An Old Mututal Survey of 100 South African companies found that most companies were unaware of the number of HIV-positive people in their workplaces, noting that 25 companies had conducted prior prevalence testing. Compared with a few years ago, companies are more conscious of the risk HIV/AIDS poses to their business, according to the survey. While all employees polled had access to antiretroviral drugs,only a minority of companies had established disease management programs.
Equity and HIV/AIDS
HIV prevalence rate in corporate South Africa has increased to 19.4%, study says
Kaisernetwork 15 September 2005
HIV Prevention and primary care for transgender women in a community-based clinic
Melendez RM and Pinto RM: Journal of the Association of Nurses in AIDS care 20(5): 387–397, September/October 2009
Male-to-female transgender individuals, or transgender women (TW), are at high risk for HIV infection and face multiple barriers to HIV care. This article examines how a community-based clinic that offers free or low-cost care addresses the health care needs of TW. A total of twenty TW who attended a health care clinic dedicated to community-based health were interviewed regarding best practices for HIV prevention and primary care. In-depth interviews were conducted, transcribed, coded, and analysed. Factors reported to be effective for HIV prevention and primary care included access to health care in settings not dedicated to serving transgender and/or gay communities, a friendly atmosphere and staff sensitivity, and holistic care, including hormone therapy. Community-based health care settings can be ideal locales for HIV prevention and primary care for TW.
HIV prevention awareness and practices among married couples in Malawi
Chirwa E, Malata A and Norr K: Malawi Medical Journal 23(2): 32-37, June 2011
In this study researchers explored the level of awareness and practice on HIV prevention among married couples from selected communities in Malawi. They carried out the study from October to December 2008 in four communities, two each from Chiradzulu and Chikhwawa districts of Malawi. They conducted face-to-face in-depth interviews with 30 couples in each district using a semi-structured interview guide. The couples’ ages ranged from 20 to 53 years, most (52%) being in the 20-31 year-old age group. All couples were aware of HIV prevention methods and talked about them in their marriages. For most couples (54) there was mutual trust between husbands and wives, and members of only a few couples (six) doubted their partners’ ability to maintain mutual fidelity, but researchers detected infidelity among 25 couples. A few couples (5) had been tested for HIV. No couples favoured the use of condoms with a marriage partner as an HIV prevention method. The researchers conclude that the level of HIV prevention awareness among couples in Malawi is high and almost universal. However, there is low adoption of the HIV prevention methods among the couples because they are perceived to be couple unfriendly due to their incompatibility with the socio-cultural beliefs of the people. There is a need to target couples as units of intervention in the adoption of HIV prevention methods by rural communities.
HIV prevention for South African youth: Which interventions work? A systematic review of current evidence
Harrison A, Newell M, Imrie J and Hoddinott G: BMC Public Health 10(102), 26 February 2010
In South Africa, HIV prevalence among youth aged 15-24 is among the world's highest, which prompted this review to assess youth HIV-prevention interventions in the country since 2000. Eight interventions were included, all of which were similar in HIV prevention content and objectives, but varied in thematic focus, hypothesised causal pathways, theoretical basis, delivery method, intensity and duration. Interventions were school- or group-based, involving in- and out-of-school youth. Primary outcomes included HIV incidence, reported sexual risk behaviour alone, or with alcohol use. Interventions led to reductions in sexually transmitted infections and reported sexual or alcohol risk behaviours, although effect size varied. All but one targeted at least one structural factor associated with HIV infection: gender and sexual coercion, alcohol/substance use or economic factors. Delivery methods and formats varied, and included teachers, peer educators and older mentors. School-based interventions experienced frequent implementation challenges. Key recommendations include: address HIV social risk factors, such as gender, poverty and alcohol; target the structural and institutional context; work to change social norms; and engage schools in new ways, including participatory learning.
HIV prevention response and modes of transmission analysis
Wabwire-Mangen F, Odiit M, Kirungi W, Kisitu DK, Wanyama JO: UNAIDS and Government of Uganda, March 2009
This review aimed to identify the current modes of transmission of HIV in Uganda, as well as where and among whom incident HIV infections are occurring. It indicates that the previously heralded decline in prevalence from a peak of 18% in 1992 to 6.1% in 2002 may have ended. There is stabilisation of prevalence between 6.1 and 6.5% in some antenatal care sites and even a rise in others. This is accompanied by deterioration in behavioural indicators especially an increase in multiple concurrent partnerships. There has also been a shift in the epidemic from spreading mainly in casual relationships to also seeing a large proportion of new infections in people in long-term stable relationships. The main risk factors for transmission were identified as having, multiple partners, discordance and non-disclosure, lack of condom use, transactional sex, cross-generational sex, presence of herpes simplex and sexually transmitted infections, alcohol and drug use, and behavioural disinhibition due to anti-retroviral therapy.
