anta Diop, Dakar, Senegal; S R Kleintjes; The Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, Private Bag 9182, Cape Town, 8000, South Africa; D C Kaseje; Tropical Institute of Community Health and Development (TICH), P O Box 2224, Kisumu, Kenya; K F Peltzer; The Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, Private Bag 9182, Cape Town, 8000, South Africa; J R Seager; The Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, Private Bag 9182, Cape Town, 8000, South Africa; O Shisana; The Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council, Private Bag 9182, Cape Town, 8000, South Africa (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2004-10-01)
      This report and policy brief summarises the overarching principles, key findings and suggested policy options that emerged from rapporteur reports of conference proceedings of the 2nd Annual Conference on Social Aspects of HIV/AIDS Research, Cape Town, 9 - 12 May 2004. SAHARA-J (2004) 1(2): 62-77 Keywords: SAHARA Network, Conference proceedings, Policy brief, HIV, AIDS, Sub-Saharan Africa, reseach, Social aspects. RÉSUMÉ Ce dossier de rapport et de politique présente un compte-rendu des principes dominants, des conclusions principales et des options d'une politique proposée qui font partie des communications présentées de la 2è Conférence Annuelle de Recherche sur les Aspects Sociaux du VIH/SIDA, le Cap, 9 - 12 mai 2004. SAHARA-J (2004) 1(2): 62-77 Mots clés: Réseau du SAHARA, démarches de conférence, dossier de politique, HIV/AIDS, Afrique Secondaire-Saharan, reseach, aspects sociaux.
    • Report and policy brief: 2nd Annual Conference on Social Aspects of HIV/AIDS Research, Cape Town, 9 – 12 May 2004

      S. Kleintjes; K. Peltzer; O. Shisana; C. Niang; J. Seager; L. Simbayi; D. Kaseje (Taylor & Francis Group, 2004-08-01)
    • Resources and infrastructure for the delivery of antiretroviral therapy at primary health

      N Jacobs; E Janse van Rensburg-Bonthuyzen; F Steyn; M Engelbrecht; H Schneider; D van Rensburg (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2009-01-07)
      There are concerns as to whether South Africa\'s public health system has sufficient resources, human and otherwise, to ensure universal access to antiretroviral treatment (ART). We report on public sector implementation of the Comprehensive Care Management and Treatment (CCMT) programme in the Free State Province, South Africa, in particular whether the primary health care (PHC) infrastructure was able to mobilise the necessary inputs to effectively provide ART, without undermining other services within facilities. A longitudinal study was conducted of the first 16 PHC facilities accredited to provide ART in the province. The facilities were visited on three occasions over 2 years, involving both structured and open-ended interviews with professional and lay staff, and observations of available resources. The resources assessed were staffing, space, essential equipment, drug supplies and laboratory systems. Approximately one-fifth (20%) of professional nurses were allocated to the CCMT programme in the facilities, although the overall number of professional nurses increased by only 14%. This process resulted in some displacement of professional nurses towards the CCMT Programme away from other services in the facilities. However, this could have been partially compensated for by task shifting towards community health workers and the appointment of additional support staff. Staff were largely positive about the programme. Drug supplies, availability of equipment and laboratory systems, although good at the baseline, improved further over the period of observation. The lack of adequate space to accommodate the new programme was a frequently reported problem. Overall, our assessment is that the PHC infrastructure in the Free State\'s public health system is capable of implementing and benefiting from the CCMT programme. Nevertheless, constraints in the availability of professional staff threaten future implementation of both the CCMT and other PHC programmes. Keywords: Resources, infrastructure, antiretroviral therapy, primary health care facilities.SAHARA-J Vol. 5 (3) 2008: pp.106-112
    • Resources and infrastructure for the delivery of antiretroviral therapy at primary health care facilities in the Free State Province, South Africa

