Nuanced approaches to HIV/AIDS research

This study explores the prevalence of symptoms of Sexually Transmitted Infections and treatment seeking behaviour for STIs among the MSM (kothis, panthis and double-deckers) in Tamil Nadu, India, and to examine the net effect of socio-demographic and sexual risk behaviour factors on the symptoms of STIs and treatment seeking behavior among MSM community. Data for this study has been drawn from the DLCC survey conducted in 2010 by AIDS Prevention and Control (APAC) project, with a sample of 532 MSM in Tamil Nadu. The technique of logistic regression model has been used to estimate the net effect of each socio-demographic and sexual risk behavior factors on the likelihood of reporting symptoms of STIs and on treatment seeking behavior. The study shows that 14.1 percent of MSM reported any symptom of STIs in the past twelve months. Out of the MSM who reported any symptom of STIs, majority of them sought treatment. Multivariate analysis reveals that the significant predictors for the prevalence of symptoms of STIs amongst the MSM were higher level of education, living-in with other sexual partners apart from the spouse, living alone away from the spouse and having more than 11 sexual partners in the last six months.

Extensive efforts to improve reproductive health generally, and to increase awareness of HIV and AIDS specifically, have taken place across Central Asia over the past two decades. Such programs have coincided with significant increases in HIV/AIDS awareness. However, among women comprehensive HIV/AIDS knowledge remains modest across the region, and misconceptions concerning HIV transmission remain. Differentials by age, education, and rural/urban residence in awareness and knowledge regarding HIV and AIDs persist among women in the countries of Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. Using Demographic and Health Surveys and Multi-Cluster Indicator Surveys from 1999 through 2011 and reports, records, and interviews from health programs in the region, I examine increases in HIV and AIDS knowledge, tracing patterns of improvement across demographic, social and cultural sub groups within each country. Findings indicate a concerning trend in poor knowledge relating to needle transmission (the major transmission route for HIV in the region) and a persistent gulf in reported knowledge (at all levels) by marital status, age, education and urban residence. These results raise questions concerning the relevance of programmatic content (emphasizing ABCs and sexual transmission) in the region and program access and reception.

This study examined the relationship between exposure to HIV/AIDS Behaviour Change Communication (BCC) messages and attitudes towards HIV/AIDS among Ghanaian youth using data from the 2003 Ghana Demographic and Health Survey. Awareness of AIDS was almost universal; however, awareness of HIV/AIDS messages was not as high as awareness of AIDS. Among those who had heard or seen all three messages (39.3% among females and 41.4% among males) only 17.0% of females and 20.7% of males had favourable attitudes. A multiple linear regression analysis revealed that hearing or seeing two or all the three messages was significantly associated with attitudes. Religious spaces also play a key role in shaping attitudes. However, high awareness of AIDS and HIV/AIDS messages did not translate into more favourable attitudes. New messages and existing BCC messages should be critically evaluated to ensure success especially among the youth.

Introduction: In Cambodia, the HIV prevalence was 2.4% in 1999 and 1.1% in 2006. Overall access to and uptake of HIV testing and antiretrovirals (ARVs) for prevention of mother-to-child transmission (PMTCT) of HIV was low and limited for most pregnant women (PW) at that time. The Linked Response (LR) was launched to integrate PMTCT into maternal and child health services.
Methods: A descriptive analysis of routine data collected at LR sites, then of PMTCT program data including all antenatal care (ANC)/ PMTCT sites at national level from 2008 to 2011 was conducted.
Results: The number of operational districts (ODs) where LR was implemented increased from 5 to 71 between 2008-2011. The coverage of HIV testing among PW from 62% to 69% from 2009 to 2011.
Countrywide, the proportion of PW who attended ANC increased from 74% to 97% and the coverage of expected PW tested for HIV at ANC augmented from 25% in 2007 to 86% in 2011. In 2011, 62% of eligible PW received ARV prophylaxis. The proportion of exposed infants (EI) who received ARVs augmented from 27% in 2008 to 62% in 2011.
Discussion: The LR increased HIV testing, ARV uptake and follow up among PW and EI.
Conclusion: The LR contributed to the results of PMTCT. The effectiveness of the LR has been used to expand the provision of comprehensive PMTCT services nationwide.

Anti-retroviral therapy (ART) is one of the interventions currently in place to prolong the progression from HIV to AIDS for PLHIV. However, since the introduction of ART in Ghana in 2003, there has been scanty research on the preferences of PLHIV in accessing ART services. The main objective of the study therefore was to examine the preferences of PLHIV on ART services in terms of media, facility, service provider, time and cost of services. Through the purposive sampling procedure, a total of 145 FGDs and 171 IDIs were conducted among PLHIV, migrant workers, female sex workers, men having sex with men in 12 cities/towns selected from the three ecological zones of Ghana. The results show that the most preferred place for treatment was facility-based because it reduces stigmatization. Females were more sensitive to stigmatization than males and thus preferred a ‘foreigner’ to attend to them while males were indifferent. The radio and television were the most preferred media for education on ART but the information should be given by trained PLHIV as resource persons. ART services should be provided free of charge. Knowledge on the preferences of PLHIV on ART could inform policies and programmes on ART service delivery in the country.