HIV program fails to decrease incidence of HIV-1 in Zimbabwe
Gregson S, Adamson S, Papaya S, et al: PLoS Medicine; 2 (5), e147, 27 March 2007
A trial in Zimbabwe has shown that a programme of integrated peer education, condom distribution, and management of sexually transmitted infections did not reduce the overall incidence of HIV-1. The study, published in PLoS Medicine, by Simon Gregson and colleagues from Imperial College London, randomised different communities in eastern Zimbabwe over a 3 year period. Six pairs of communities in Eastern Zimbabwe were compared, each of which had its own health center. Control communities received the standard government services for preventing HIV. According to the author, the results are disappointing given the urgent need for control measures for HIV-1 in sub-Saharan Africa. The authors conclude that they “emphasise the need for alternative strategies of behaviour change promotion.”
HIV rates no longer falling in Uganda: Evidence from rural population cohort 1989-2005 and ANC surveillance
Shafer LA, Biraro S, Kamali A, et al: The Sixteenth International AIDS Conference, August 2006
Throughout the 1990s, Uganda has successfully controlled its HIV epidemic, with falling prevalence and incidence rates. Recent evidence, however, indicates that this decline may not be continuing. Factors influencing recent epidemiological trends are still unclear, but may include increased risk behaviour, the natural epidemiologic cycle and others. To solidify Uganda’s success, the ongoing efforts in HIV prevention need to be re-emphasised.
HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda
Matovu J; Kisa R; Buregyeya E; et al: Global Health Action 11(1503784) 1-12, 2018
This was a qualitative study was conducted in Central Uganda between February and March 2017 through 32 in-depth interviews to document women and men’s perceptions about HIV self-testing (HIVST) strategies used by women in delivering the kits to their male partners, male partners’ reactions to receiving kits from their female partners, and positive and negative social outcomes post-test. Women were initially anxious about their male partners’ reaction if they brought HIVST kits home, but the majority eventually managed to deliver the kits to them successfully. Women who had some level of apprehension used a variety of strategies to deliver the kits including placing the kits in locations that would arouse male partners’ inquisitiveness or waited for ‘opportune’ moments when their husbands were likely to be more receptive. A few women lied about the purpose of the test kit while one woman stealthily took a mucosal swab from the husband. Most men initially doubted the ability of oral HIVST kits to test for HIV, but this did not stop them from using them. Both men and women perceived HIVST as an opportunity to learn about each other’s HIV status. No serious adverse events were reported post-test. The author’s findings lend further credence to the feasibility of female-delivered HIVST to improve male partner HIV testing in sub-Saharan Africa. They suggest that women need support in challenging relationships to minimize potential for deception and coercion.
HIV self-testing services for female sex workers, Malawi and Zimbabwe
Napierala S; Desmond N; Kumwenda M; Tumushime M; et al.: Bulletin of the World Health Organization 97(11) 764–776, 2019
n Zimbabwe, research was conducted to assess the acceptability and accuracy of human immunodeficiency virus (HIV) self-testing. During implementation, the authors evaluated sex workers’ preferences for and feasibility of distribution of test kits before the programme was scaled-up. In Malawi, the authors conducted a rapid ethnographic assessment to explore the context and needs of female sex workers and resources available, leading to a workshop to define the distribution approach for test kits. Once distribution was implemented, the authors conducted a process evaluation and established a system for monitoring social harm. In Zimbabwe, female sex workers were able to accurately self-test. The preference study helped to refine systems for national scale-up through existing services for female sex workers. The qualitative data helped to identify additional distribution strategies and mediate potential social harm to women. In Malawi, peer distribution of test kits was the preferred strategy. The authors identified some incidents of social harm among peer distributors and female sex workers, as well as supply-side barriers to implementation which hindered uptake of testing. Involving female sex workers in planning and ongoing implementation of human immunodeficiency virus self-testing is essential, along with strategies to mitigate potential harm. Optimal strategies for distribution and post-test support are argued to be context-specific and to need to consider existing support for female sex workers and levels of trust and cohesion within their communities.
HIV transmission still on the up, says UN report
There is new evidence that adult HIV infection rates have decreased in certain countries and that changes in behaviour to prevent infection - such as increased use of condoms, delay of first sexual experience and fewer sexual partners - have played a key part in these declines. A new UN report - Aids Epidemic Update - also indicates, however, that overall trends in HIV transmission are still increasing, and that far greater HIV prevention efforts are needed to slow the epidemic. Kenya, Zimbabwe and some countries in the Caribbean region all show declines in HIV prevalence over the past few years with overall adult infection rates decreasing in Kenya from a peak of 10% in the late 1990s to 7% in 2003 and evidence of drops in HIV rates among pregnant women in Zimbabwe from 26% in 2003 to 21% in 2004. In urban areas of Burkina Faso prevalence among young pregnant women declined from around 4% in 2001 to just under 2% in 2003.