In 2011, three international organisations and a number of Namibian sex worker organisations conducted a series of rapid assessments on sex work and HIV in five towns in Namibia. In the assessments, a number of issues were raised in case of most or all the towns. These include stigma from health care providers and the community, a preference for traditional medicine, violence from a number of sources, and extortion and abuse from police officers. Yet, the way these affect sex workers are different in each location. The authors note that much more support is required to help sex workers organise and collaborate more effectively and to tackle the problems they face. Active participation of sex workers, as well as addressing HIV through a framework of human rights, are essential to making HIV programmes aiming to reach sex workers more effective. Violence, stigma in access to services, and discrimination should be identified and addressed as a matter of course in any HIV programmes aiming to reach sex workers. At the same time, relevant ministries, NGOs, UN agencies and external funders should use the findings drawn in this paper to raise awareness and advocate for national level action.
Equity and HIV/AIDS
Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, the authors aimed to assess trends in a set of behaviours sexual abstinence, contraceptive use, and condom use-that are known to affect the rates of HIV transmission. Methods involved secondary analysis of public-access data sets in 18 African countries (132800 women), calculating changes in a set of behavioural indicators over time. Condom promotion campaigns in sub-Saharan Africa were found to have affected the behaviour of young single women; the pace of change having matched the rise in contraceptive use by married couples in developing countries over recent decades.
The dynamics of HIV transmission in developing countries is compromised by unreliable data concerning sexual behaviour. This paper represents an effort to investigate young people’s reporting of sexual behaviour. It summarises the results from an interview-mode experiment conducted with unmarried young women aged 15–21 in rural southern Malawi in which respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. In both Kenya and Malawi, clear evidence indicates that the mode of interviewing and probing concerning various sexual partnerships affects respondents’ reporting of their sexual activity. Yet the results are not always in accordance with expectations. Reporting for ‘ever had sex’ and ‘sex with a boyfriend’ is higher in the FTF mode. When asked about other partners as well as multiple lifetime partners, however, the reporting was consistently higher with ACASI, in many cases significantly so. As in Kenya, in Malawi the interview-administered mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. Finally, the association between infection status and reporting of sexual behaviour is stronger in the FTF mode, although, in both modes, some young women who denied ever having had sex tested positive for STIs/HIV.
The aim of this study was to identify risk factors that could explain the large differences in HIV-1 prevalence among pregnant women in Harare, Zimbabwe, and Moshi, Tanzania. Cross-sectional data from a two-centre study that enrolled pregnant women in Harare and Moshi was used. Consenting women were interviewed about their socio-demographic background and sexual behaviour, and tested for presence of sexually transmitted infections and reproductive tract infections. The prevalence of HIV-1 among pregnant women was 26% in Zimbabwe and 7% in Tanzania. The HIV prevalence in both countries rises constantly with age up to the 25-30 year age group. After that, it continues to rise among Zimbabwean women, while it drops for Tanzanian women. Risky sexual behaviour was more prominent among Tanzanians than Zimbabweans. Mobility and such infections as HSV-2, trichomoniasis and bacterial vaginosis were more prevalent among Zimbabweans than Tanzanians. In conclusion, the higher HIV-1 prevalence among pregnant women in Zimbabwe compared with Tanzania could not be explained by differences in risky sexual behaviour: all risk factors tested for in the study were higher for Tanzania than Zimbabwe. Non-sexual transmission of HIV might have played an important role in variation of HIV prevalence.
This study in Mombasa Kenya explored sexual behaviours of people living with HIV (PLHIV) who are not receiving any HIV treatment. Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships. Main risk factors associated with unsafe sex were found to be non-disclosure of HIV status, stigma and the belief that condoms reduce sexual pleasure. In conclusion, high-risk sexual behaviours were found to be common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. The authors urge government to identify and reach this population to provide health services.
