There is a huge interest by faith-based organizations (FBOs) in sub-Saharan Africa and elsewhere in HIV prevention interventions that build on the religious aspects of being. Successful partnerships between the public health services and FBOs will require a better understanding of the conceptual framing of HIV prevention by FBOS to access for prevention intervention, those concepts the churches of various denominations and their members would support or endorse. This paper reports the findings of a study on the conceptual framing of HIV prevention among church youths in Botswana. The findings suggest the church youth to conceptually frame their HIV prevention from both faith-oriented and secular-oriented perspectives, while prioritizing the faith-oriented concepts based on biblical teachings and future focus. In their secular-oriented framing of HIV prevention, the church youths endorsed the importance to learn the facts about HIV and AIDS, understanding of community norms that increased risk for HIV and prevention education. However, components of secular-oriented framing of HIV prevention concepts were comparatively less was well differentiated among the youths than with faith-oriented framing, suggesting latent influences of the church knowledge environment to undervalue secular oriented concepts. Older and sexually experienced church youths in their framing of HIV prevention valued future focus and prevention education less than contrasting peer cohorts, suggesting their greater relative risk for HIV infection.
Equity and HIV/AIDS
When it comes to sub-Saharan Africa's devastating AIDS crisis, there is an understandable tendency to latch onto any scrap of good news. Figures suggesting the epidemic is waning in some countries are being trumpeted by governments and international donor agencies as evidence that their prevention efforts are succeeding. But the real story behind increases and decreases in HIV prevalence is far less clear.
This paper based on findings from the KwaZulu-Natal Income Dynamics Study (KIDS) describes caregivers’ perspectives on providing care for HIV positive family members. The paper focuses on understanding what care provision means to family caregivers and in turn why they provide care. More centrally it highlights various aspects of the experience of providing care and the effects of care on caregivers’ lives. Caregiver’s reported that caring is stressful and physically, emotionally and socially taxing. Moreover, in households in which care takes place there is in most cases a lack of resources to provide appropriate care. Almost all caregivers indicate that they do not always know what to do to provide care. The report recommends increased support for caregivers, namely training in how to provide the highest quality care possible such as delivering palliative care. This should be provided by home-based care organisations and health workers such as community health workers and nurses through home visits.
People living with HIV in Kenya do not have adequate access to family planning services, even though most HIV-infected women do not want children in the immediate future. A recent study by the reproductive health NGO, Family Health International (FHI), in the Nakuru district of Rift Valley Province, found that 80% of HIV-positive women had no intention of having a child in the next two years. However, according to the 2007 Kenya AIDS Indicator Survey, only half the HIV-positive people needing family planning services had access to them. ‘Most prevention of mother-to-child transmission [PMTCT] programmes... looked at it only in the context of preventing transmission to an already conceived child, but meeting contraceptive needs of those living with HIV is a sure way of reducing transmission by avoiding unwanted pregnancies in the first place,’ said Maurine Kuyo, a project director at FHI. About 56% of women in the FHI study mentioned a fear of vertical transmission of HIV to their children as one the reasons they would not want another pregnancy, while 50% mentioned the risk of lowered immunity during pregnancy.
Alcohol consumption is a recognised risk factor for HIV infection. Alcohol serving establishments have been identified as appropriate venues in which to deliver HIV prevention interventions. This paper describes experiences and lessons learnt from implementing a combined HIV prevention intervention in bar settings in one city- and one township-based bar in Tshwane, South Africa. The intervention consisted of peer-led and brief intervention counselling sub-components. Thirty-nine bar patrons were recruited and trained, and delivered HIV and alcohol risk reduction activities to their peers as peer interventionists. At the same time, nine counselors received training and visited the bars weekly to provide brief motivational interviewing counselling, advice, and referrals to the patrons of the bars. The intervention was overall well received and suggests that bar patrons and servers can accept a myriad of intervention activities to reduce sexual risk behaviour within their drinking settings. However, HIV- and AIDS-related stigma hindered participation in certain intervention activities. The buy-in received from the relevant stakeholders (i.e. bar owners/managers and patrons, and the community at large) was an important contributor to the feasibility and acceptability of the intervention.
The authors describe the change in 12-24 year old peer leaders' knowledge and leadership of a peer youth led HIV curriculum applied during monthly Saturday adolescent HIV clinics at two clinical sites in Moshi, Tanzania. Peer leaders previously participated in a mental health and life skills intervention called Sauti ya Vijana and were recommended for leadership by Sauti ya Vijana facilitators and clinic staff. Peer leaders demonstrated high fidelity to activities in each lesson and participant feedback was positive for curriculum delivery. Participants’ knowledge improved in nine of ten sessions. Peer leaders reported improved leadership confidence and resilience, and their perception was that the curriculum helped normalize the HIV experience for Youth Living with HIV attending clinic. Nevertheless, anticipated stigma, difficulty disclosing HIV status, and teaching ability remained barriers. This study provides evidence to support efforts to scale and sustain peer youth led interventions for Youth Living with HIV.
A shortage of free female condoms in public hospitals in Kenya's Coast Province is compromising the ability of women to protect themselves from unwanted pregnancy and sexually transmitted infections. Female condoms are available in private hospitals and pharmacies in the province, but at a cost of up to US$5 – five times the cost of a male condom – they are too expensive for most women, especially in a time of famine, where every penny goes towards food. Sex workers are among those affected most by the shortage. Some have reported that that the female condom was a key part of their business. If customers refuse to wear a condom, sex workers at least have the option of wearing a female condom to protect themselves against sexually transmitted diseases like HIV.
Health programmes that serve people living with HIV/AIDS (PLWHA) pay little attention to PLWHA’s reproductive health needs. In this study, researchers collected data on fertility desire and intention to assist in the integration of sexual and reproductive health in routine care and treatment clinics. They conducted a cross-sectional study of 410 PLWHAs aged 15-49 residing in Kahe ward in rural Kilimanjaro, Tanzania. Fifty-one per cent reported they were married or cohabiting, 73.9% lived with their partners and 60.5% were sexually active. The rate of unprotected sex was 69%, with 12.5% of women reporting to be pregnant at the time of the survey. Further biological children were desired by 37.1% of the participants and lifetime fertility intention was 2.4 children. Increased fertility desire was associated with living and having sex with a partner, HIV disclosure, good perceived health status and CD4 count ≥200 cells for both sexes. These results showed that fertility desire and intention of PLWHA was relatively high, although lower than that of the general population in Tanzania. With increasing antiretroviral coverage and subsequent improved quality of life of PLWHA, these findings underscore the importance of integrating reproductive health services in the routine care and treatment of HIV and AIDS.
This study describes the fertility intentions and discusses the potential reproductive health needs of post-natal HIV-infected Ugandan women. HIV-infected mothers attending post-natal services in Kampala, Uganda participated in this cross-sectional study using structured interviewer administered questionnaires. Among 403 participants, 35% desired more children. Of these, 25% wanted another child within 2 years and 75% within 3 years or more. In multivariable analyses, believing that one’s partners wanted more children was associated with the desire for future children while having more living children was negatively associated with the desire for future children. A minority of women desired future pregnancies, and most wanted to delay pregnancy for 3 years. These women are in need of family planning methods to meet stated desires to delay or end future pregnancies. Perceived partner desire for children also impacts on women’s fertility intentions, highlighting the importance of engaging men during the post-natal period.
What happens when there aren't enough doctors to administer treatments? What happens when patients sell their medications to buy food? What happens when people are afraid to get tested for a disease? The International Development Research Centre (IDRC) working with South African researchers are developing techniques to manage AIDS in resource constrained settings.