The authors investigated the prevalence and determinants of reproductive-age women’s ability to refuse sex analysing secondary data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey for 9,090 women aged 15–49. The study found that 69.6% of Tanzanian women of reproductive age had the ability to refuse sex. After adjusting for confounders, women’s ability to refuse sex was associated with their higher levels of their and their partners’ education, wealth, awareness of sexually transmitted infections, prior HIV testing, media access, and contraceptive use, albeit with some geographical variability.
Equity and HIV/AIDS
Prevalence and determinants of ability to refuse sex among women of reproductive age in Tanzania: evidence from national representative surveys
Moshi F V; Buname R E: BMC Women's Health 26(65), 1-16, doi: https://doi.org/10.1186/s12905-025-04203-2, 2026
Factors associated with unawareness of HIV-positive status among individuals aged ≥ 15 years in Tanzania: Evidence from the Tanzania HIV Impact Survey 2022–2023
Damian D; Cosmas S; Wang A; et al: BMC Public Health 1-22, doi: https://doi.org/10.1186/ s12889-026-26597-w, 2026
This paper estimated the proportion of individuals aged ≥15 years living with HIV in Tanzania who were unaware of their status, and identified factors associated with that unawareness, using data from the Tanzania HIV Impact Survey 2022–2023. Of 1,850 individuals aged ≥15 years who tested HIV-positive, 266 were unaware of their status. Males were more likely to be unaware than females. Those aged 15–24 were over five times more likely to be unaware compared to individuals aged ≥55 years. Individuals reporting no condom use at last intercourse were more likely to be unaware of their status, while those with at least one partner known to be living with HIV were less likely to be unaware. Despite robust HIV case-finding efforts in Tanzania, 1 in 6 people living with HIV remained unaware of their status. Targeted case-finding in men and young people, and HIV prevention strategies are thus proposed.
Geospatial and multilevel analysis of lifetime HIV testing uptake among high-risk adults in Mozambique: evidence from the 2022–2023 DHS
Yewodiaw T; Endalew H; Getnet M; et al: International Journal of Health Geographics, 1-11, doi: https://doi.org/10.1186/ s12942-026-00462-w, 2026
This paper investigates the prevalence, spatial distribution, and determinants of lifetime HIV testing among high-risk adults aged 15–49 in Mozambique, using 2022–2023 DHS data. A cross-sectional analysis of 15,393 high-risk adults applied descriptive statistics, spatial analyses, and multilevel logistic regression to identify individual- and community-level factors associated with testing uptake. Overall, 63.7% of high-risk adults had ever tested for HIV. Uptake was higher among females, urban residents, and those aged 25–34, and lowest among adolescents aged 15–19. Wealth, education, marital status, employment, media exposure, and HIV knowledge were all positively associated with testing. Significant regional disparities were observed, with southern provinces showing higher uptake than northern and central provinces, and spatial analysis confirmed clustering of low-testing hotspots in northern and central rural areas. Individual and community factors together explained 62.9% of between-cluster variance. HIV testing in Mozambique remains uneven across sociodemographic and geographic groups. The authors recommend targeted, equity-focused interventions to reach adolescents, men, rural populations, and residents of underserved provinces, with priority given to community-based testing, health education, and addressing geographic barriers
Hypertension is a marker of the micro-epidemiologic transition in ageing HIV populations in Kenya, Uganda and Tanzania (AFRICOS, 2013–2023)
Mayambala D; Ojjambo W S; Lwanga C; et al: BMC Public Health https://doi. org/10.1186/s12889-026-27241-3, 2026
This paper estimated the association of hypertension with all-cause mortality among adults aged ≥40 years. At enrolment, 18.6% were hypertensive; 60.1% experienced hypertension during follow-up, and all-cause mortality was 6.4%. Excess mortality was largest among adults aged 50–59, men, underweight participants, and those with suppressed HIV viral load. Among underweight participants, hypertensives had 3.6-fold higher mortality than non-hypertensives; among those with suppressed viral load, the association was 2.3-fold. In adjusted models, mortality odds were higher among participants aged ≥60 and those with high viral load, while overweight and obese participants had substantially lower odds. These findings reflect a demographic transformation of the HIV epidemic in East Africa, where mortality among people living with HIV increasingly reflects a chronic disease burden, with hypertension emerging as a key driver.