The need for empirical evidence on the state of HIV and AIDS in prisons in Kenya which can influence prison specific policy formulation nationally prompted this study. Its objectives included describing the level of knowledge of HIV among male inmates; describing the sexual health knowledge and practices among male inmates before and during imprisonment; determining the prevalence and predictors of HIV infection among male inmates; and examining policy, practice and legal frameworks around prevention of HIV infection in prisons. A cross sectional study design was utilised. Data was collected from inmates and stakeholders involved in HIV and AIDS policy formulation using quantitative and qualitative approaches respectively. Both the inmates and the key informants agreed that consensual and non-consensual sex occurs between inmates. Although not many inmates were found to be abusing drugs, those who were doing so were likely to be first timers in prison. Without underestimating the role played by condoms in HIV prevention, their provision in prisons is not a panacea to the consequences of sexual practice among inmates. There is therefore a need for a comprehensive approach in programming which will be fundamental in alleviating the HIV/AIDS scourge in prisons.
The authors of this study analysed demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa's largest informal urban settlement, Kibera in Nairobi, Kenya. In the study, they included 515 consecutive adult patients on ART attending the African Medical and Research Foundation clinic in Kibera in Nairobi. Interviewers used structured questionnaires covering socio-demographic characteristics, time on ART, number of sexual partners during the previous six months and consistency of condom use. Twenty-eight% of patients reported inconsistent condom use. Female patients were significantly more likely than men to report inconsistent condom use. Shorter time on ART was significantly associated with inconsistent condom use. Multiple sexual partners were more common among married men than among married women. ART needs to be accompanied by other preventive interventions, the authors conclude, to reduce the risk of new HIV infections among sero-discordant couples and to increase overall community effectiveness.
This ethnographic study in Dzivaresekwa district, Harare, Zimbabwe, examines the issue of sexuality among the elderly and their challenges in accessing information, education, and communication (IEC) campaigns in the face of HIV and AIDS. The research depended heavily on collecting life histories through key informant interviews. The theory of structuration as proposed by Anthony Giddens was adopted as a framework to analyse the findings. The findings reveal that although the sample of elderly people in Dzivaresekwa district were sexually active, HIV/AIDS-related interventions in the form of IEC campaigns mainly focus on the age group of 14–49-year-olds, and otherwise consider the elderly only as a group indirectly affected by the epidemic and less at risk of HIV infection. This is mainly a result of society’s presumption that people withdraw from sexual life with advanced age. Thus, the elderly are incorrectly regarded as sexually inactive and not susceptible to contracting sexually transmitted infections. A fuller understanding of the sexuality of the elderly is important to increase the usefulness HIV/AIDS efforts, while IEC campaigns that target them are still needed.
The Southern and Eastern Africa Youth Conference on HIV and AIDS and Reproductive Health Rights for Sustainable Development (SEYCOHAIDS 2012) was held in Malawi, 6-8 November 2012, and delegates produced this statement at the end of the conference. During the conference, delegates were able to share best practices and lessons in HIV and adolescent Sexual Reproductive Health (SRH) interventions in the region. Although regional governments have ratified the African Youth Charter; the signatories to this statement recommend that it is domesticated and used to inform the Youth policies and development programmes in the respective countries. Funding alone cannot deal with the issues of child marriages, as well as HIV and SRH support. The community systems require strengthening in order to support effective HIV and SRH programmes and interventions for adolescents at the community level to achieve universal access to health and the Millennium Development Goals by 2015. The statement points to best practices and models of HIV and SRH capacity building in the region that can be replicated and scaled up, including improved family planning programmes targeted at the youth, to prevent unplanned pregnancies and unsafe abortions.
A dramatic 41% decline in HIV prevalence has been reported in pregnant women in Zimbabwe, according to the latest survey done in this population. The results were reported in a poster presentation at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago this week. Previous studies have suggested that HIV prevalence is on the decline among adults in Zimbabwe. This study only looked at pregnant women presenting to the Salvation Army Howard Hospital in the Mazowe district of rural northern Zimbabwe, but dramatically confirmed this decline in prevalence among these women.