Nuanced approaches to HIV/AIDS research

Over the last decade, the Zimbabwe Government has implemented a range of services to prevent new infections and to support people living with HIV, e.g. HIV testing and counselling (HTC), anti-retroviral treatment (ART), prevention of mother-to-child transmission (PMTCT), and male circumcision (MC).

We describe trends and patterns in knowledge and uptake of these services, investigate individual-level factors associated with greater levels of coverage, and analyse shortfalls in order to inform future policies on the scale-up of HIV services.

Data from the latest round of a large (n≈12,000) population-based cohort study in eastern Zimbabwe will be used in logistic regression models to analyse associations between demographic, socio-economic, behavioural and other factors, and knowledge and uptake of services. Temporal trends in uptake of services will be measured using data from earlier rounds of the study.

Preliminary univariate results suggest that knowledge of HIV services was high for HTC (82.3%; 95% CI: 91.6%-82.9%) and PMTCT (90.1%; 88.9%-91.2%) but lower for ART (40.1%; 39.3%-40.9%) and MC (8.4%; 7.7%-9.2%). Overall uptake was moderate for HTC (49.6%; 48.7%-50.4%) but quite high for PMTCT (86.4%; 79.3%-91.7%) and ART (79.8%; 76.9%-82.5%). Uptake varied by sex and age and may also differ by many other factors.

Background: The epidemiology of HIV in children in sub-Saharan Africa remains poorly understood. We describe patterns of HIV infection in children aged 2-14 years in eastern Zimbabwe in 2009-2011.
Methods: Data on possible socio-demographic correlates of HIV prevalence, sources of childhood infection, and the effects of HIV were collected in a general population survey and analysed using multi-variable logistic regression. The possibility of horizontal transmission was assessed by comparing the age-pattern of HIV prevalence with a mathematical model of the pattern expected from survival of infants infected through mother-to-child transmission (MTCT).
Results: HIV prevalence in children was 2.2% (73/3,399). Prevalence did not differ by sex, age, socio-economic status, location or religion. The age-specific HIV pattern was consistent with the model prediction of that expected from survival of infants infected through MTCT, but 9/73 infected children had living HIV-negative mothers. Infected children were more likely than uninfected ones to be malnourished (21.6% vs 9.9%, p=0.006) and stunted (42.0% vs 30.6%, p=0.03). HIV status was not correlated with physical or psychological ill-health, or school drop-out.
Conclusion: Childhood HIV infection in Zimbabwe is due primarily to MTCT and is linked with poor physical development.

We examined the correlates of frequent alcohol use among men who have sex with men (MSM) to inform designing alcohol abuse interventions. Survey data from 3,880 MSM from three Indian states were analyzed using binary logistic regression. We categorized those who reported consuming alcohol daily or once a week as ‘frequent’ drinkers (40% of the sample) and those who consumed less than a week or did not drink as ‘infrequent’ drinkers. Among frequent drinkers, about two-thirds were above 24 years (66%), most (85%) were literate, about a half (53%) self-identified as Kothi – feminine/receptive, and about three-fourths had paying partners (73%) and were exposed to any HIV prevention interventions (78%). In multivariate analysis, frequent alcohol users were more likely to be non-kothi-identified MSM (AOR 1.35, p<0.001), exposed to HIV intervention (AOR 1.22, p<0.05), and to have paying/paid partners (AOR 1.56, p<0.001); and less likely to use condom with paying male partners (AOR 1.51, p<0.001) and to report being in self-help groups (AOR 0.738, p<0.001). HIV interventions among MSM need to screen for alcohol use and refer frequent alcohol users to alcohol dependence interventions. Future studies need to identify the various causes behind alcohol use among MSM.

ABSTRACT
The present study is based on data screened at ICTC, I.M.S., B.H.U., Varanasi. Among 2806 females cases, 341 (i.e. 11.8%) were HIV positive. The percentage distribution of HIV positivity was 3.56, 14.73 and 18.54 in the age groups 15-24, 25-34 and 35-49 years respectively. This shows that as the age increases, HIV positive cases also increase and there was significant difference in the positivity percentage of HIV and the age groups (2 = 93.58, p<0.001). The percentage distribution of having experiences of multiple sexual contacts in HIV positive females is 60.34. The relative risk (R.R.) is 11.32 and 95% C.I. is 11.06-11.593. The positivity of HIV infection is also high (11.7%) and significant among women having the history of migration. The prevalence of infection is also high (17.33) in rural areas in comparison to 5.36% in urban areas. The co-morbidities were absent in 37.35% cases whereas 62.65% were with one or more morbidities. The significant morbidities with HIV infection were fever, weight loss, weakness, loose motion, T.B., cough, anorexia and others including STD symptoms and AIDS symptoms.

HIV/AIDS is a leading cause of morbidity and mortality in Sub-Saharan African (SSA) countries. As number of new HIV infection continues to increase in the region, interventions to reduce the spread of HIV/AIDS are needed especially in countries with high prevalence. Recent scientific evidence has shown that circumcision reduces HIV infection among heterosexuals. Swaziland is one of the countries with high HIV prevalence and low male circumcision rates. It is therefore important to examine the association between male circumcision and HIV infection in Swaziland.