A heart of the man is lighter than that of the woman….exploring men’s motivation and capability to access HIV services in Lusaka, Zambia: findings from the Yaba Guy Che study
Mwansa C; Phiri M M; Belemu S; et al. BMC Public Health 25(3353); 1-12; https://doi.org/10.1186/s12889-025-23703-2, 2025
This paper explored how social norms and social networks influence men’s engagement with services in Lusaka, Zambia. The authors conducted seven focus group discussions (FGDs) with 70 men and women in an urban community in Lusaka. Pervasive negative community narratives around HIV, negative social and gender norms, the influence of men’s social networks, including stigma related to a positive HIV test result and fear of social isolation, were among the key factors influencing men’s access to HIV services. For HIV testing, the organization and delivery of services in health facilities, including location of HIV testing, waiting times, and likelihood of being seen accessing services, dissuaded men from testing for HIV. In general, health facilities were seen as women’s spaces and unresponsive to men’s needs. However, provider-initiated initiatives, including couples testing in antenatal care and an offer of HIV testing prior to medical male circumcision, and community-based HIV testing facilitated service use. Though condoms were the primary HIV prevention tool mentioned by study participants, norms of their use in marriage and sexual relations limited use. Despite HIV having evolved to a chronic condition and various HIV prevention tools available, fear, social isolation, stigma, and harmful gender norms continue to negatively impact men’s motivation and capability to engage with available HIV services. Measures to facilitate men’s use of these services should consider how to increase social support alongside the delivery of services in spaces that meet men’s needs.
Migrants are human beings and they don’t sleep with animals: healthcare workers and migrants’ experiences of the impact of inadequate antiretroviral therapy provision in Botswana
Balekang G B; Galvin T; Rakgoasi D S: International Journal for Equity in Health 24(239), 1-11, doi: https://doi.org/10.1186/s12939-025-02621-0, 2025
This study explores the perceptions of healthcare workers and cross-border migrants on the impact of inadequate antiretroviral therapy provision to migrants and the consequences for the local population. A qualitative study was conducted in Gaborone and Francistown, Botswana with 12 healthcare providers and 20 cross-border migrants. Participants highlighted that excluding migrant from antiretroviral therapy exacerbates health inequalities and contributes to HIV transmission. Migrants, particularly those involved in sex work were perceived as both vulnerable to HIV and as potential vectors of transmission to the broader population. Denying treatment in critical contexts such as during childbirth, was regarded by both groups as a major public health and ethical failure. Healthcare workers expressed moral distress in being unable to provide care due to institutional restrictions, and emphasized that access to essential health services should not be contingent on migration status. The findings underscore an urgent need for inclusive health policies that extend antiretroviral therapy and related HIV services to all individuals in Botswana, regardless of migration status, for both migrant and population health.
The Perspectives of Key Informants on Programs and Policies Pertaining to HIV Prevention and Treatment for Farm Workers in Rural South Africa
Mlangeni N; Lembani M; Adetokunboh O; et al: Advances in Public Health (7937775), 1-13, https://doi.org/10.1155/adph/7937775, 2025
This study explored perspectives on the challenges and opportunities in providing HIV prevention and care to people working on farms in three provinces of South Africa. Eight policy documents were analyzed, and eight key informants were interviewed. Several challenges in providing HIV care to farm workers were presented, including their high mobility which leads to treatment interruptions and loss to follow-up. As a result, farm workers easily get lost to follow-up and are likely to have poor treatment outcomes. Some of the effective strategies included community-based prevention, treatment and support services, and the use of health passports to improve linkages to care. Community health workers, mobile clinics, and community-based pick-up points improve access to HIV counselling and testing, adherence to antiretroviral therapy, and retention in care. Program and policy recommendations included customized HIV services and designing sector-specific HIV policies.
