The authors of this study examined the association between young people's interests in the consumption of modern goods and their sexual behaviour in Antananarivo and Antsiranana, Madagascar. Their survey included 2, 255 youth ages 15-24. Overall, 7.3% of women and 30.7% of men reported having had multiple partners in the last year; and 5.9% of women reported ever practising transactional sex. This was associated with perceptions concerning the importance of fashion and a series of activities associated with modern lifestyles. For transactional sex, results suggested perceptions around fashion, nightclub attendance and getting to know a foreigner were key determinants. The authors found that peri-urban residence was more associated with transactional sex than urban residence; and ethnic origin was the strongest predictor of both outcomes for women. While they found some evidence of an association between sexual behaviour and interest in modern goods, or modern lifestyles, they caution that such processes did not single-handedly explain risky sexual behaviour among youth: these behaviours were also shaped by culture and conditions of economic uncertainty. These determinants must all be accounted for when developing interventions to reduce risky transactional sex and vulnerability to HIV.
Equity and HIV/AIDS
The aim of this study was to determine the proportion, characteristics and outcomes of patients who transfer-out from an antiretroviral therapy (ART) service in a South African township. Researchers included all patients aged ≥15 years who enrolled between September 2002 and December 2009. Follow-up data were censored in December 2010. A total of 4,511 patients received ART during the study period. Overall, 597 (13.2%) transferred out. The probability of transferring out by one year of ART steadily increased from 1.4% in 2002/2004 cohort to 8.9% for the 2009 cohort. Independent risk factors for transfer-out were more recent calendar year of enrolment, younger age (≤25 years) and being ART non-naïve at baseline (i.e., having previously transferred into this clinic from another facility). The proportions of patients transferred out who had a CD4 cell count <200 cells/µL and/or a viral load ≥1000 copies/mL were 19% and 20%, respectively. With scale-up of ART over time, an increasing proportion of patients are transferring between ART services and the authors argue that information systems are needed to track patients. Approximately one-fifth of these have viral loads >1000 copies/mL around the time of transfer, suggesting the need for careful adherence counselling and assessment of medication supplies among those planning transfer.
The objective for this study was to explore street children’s vulnerability to HIV and STIs infection. Researchers employed In-depth interviews with street children in the two main cities of Malawi, Blantyre and Lilongwe. A total of 23 street children were interviewed. Results of the study strongly suggest that street children could be vulnerable to HIV and other sexually transmitted infections (STIs). This is due to various factors which include low knowledge levels of STIs and HIV, high risk sexual practices, lack of safer place to spend their nights for both boys and girls rendering them vulnerable to sexual abuses and the use of sex as a tool to secure protection and to be accepted especially for the newcomers on the street. This study highlights street children’s vulnerability to sexual exploitation which predisposes them to risk of HIV and AIDS as well as STIs. Furthermore, the street environment offers no protection against such vulnerability. There is need to explore potential and context sensitive strategies that could be used to protect street children from sexual exploitation and HIV and STIs.
In this study, researchers synthesised published qualitative research to identify the factors enabling and deterring uptake of HIV testing in sub-Saharan Africa (SSA). A total of 42 papers from 13 countries were synthesised in the final analysis. Results indicated that the predominant factors enabling uptake of HIV testing were deterioration of physical health and/or death of sexual partner or child. Other enabling factors were the roll-out of various new HIV testing initiatives, such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing, availability of treatment and social network influence and support. Major barriers to uptake of HIV testing were perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. Other barriers were direct and indirect financial costs of accessing HIV testing, and gender inequality, which undermines women’s decision making autonomy about HIV testing. The authors conclude that improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived inability to live with HIV. There is also a need to continue addressing HIV-related stigma, which is intricately linked to individual economic support.
This paper describes the development of a family-centred, structured intervention to support mothers to disclose their HIV status to their HIV-negative school-aged children in rural South Africa, an area with high HIV prevalence. The intervention was piloted with 24 Zulu families, all mothers were HIV-positive and had an HIV-negative child aged 6–9 years. Lay counsellors delivered the six session intervention over a six to eight week period. Qualitative data were collected on the acceptability, feasibility and the effectiveness of the intervention in increasing disclosure, health promotion and custody planning. All mothers disclosed something to their children: 11/24 disclosed fully using the words "HIV" while 13/24 disclosed partially using the word "virus". This pilot study found the intervention was feasible and acceptable to mothers and counsellors, and provides preliminary evidence that participation in the intervention encouraged disclosure and health promotion. The pilot methodology and small sample size has limitations and further research is required to test the potential of this intervention. A larger demonstration project with 300 families is currently underway.