      Ega Janse van Rensburg-Bonthuyzen; Michelle Engelbrecht; Francois Steyn; Nandi Jacobs; Helen Schneider; Dingie van Rensburg (Taylor & Francis Group, 2008-09-01)
      There are concerns as to whether South Africa's public health system has sufficient resources, human and otherwise, to ensure universal access to antiretroviral treatment (ART). We report on public sector implementation of the Comprehensive Care Management and Treatment (CCMT) programme in the Free State Province, South Africa, in particular whether the primary health care (PHC) infrastructure was able to mobilise the necessary inputs to effectively provide ART, without undermining other services within facilities.A longitudinal study was conducted of the first 16 PHC facilities accredited to provide ART in the province. The facilities were visited on three occasions over 2 years, involving both structured and open-ended interviews with professional and lay staff, and observations of available resources. The resources assessed were staffing, space, essential equipment, drug supplies and laboratory systems.Approximately one-fifth (20%) of professional nurses were allocated to the CCMT programme in the facilities, although the overall number of professional nurses increased by only 14%. This process resulted in some displacement of professional nurses towards the CCMT Programme away from other services in the facilities. However, this could have been partially compensated for by task shifting towards community health workers and the appointment of additional support staff. Staff were largely positive about the programme. Drug supplies, availability of equipment and laboratory systems, although good at the baseline, improved further over the period of observation. The lack of adequate space to accommodate the new programme was a frequently reported problem.Overall, our assessment is that the PHC infrastructure in the Free State's public health system is capable of implementing and benefiting from the CCMT programme. Nevertheless, constraints in the availability of professional staff threaten future implementation of both the CCMT and other PHC programmes.
    • Rethinking HIV-prevention for school-going young people based on current behaviour patterns

      Visser, Maretha (SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2017-09-22)
      The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5–12) from highrisk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8–12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people’s behaviour and need to be addressed to allow the youth to make healthy behavioural choices.Keywords: HIV-prevention, sexual risk behaviour, school going youth, perceived social norms, community gender norms, South Africa
    • Rethinking HIV-prevention for school-going young people based on current behaviour patterns

      Maretha Visser (Taylor & Francis Group, 2017-01-01)
      The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5–12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8–12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.
    • Review of national AIDS councils in Africa: Findings from five countries

      C Hongoro; AJ Mturi; J Kembo (SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance), 2009-01-07)
      National AIDS councils (NACs) were established in many African countries to co-ordinate the multi-sectoral response to HIV/AIDS. Their main mandate is to provide strategic leadership and co-ordinate activities geared to fight against HIV/AIDS. This study sought to understand the extent to which NACs have achieved their goals and the challenges they face. Best practices were identified and shared among countries involved, so as to enhance their efforts. This review is crucial given that the fight against HIV/AIDS is far from being won. Data for this study were collected from five countries: Ghana, Tanzania, Kenya, Zimbabwe and Lesotho. A qualitative study approach was employed by conducting individual in-depth interviews with senior staff members of NACs. We also collected important NAC documents that are used in achieving their mandates. The NAC documentation seemed to be in order in all countries visited, and there was a good understanding of the NACs\' mandate and their functioning. There were numerous constraints and challenges that need to be addressed in order to make NACs perform their activities better. NACs need to operate independently of the usual government bureaucracy. Additional work is still needed by governments in making NACs responsible for the multi-sectoral response in sub-Saharan Africa. Keywords: National AIDS Council, HIV/AIDS, multi-sectoral response.SAHARA-J Vol. 5 (4) 2008: pp. 192-200Download article
    • Review of national AIDS councils in Africa: Findings from five countries

      Charles Hongoro; Akim J Mturi; Joshua Kembo (Taylor & Francis Group, 2008-12-01)
      National AIDS councils (NACs) were established in many African countries to co-ordinate the multi-sectoral response to HIV/ AIDS. Their main mandate is to provide strategic leadership and co-ordinate activities geared to fight against HIV/AIDS. This study sought to understand the extent to which NACs have achieved their goals and the challenges they face. Best practices were identified and shared among countries involved, so as to enhance their efforts. This review is crucial given that the fight against HIV/AIDS is far from being won. Data for this study were collected from five countries: Ghana, Tanzania, Kenya, Zimbabwe and Lesotho. A qualitative study approach was employed by conducting individual in-depth interviews with senior staff members of NACs. We also collected important NAC documents that are used in achieving their mandates. The NAC documentation seemed to be in order in all countries visited, and there was a good understanding of the NACs' mandate and their functioning. There were numerous constraints and challenges that need to be addressed in order to make NACs perform their activities better. NACs need to operate independently of the usual government bureaucracy. Additional work is still needed by governments in making NACs responsible for the multi-sectoral response in sub-Saharan Africa.
    • Rewriting the narrative of the epidemiology of HIV in sub-Saharan Africa