Structural barriers and facilitators to accessing HIV services for marginalized working populations: insights from farm workers in South Africa
Mlangeni N; Lembani M; Adetokunboh; et al: Health Policy and Planning 40(1), 75-84, doi: https://doi.org/10.1093/heapol/czae098 , 2025
Farm workers are vulnerable working populations face significant inequalities in accessing health services, including those for human immunodeficiency virus (HIV) prevention, treatment and care. This study explored through in-depth interviews and focus group discussions farm workers’ experiences when accessing HIV services in Limpopo province, South Africa. The results reveal that farm workers report multiple interdependent factors that inhibit or enable their access to HIV healthcare services, including transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities and difficult working conditions. Key facilitators for their HIV healthcare access were reported to include the availability of mobile health services, the presence of community health workers and a supportive work environment. The findings suggest disparities in farm workers’ access to HIV services, with work being the main determinant of access. The authors recommend a review of HIV policies and programmes for the agricultural sector and models of HIV healthcare delivery that address the unique needs of farm workers.
Towards a sustainable HIV response: strengthening Zimbabwe's domestic financing for HIV programs amid declining donor support
Musuka G; Makoni T; Dzinamarira T: Frontiers in Health Services (2025) 5:1558992, doi: https://doi.org/10.3389/frhs.2025.1558992, 2025
This paper examines Zimbabwe's transition toward sustainable domestic financing for HIV programs as external funder support declines. With Zimbabwe's economy projected to achieve middle-income status by 2030, driven by mineral exports (gold, platinum, lithium) and diaspora remittances totalling US$1.9 billion in 2024, the country has opportunities to strengthen health system financing. The authors analyse existing domestic revenue mechanisms including the AIDS levy (generating ~US$40 million annually), Health Fund Levy, and sugary drinks tax. Key findings highlight Zimbabwe's achievement of UNAIDS 95-95-95 targets in 2023, but emphasize the critical need to integrate HIV services into mainstream health systems rather than maintaining standalone programs. The paper proposes innovative financing approaches, strengthening local pharmaceutical manufacturing capacity for ARV drugs, improving accountability mechanisms to prevent corruption and mismanagement, engaging informal sector and private sector stakeholders, and addressing regulatory barriers like the Private Voluntary Organisations Amendment Act that restricts NGO participation.
Over a decade of HIV infection prevalence and incidence among Mozambican pregnant women: a secondary analysis of prospectively collected data
Mendes-Muxlhanga A; Nhacolo A; Figueroa-Romero A; et al: BMC Public Health 25(251), 1-11, doi: https://doi.org/10.1186/s1288902521467-3, 2025
This paper describes HIV infection trends over eleven years in women attending selected antenatal care clinics in southern Mozambique. The authors performed a secondary analysis of data registered at the ANC clinic of the Manhiça District Hospital and from the Ministry of Health's HIV National Program Registry between 2010 and 2021. HIV incidence was calculated using prevalence estimates. HIV incidence trends over time were obtained by fitting splines regression model. Data from 21,810 pregnant women were included in the analysis. Overall HIV prevalence was 29.3%, with a reduction from 28.2% in 2010 to 21.7%, except for a peak in prevalence in 2016. Over the study period, by maternal age group, the largest reduction in HIV prevalence was in the 15–20 year-old group, followed by the 20–25 year old group and the 25–30 year old group. Incidence of HIV infection increased from 12.75 per 100 person-years in 2010 to 18.65 per 100 person-years in 2018, and then decreased to 11.48 per 100 person-years in 2021. The prevalence of HIV decreased while the overall incidence stayed similar in Mozambican pregnant women, during 2010 to 2021. However, both estimates remain unacceptably high, which authors suggest indicates the need to revise current preventive policies and implement effective ones to improve HIV control among pregnant women.