At least 28% of schoolgirls across South Africa are HIV positive, with only 4% of boys at schools HIV positive in comparison, according to figures released by Health Minister Aaron Motsoaledi at a National Council of Provinces ‘taking Parliament to the people’ event. He added that 94,000 schoolgirls got pregnant in 2011 and about 77,000 girls had abortions at public facilities. The minister attributed the high figures to the sugar daddy phenomenon, a transactional sexual relationship between older men with money and schoolgirls, where sex is traded for physical goods, such as cell phones and accessories. Young women put themselves at risk because they don’t have the agency to be able to negotiate safe sex, he argued. There is the risk for considerable physical, psychological and emotional harm. In recognition of the growing problem, in January 2012 the KwaZulu-Natal department of health launched a campaign against sugar daddies with a call to action to ‘protect your loved ones from sugar daddies’.
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.
Aids in Africa is a symptom of an unjust global order, argues the author of this article. Mass poverty leaves people with no option other than labour migration and transactional sex, which he identifies as the key drivers of HIV transmission in southern Africa. Old approaches to rolling back AIDS don’t work any longer – what is needed is a new, more systematic approach in which poor African countries are released from structural adjustment programmes so they can rebuild their economies using tariffs, subsidies, state spending and low interest rates – the very policies that rich countries use. The author also calls for the cancellation of odious debts so African countries can spend money on health services instead of interest payments. Furthermore, governments need to amend TRIPS to decommoditise life-saving drugs and amend the World Trade Organisation’s (WTO) Agreement on Agriculture to ban the dumping of subsidised farm products in Africa and elsewhere. This means reforming the World Bank, the International Monetary Fund and the WTO, where voting power is monopolised by rich nations and special interests. The World Bank and the Gates Foundation – the biggest funders of AIDS prevention – cannot be entrusted with these tasks, as they have clear interests in the very policies (debt service, structural adjustment and patent laws) that have created the problem in the first place.
Despite the successes in rolling out antiretroviral therapy in sub-Saharan Africa, treatment remains lifelong and systematic investigations of retention have repeatedly documented high rates of loss to follow-up from HIV treatment programmes. This paper introduces an explanation for missed clinic visits and subsequent disengagement among patients enrolled in HIV treatment and care programmes in Africa. They interviewed 890 patients enrolled in HIV treatment programmes in Jos in Nigeria, Dar es Salaam in Tanzania and Mbarara in Uganda who had extended absences from care. Two-hundred-eighty-seven were located, and 91 took part in the study. Findings revealed unintentional and intentional reasons for missing, along with reluctance to return to care following an absence. Through the process of disengagement, patients who missed visits and felt reluctant to return over time lost their subjective sense of connectedness to care. The authors conclude that efforts to prevent missed clinic visits combined with moves to minimise barriers to re-entry into care are more likely than either approach alone to keep missed visits from turning into long-term disengagement.
In this report, the United Nations Children’s Fund (UNICEF) and its partners note progress on preventing mother-to-child HIV transmission (PMTCT), with most women around the world getting anti-retroviral drugs to prevent transmission to newborns. However, globally, AIDS remains the leading cause of death amongst women of childbearing age and UNICEF’s goal now is to help eliminate vertical mother-to-child transmission so that fewer or no newborns will be infected, especially in Africa, where 1,000 babies acquire the virus every day. UNICEF notes general progress in four priority areas: prevention of mother-to-child transmission of HIV; paediatric treatment; prevention among adolescents and young people; and protection for orphans and vulnerable children. The report emphasises that reaching the poorest, most marginalised and least served has been at the core of successful AIDS programming. That imperative is even greater in an era of static resources and ever more complex competing priorities. The AIDS-free generation that is now in sight can be achieved – but only if governments accelerate the scale-up of proven measures, and only if they are viewed as part of a rights-based, results-focused drive to reach all those in need. Integrating interventions into existing systems without losing the capacity to address the specific needs of children affected by AIDS remains a significant challenge.