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.
Equity and HIV/AIDS
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.
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.
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.
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.
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.
This report outlines how Pepfar-funded HIV organisations in South Africa, who receive their funds through the United States Agency for International Development, USAID, woke up to letters that were sent overnight telling them their grants have been ended - permanently. USAID-funded district health projects, supported outside of Pepfar, but with other US government funds administered by USAID, have also been instructed to close down, including several projects working on fighting HIV within key populations such as LGBTQI+ groups, and also those working with orphans and vulnerable children, to close down their projects immediately. South African organisations say they have also had reports from Pepfar-funded projects in Kenya and Malawi saying they had received similar letters. The article outlines responses from organisations working on HIV. The Treatment Action Campaign chairperson is reported to have said " It is so painful that these terminations mean death to poor people of the world. Key and vulnerable populations are the most affected". Many organisations noted that HIV related deaths and infections will increase and called for a more urgent government and global response. As one public health specialist noted ""The people - the patients, the frontline workers, the programme recipients who relied on these services for survival - are now left stranded, abandoned by a system that once promised progress and partnership. Every contract cancelled is not just a number; it represents a life, a community, a future now in jeopardy. The sheer disregard for the impact on millions of vulnerable people is unfathomable, and the ripple effects of these decisions will be felt for generations to come".
This study aimed to identify women’s HIV Self-Testing (HIVST) knowledge, utilization, and its associated factors in Sub-Saharan Africa (SSA). The data used were gathered from the most recent demographic and health surveys conducted in 21 SSA nations between 2015 and 2022. The level of knowledge and utilization of HIVST among women in SSA was very low. To improve this situation, the authors suggest facilitating institutional delivery, promoting access to modern contraception, increasing ANC coverage, empowering women’s associations, creating culturally respectful mass media content, and involving rural and economically disadvantaged women.
This study conducted in 2022 aimed to elucidate the experiences of these in a small group of young, HIV + men who have sex with men and transgender women in Zambia through in-depth interviews and a questionnaire. The authors recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants’ mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of transgender women had moderate to significant symptoms of depression or major depression compared to men who have sex with men, at 33% and 6%, respectively. Similarly, more transgender women had contemplated suicide than MSM peers. Overall, having to hide both one’s sexuality and HIV status had a compounding effect and was described as living a private lie. The authors argue that effectively addressing stigma and poor mental health outcomes among young HIV-positive MSM and transgender women requires a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening community-informed public health efforts.
This paper assessed the socioeconomic inequalities in HIV testing during antenatal care in sub-Saharan Africa, using Demographic and Health Surveys data spanning from 2015 to 2022. Overall, 73.9% of women in sub-Saharan Africa tested for HIV during antenatal care. Being among the richer and richest wealth quintiles increased the odds of HIV testing during antenatal care. The authors emphasize the necessity for sub-Saharan Africa public health programs to think about concentrating their limited resources on focused initiatives to reach poorer women and should provide women with comprehensive HIV knowledge and decrease the number of lost opportunities for women to get tested for HIV.