The study used the 2006/7 Swaziland Demographic and Health Survey male and HIV datasets. Bivariate logistic regression was used to model the unadjusted, multivariate logistic regression was used to model adjusted association between MC and HIV infection. Results show that out of 2479 respondents that constituted the analysis sample, 91% were uncircumcised and HIV positive, while 8.9% were circumcised and HIV positive. Unadjusted results showed no association between circumcision status and HIV infection while adjusted results showed that male circumcision is protective against HIV infection. This suggests that male circumcision is not consistently associated with HIV infection in the studied population. Implications of the findings are discussed.

Youths are a priority age group for the policy makers, due to the fact that they are at higher risk to HIV/ADS and STIs. Their less knowledge and risky behavior may lead to make them more vulnerable. Government of India launched a nation-wide campaign, namely the Red Ribbon Express Train to create awareness among general population. The present study examined the impact of the second round of this intervention on increasing comprehensive knowledge and awareness about testing facilities. Findings reveals that youth have less knowledge about linkages between HIV/AIDS and testing facility as compare to adults, moreover, youth aged 15-19 years are found to be at higher risk due to having less knowledge of HIV/AIDS. The impact assessment findings suggest that overall RRE has been successful in increasing the knowledge levels in all concerned variables, and the average treatment effect is found to be 12 percent which is consistent in different models. The paper recommends reaching out to those segments of the youth population which are more vulnerable such as females, illiterate and those who are not exposed to any form of media to achieve better results in its next rounds.

Since HIV was identified as the cause of AIDS, variety of tests have been developed to help diagnose HIV infection and to determine its progress. Voluntary counseling and testing was introduced to prepare clients for HIV test because it is accompanied by fear.
The study analyses perceptions on HIV/AIDS among University of Cape Coast students. It is a quantitative study which employed questionnaires to collect data. Chi-square statistic was used to test the relationship between fear and decision to test for HIV.
Results indicate that 93% had knowledge about HIV test. More students (73%) were frightened to go for HIV test. Students (76.3%) perceived that when tested positive to HIV, they would be stigmatized, grieved or rejected. The students (26%) who tested for HIV were compelled: the prominent reasons were traveling requirements and medical conditions. Females were more frightened than males to test for HIV. Most of the married students were prepared to go for the test than unmarried students.
It is profitable to test for HIV but its perceptions make it difficult. Therefore, opinion leaders and healthcare professionals should educate students to correct wrong perceptions about HIV/AIDS to eliminate fear to reduce the spread and burden of HIV/AIDS pandemic.

Migration is radically changing the socio-economic, demographic and development profile of India. Hence an attempt has been made to explore the impact of male out-migration on the left-behind wives and compare the situation of these women with the wives of non-migrants using the National Family Health Survey-3 (2005-2006) data. The main focus of the study is on the health of the left-behind wives including RTI/STI and HIV. The study reveals that most of the out-migration is taking place from the rural areas in India. In a nutshell, one can say that migration of men provides some economic relief to their families, but the women have to pay a heavy price in the form of excessive stress. It does not improve the health status of the left-behind wives; rather, it puts them at a greater risk of developing STDs. Hence, male out-migration portrays dual predicament (positive and negative) for left-behind wives.

Antiretroviral Therapy (ART) has two well-described beneficial effects. First, it drastically prolongs the life expectancy of those receiving treatment, and second, it reduces HIV transmission to uninfected partners. The expansion of ART programs is thus expected to elevate HIV prevalence rates and reduce HIV incidence at the same time. These expectations are largely confirmed in a pooled dataset of five African demographic surveillance sites with HIV status information. Further, we find that the F/M sex ratio of prevalent infections increases over time and that suggests that ART coverage is better among women than men. This is corroborated by an increasing F/M sex ratio of incidence, suggesting that although the pool of HIV infected women is increased, less are infectious compared to the pool of HIV positive men. Our results thus indicate that higher ART coverage rates benefit HIV positive women (more than men) in term of increased survival, but benefit HIV negative men (more than women) because of a greater reduction in new infections.

Empirical estimates of the female-to-male sex ratio of infections in generalized HIV epidemics in sub-Saharan Africa range from 1.31 in Zambia to 2.21 in Ivory Coast. Gender inequalities in the sex ratio of infections can arise because of differences in exposure (to HIV positive partners), susceptibility (given exposure), and survival (once infected). Differences in susceptibility have to date received most attention, but neither the relatively high sex ratio of infections nor the heterogeneity in the empirical estimates in generalized epidemics is fully understood. In this contribution we focus on partnership network attributes and sexual mixing patterns that could lead to gender differences in the exposure to HIV positive partners. Using agent-based simulations, we show that gender asymmetric partnership concurrency, rapid partnership turnover, elevated partnership dissolution in female positive serodiscordant couples and lower partnership re-entry rates among HIV positive women can produce (substantial) differences in the sex ratio of infections. Coital dilution and serosorting have modest moderating effects.