This paper studies sexual behavior related to the spread of STIs including HIV/AIDS using the 2006 Uganda Demographic and Health survey women dataset. These include multiple sexual partnerships in the last 12 months preceding the survey, transactional sex, premarital sex and condom use. Results of the study show that 4.8% of the 8513 women studied were involved in sex for gain, 39.7% reported having involved in premarital sex, 20% having multiple sexual relationships and 67.3% reported non condom use at their last sexual encounter. There was statistical significance between the risky sexual behaviour of the women studied and having sexually transmitted diseases. Logistic regression shows statistical significance between risky sexual behaviour and sexual infection except for transactional sex. Findings suggest the need for educating people about sexual transmission preventive messages that are aimed at transforming beliefs, norms and behaviour about sexual health among women in Uganda. STIs prevention programmes should seek to understand and alter the risky sexual behaviour that increase susceptibility to sexual infections among the population

The link between HIV infection and poverty has attracted considerable research attention in recent years, but the relationship is rather complex and findings from existing studies remain inconclusive. While some argue that poverty increases vulnerability, existing empirical evidence from sub-Saharan Africa largely support the view that wealthier men and women, especially rural residents, have higher prevalence of HIV. In this paper, we focus on urban/rural differentials in the association between HIV infection and poverty in Kenya. The study is based on secondary analysis of data from the Kenya Demographic and Health Surveys conducted in 2003 and 2008. We apply multilevel logistic regression models, allowing the poverty risk factor to vary across rural and urban communities (i.e. clusters) in Kenya. The results suggest that the urban poor in Kenya have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Interesting urban/rural differentials are observed in poverty risk factor by key demographic and socio-cultural characteristics, including gender disparities and ethnicity. For example, the rich-poor gap among urban residents is wider for women, with poor urban women being particularly vulnerable.

Information on the health knowledge of migrants in Thailand is still lacking. Routine health intervention programs do not examine the useful analysis to evaluate the effectiveness of health information dissimilation despite the worldwide attempts to develop the comprehensive health information system. This paper studies the exposure to HIV/AIDS, Sexually Transmitted Infections - STIs, and reproductive health knowledge of migrant workers employing the data from an evaluation survey of the HIV/AIDS prevention program among migrant workers in Thailand (PHAMIT). Only one third of migrant workers have ever received information associated to HIV/AIDS, STIs, and reproductive health. Migrant workers in fishery, manufacturing, and construction industries were relatively disadvantage on information exposure since they were commonly bounded by protective fences and high walls which limit their capability to attach the useful information. The design of small group activities in the outreach program performed as a good model to strengthen knowledge of migrant workers.

The effectiveness of school-based sexual and reproductive health education may be limited by the socio-cultural and policy environment, the technical capacity of teachers to conduct such education, as well as technological advancements that may render traditional teaching approaches unappealing to many young people. This paper uses data from a pilot pre- and post-intervention study that was conducted in eight secondary schools in Nairobi, Kenya, between 2010 and 2011 to examine the effectiveness of using comic books to deliver HIV and AIDS messages to in-school young people. Information was collected through structured self-administered interviews with 3624 and 2914 students at baseline and endline respectively. Qualitative feedback from students was also obtained through drop-boxes. The findings show that the comic books were effective in improving students’ knowledge about modes of HIV infection; enhancing communication about the epidemic among them; positively changing their attitudes towards people living with HIV; reducing their fear and increasing their likelihood and intention of getting tested for HIV; and positively changing their sexual behaviours. The study underscores the need for age-appropriate communications channels to reach young people with HIV and AIDS information in settings that are affected by the epidemic.

Background: Failure to adhere to ART therapy led to increase in clients’ morbidity, mortality and development of drug resistance leading to unsuccessful outcome. There was lack of systematic and coordinated process of tracking clients.
Method: CT system was introduced, developed and implemented in 2007 to reduce loss to follow-up and increase client retention in care. Contact Tracking Team (CTT) were trained and supported via mentoring on the use of standardized CT tools and ART register update.
The CTT began tracking defaulters monthly and later a day after a client misses a refill appointment. Clients who miss refill appointment are captured as defaulters and are tracked immediately.
Referral network was established through and they are mentored on linkages/referral services and on defaulter tracking.
RESULTS: Three years after, the number of clients lost to follow-up reduced from 370 in 2006 to 45 in 2010. 222 clients who were once lost to follow-up have been re-started on ARV. The formation of CTT improved working relationship between staff and successful CT outcomes.
Conclusion: Effective CT can increase the number of HIV clients retained in care and reduce loss to follow-up. Use of standardized CT tools enhances systematic documentation of clients for improved treatment outcomes.