      Baral, S; Phaswana-Mafuya, N (Taylor & Francis, 2012-12-06)
      The fight against HIV remains complicated with contracting donor resources and high burden of HIV among reproductive age adults still often limiting independent economic development. In the widespread HIV epidemics of sub-Saharan Africa (SSA), it is proposed that key populations with specific HIV acquisition and transmission risk factors, such as men who have sex with men (MSM), female sex workers (FSW), and people who use drugs (PUD), are less relevant because HIV transmission is sustained in the general population with average HIV acquisition and transmission risks. However, the understanding that key populations are less relevant in the epidemics of Africa is based on the surveillance system from which these populations are mostly excluded. Outside of SSA, the epidemics of HIV are generally concentrated in the same populations that are excluded from the primary HIV surveillance systems in SSA. The manuscripts included in this special issue present convincing data that FSW, MSM, and PUD carry disproportionate burdens of HIV wherever studied in SSA, are underrepresented in HIV programs and research, and require specific HIV prevention services. These manuscripts collectively suggest that the only effective path forward is one that transcends denial and stigma and focuses on systematically collecting data on all populations at risk for HIV. In addition, there is a need to move to a third generation of HIV surveillance as the current one inadvertently devalues HIV surveillance among key populations in the context of widespread HIV epidemics. Overall, the data reviewed here demonstrate that the dynamics of HIV in Africa are complex and achieving an AIDS-free generation necessitates acceptance of that complexity in all HIV surveillance, research, and prevention, treatment, and care programs.
    • Risk factors associated with HIV infection among young persons aged 15–24 years: Evidence from an in-depth analysis of the 2005–06 Zimbabwe Demographic and Health Survey

      Kembo, J (Taylor & Francis, 2012-08-28)
      This study focuses on factors that predispose young persons aged 15–24 years in Zimbabwe to infection from HIV. Using the Mosley and Chen framework, multivariate modelling was used to assess the effect of demographic, socio-economic and behavioural factors on the risk of HIV infection among this target group. The study utilised data from the Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005–06. Only the variables that were significant in the bivariate analysis were included in the multivariate binary logistic regression. Young females aged 15–24 years are associated with a significant two-fold elevated risk of HIV infection relative to their male peers (p , 0.000). Young persons aged 15–24 years who were divorced, widowed or not living together have significantly elevated risk compared with their never-married counterparts, OR ¼ 5.267 (p ¼ 0.000); OR ¼ 4.323 (p ¼ 0.000) and OR ¼ 3.272 (p ¼ 0.000), respectively. Young persons whose age at first sexual intercourse was less than 14 years are significantly associated with 2.696 times more risk of HIV infection relative to their peers whose age at first sexual intercourse was 20–24 years (p ¼ 0.000). Young persons aged 15–24years with two or more sex partners in the past 12 months preceding the 2005–06 ZDHS survey had a significantly elevated risk of HIV infection of 1.568 times relative to their counterparts with no sex partners in the same period of time. Great challenges still exist for the control of HIV and AIDS among young persons in Zimbabwe. HIV prevention programmestargeted at young persons aged 15–24 years should provide invigorated focus on marital status, age at sexual debut, number of sexual partners, sexually transmitted infections and condom use so as to mitigate these predisposing factors for HIV infection.
    • Risky sexual behaviours among young people in sub-Saharan Africa: how can parents use the Ottawa Charter for Health Promotion for change?

