Equity and HIV/AIDS

This study aimed to determine important factors that affect antiretroviral drug adherence among HIV and AIDS male and female adult patients in Kenya. A cross sectional study involving 384 adult patients on ARV drugs and attending Moi Hospital, Eldoret, was conducted. Sixty-eight percent of the respondents on ARVs were females aged between 18-63, of which 52.1% had secondary and post secondary education. Results showed that only 43.2% adhered to the prescribed time of taking drugs. Only 93.5% of the respondents kept clinic appointments. It recommends patients should be educated on the importance of strict adherence to the prescribed doses of ARVs as a suitable measure of intervention. Future research should explore multiple-target interventions to resolve barriers to adherence.

The main aim of this study was to identify predictors of HIV testing and condom use in Mozambique. Researchers analysed nationally representative survey data collected in 2009 for two outcomes: HIV testing and condom use. Results indicated that women at a higher risk of HIV were less likely to be tested for HIV than women at a lower risk. Large wealth differentials were observed: compared to the poorest women, HIV testing was higher among the wealthiest women. Perceived quality of health services was an important predictor of HIV testing, as HIV testing was higher among women who rated health services as being of very good quality. In terms of condom use, condom use was higher among men with girlfriends or those who had casual sex. Interestingly, being tested for HIV more than two years ago was not associated with condom use, and frequent mass media exposure was neither associated with HIV testing nor with condom use. The authors argue that the focus of HIV testing should shift from married women (routinely tested during antenatal care visits) to unmarried women and women with multiple sexual partners. Although services are free, transport costs to health facilities prove a major financial barrier to HIV testing. Mechanisms should be developed to cover the cost of transport, and the cost can also be reduced by substantially increasing community-based counselling. Men should be encouraged to test for HIV periodically.

Published data on adherence to antiretroviral therapy (ART) in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non-adherence in Nairobi. This is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Overall, 403 patients responded: 35% males and 65% females, of whom 18% were non-adherent, and the main (38%) reasons for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home and difficulty with dosing schedule predicted non-adherence. The study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, the authors argue that adherence can be improved further by employing fitting strategies to improve patients' ability to fit therapy into their lifestyles and implementing cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ART clinics within walking distance from their residence did not adhere is recommended.

This study seeks to understand the various factors influencing HIV-related risk behaviours and the resulting HIV positive status of Mozambican miners employed by South African mines to inform a broader and more effective HIV preventive framework in Mozambique. It used data sourced from the first integrated biological and behavioural survey among Mozambican miners earning their living in South African mines. The odds of reporting one sexual partner were roughly three times higher for miners working as perforators as opposed to other types of occupation. The odds of condom use – always or sometimes – for miners in the 31-40 age group were three times higher than the odds of condom use in the 51+ age group. Miners with lower education levels were less likely to use condoms. The odds of being HIV positive when the miner reports use of alcohol or drugs is 0.32 times lower than the odds for those reporting never use of alcohol or drugs. And finally, the odds of HIV positive status for those using condoms were 2.16 times that of miners who never used condoms, controlling for biological and other proximate determinants. In Mozambique, behavioural theory emphasising personal behavioural changes is the main strategy to combat HIV among miners. The findings suggested that there is a need to change thinking processes about how to influence safer sexual behaviour. This only stresses the need for HIV prevention strategies to exclusively transcend individual factors while considering the broader social and contextual phenomena influencing HIV risk among Mozambican miners.