      Elvis Tarkang; Lilian Pencille; Hubert Amu; Joyce Komesour; Prosper Lutala (Taylor & Francis Group, 2019-01-01)
      Despite progress made in the treatment of HIV and AIDS by making available the antiretroviral treatment in Africa, youth are still struggling with inadequate knowledge, a negative attitude towards AIDS and high-risk sexual behaviour. All of these are compounded by a lack of open communication between parents and youths which among others, which impedes on the control of the pandemic in this vulnerable group. Building on ‘Ottawa Charter for Health Promotion’ as one way of breaking all barriers in this communication, we suggest keys points in five different domains of this framework namely: building healthy public policies, creating a supportive environment, strengthening community action, developing personal skills, and reorienting the health services.
    • Rwandan young people’s perceptions on sexuality and relationships: Results from a qualitative study using the ‘mailbox technique’

      Michielsen, K; Remes, P; Rugabo, J; Van Rossen, R; Temmerman, M (Taylor & Francis, 2014-10-08)
      This study aimed to gain more insight into young Rwandans’ perceptions on sex and relationships, which is essential for formulating effective sexual and reproductive health (SRH) promotion interventions. Using a  ‘mailbox technique’, this paper studies the spontaneous thoughts of Rwandan young people on sexuality.  Mailboxes were installed in five secondary schools in the Bugesera district and students were invited to write about their ideas, secrets, wishes, desires and fears on sexuality and relationships. Of the 186 letters collected, 154 addressed SRH topics. The letters were analysed in NVivo 9 using a theoretical model on vulnerability. Two  stereotypical sexual interactions co-exist: experimental sex, taking place unprepared, driven by desire among young people of the same age, and transactional sex, occurring after negotiation between older men/women and younger girls/boys in exchange for money or goods. Both types expose young people to poor, though different, SRH outcomes. Young people have little capacity to manage their vulnerability in these relationships: they have limited knowledge on SRH topics, lack adult guidance or support and have difficult access to condoms. They apply seemingly contradictory norms and behaviours concerning sexuality. In conclusion, we have formulated several recommendations for SRH interventions.Keywords: mailbox technique, vulnerability, young people, sexuality and reproductive health, RwandaCette e´tude vise a` e´tudier les perceptions des jeunes Rwandais sur la sexualite´ et les relations, ce qui est essentiel pour la formulation des interventions efficaces en promotion de la sante´ sexuelle et reproductive (SSR). En utilisant une «te´chnique de boıˆte aux lettres », cet article e´tudie les pense´es spontane´es de jeunes Rwandais. Des boıˆtes aux lettres ont e´te´ installe´es dans cinq e´coles secondaires dans le district de Bugesera et les e´tudiants ont e´te´ invite´s a` noter leurs ide´es, secrets, souhaits, de´sirs et craintes sur le sujet de la sexualite´ et les relations. Sur les 186 lettres collecte´es, 154 traitaient la SSR. Les lettres ont e´te´ analyse´es dans NVivo 9 a` l’aide d’un mode`le the´orique de vulne´rabilite´. Deux interactions sexuelles ste´re´otype´es coexistent: le sexe expe´rimental, qui aura lieu a` l’impre´vu, entraine´ par le de´sir, entre les jeunes du meˆme aˆge, et le sexe transactionnel, survenant apre`s ne´gociation entre hommes/femmes plus age´(e)s et entre de jeunes filles/garc¸ons en e´change d’argent ou de biens. Les deux types exposent les jeunes, de manie`re diffe´rente, a` une mauvaise SSR. Les jeunes ont une capacite´ limite´e de ge´rer leur vulne´rabilite´: ils ont des connaissances limite´es sur des sujets de SSR, n’ont pas l’orientation ou le soutien des adultes, et ont un acce`s difficile aux pre´servatifs. Ils appliquent les normes et les comportements  apparemment contradictoires concernant la sexualite´. En conclusion, nous avons formule´ plusieurs recommandations pour les interventions de SSR.Mots-cle´s: technique de boıˆte aux lettres, vulne´rabilite´, adolescents, sante´ sexuelle et reproductive, Rwanda