Nuanced approaches to HIV/AIDS research

Little is known about risky sexual behaviors of HIV-positive Female Sex Workers (FSWs) in the developing world. This study aims to shed light on their condom use with regular clients and husbands, a first in India. Logistic regression analyses for consistent condom use with those partners are conducted for the sample of 606 HIV-positive FSWs in Karnataka. Older and non-migrant FSWs are less likely to consistently use condoms than younger and mobile FSWs (90 and 70% respectively). FSWs who changed occupations after HIV diagnosis are 70% less likely to use condoms. FSWs on ART, those currently cohabiting, and those that have felt stigma associated with being HIV-positive are more likely to have consistent condom use. FSWs with multiple repeat clients and who do not know the sexual behavior of these clients are more likely to use condoms consistently. These findings would help inform programs to target particularly vulnerable HIV-positive FSWs.

This study is based on 6007 subjects of reproductive age group (3201 males and 2806 females) referred for sero-positivity status at ICTC, IMS, BHU, Varanasi. Overall sero-positivity of HIV was 15.3% (18.1% in males and 12.2% in females) which increased 6-7 folds in the age group 35-49 years as compared to 15-24 years in both the sexes. Sero-positivity rate in male migrants was 43.1%, while in female migrants it was 18.7%. The history of multiple sexual contacts was about 3 times higher in males as compared to females; predominantly very high in male migrants (67.7%) compared to male non-migrants (15.8%). History of multiple sexual contacts was not uncommon in females migrants (25.0%) and 9.7% in non-migrant females. The sero-positivity rate with the history of multiple sexual contacts was 45.4% in males and 60.3% in females, while without history of multiple sexual contacts these were only 2.8% and 5.3% respectively. Sero-positive cases had on an average 3.6±1.7 various morbidity symptoms as compared to 0.7±1.1 in sero-negatives. Sero-positivity rate was more in those females who seemed apparently healthy compared to those presenting with some of the symptoms; males presenting with some symptoms HIV infection was 7 times higher than those without symptoms.

The number of People Living with HIV/AIDS (PLWHA) in Nigeria is among the highest in sub-Saharan Africa. Escalating number of PLWHA in Nigeria demands for more number of caregivers. The information on perception of women on Willingness to Give Care (WGC) to PLWHA is insufficient in Nigeria, hence this study. The study utilized NDHS 2008 dataset with focus on women aged 15-49(n=27,195). Analysis was done using Chi-square and logistic regression models. Mean age of the women was 28.79±9.4years. The prevalence of women who were WGC to PLWHA was 65.4% with urban women (70.8%) WGC to PLWHA than their rural counterparts (61.9%;p<0.05). WGC to PLWHA increases with increasing level of education (p<0.05). The higher the level of wealth index, the higher the percentage of women who were WGC to PLWHA. Women who knew someone who had died of HIV/AIDS (82.8%) were WGC than those who did not (62.8%;p<0.05). Female youths (15-24 years) were more likely (OR=1.1,C.I=1.07-1.23) not Willing to Give Care (NWGC) to PLWHA than older women. Agreeing that PLWHA should be ashamed of themselves (OR=2.8,C.I=2.60-2.90) inhibits NWGC to PLWHA than disagreeing. The odds of NWGC to PLWHA was strikingly lower among women residing in the Northern Nigeria (OR=0.30,C.I=0.28-0.33) than South.

Using data from the 2007 IBBS in Indonesia, the study investigated the influence of individual- and contextual-level factors on condom use among 1,371 clients of female sex workers (FSW). A two-level random intercept model was specified for the multilevel analysis. The model included individuals at the first level and derived aggregates of an environmental-structural index, constructed using principal component analysis (Cronbach’s α = 0.71; Eigenvalue 2.94), at the second level. The analysis measured three outcome variables: condom use at last sex; in past 3 months; and in past year. Controlling for sociodemographic characteristics, environmental-structural support was a significant predictor of condom use at last sex (OR 1.77; 95% CI: 1.22-2.55; p<0.01), in the past 3 months (OR 2.23; 95% CI: 1.31-3.82; p<0.01); and in the past year (OR 2.09; 95% CI: 1.27-3.42; p<0.01). Almost one-fourth of the variation of condom use at last sex was accounted for by environmental-structural factors; this increased to almost one-third for condom use in the past 3 months and year. HIV prevention programs would benefit from efforts targeting the environmental-structural context to improve condom use behaviors and reduce HIV risk among male clients.

Though global HIV/ AIDS incidence is declining, HIV/AIDS remained the leading cause of death in women of reproductive age in low-and middle-income countries, particularly in sub-Sahara Africa. Given the high costs of HIV treatment, evidence-based targeted interventions are advocated as cost-effective strategy to fighting HIV/AIDS.
This study aims to assess the socioeconomic predictors of HIV infection and identify the most-a-risk groups among women in Malawi using a Chi-square Automatic Interaction Detector. The analysis was performed on a sample of 8,596 women aged 15-49 years from the 2004 and 2010 Malawi Health and Demographic Surveys.
The results revealed that marital status is the most significant predictor of HIV infection among women in Malawi. Women who are no longer in union and living in the households within the highest wealth quintiles were the most-at-risk group of HIV infection. The less-at-risk group included nulliparous never married women living in the rural areas. In the light of these findings, we recommend targeted interventions taking into account HIV prevalence and the demographic size of different groups at risk groups; and reinforcement of integration of family planning and HIV/AIDS services through community health workers, households and school based campaign and reproduction health services.

Uganda registered a tremendous decline in HIV prevalence rates from 15% in 1991 to 5% in 2002 then up again to 6.4% in 2006 (2006 UDHS). Over years, the uptake and practice of preventive behaviour have declined, particularly among men. Currently, almost 40% of people with HIV are not diagnosed until they already have developed AIDS. The study aimed to assess the contribution of men in the fight of HIV/AIDS through HIV Counselling and Testing (HCT). The project monitored all individuals attending Sexually Transmitted Disease (STD), Safe Male Circumcision (SMC) and Anti Retroviral Treatment (ART) clinics. The project sought to check whether when requested, males brought their female counterparts for testing and vice versa during the September 2010 to Sept 2011 at a health facility. Clinical data was used. More males once tested brought more spouses for testing. The numbers were much less vice versa. For every 1 man tested at least 3 women were tested. This was also recorded in polygamous relationships.

Background:India housing world’s largest rural population of around 0.8 billion (UN Report 2006) is estimated to have over 57% of HIV positive persons living in rural areas (HSS India 2007). Paper describes findings from study of Link Worker Scheme (LWS) in rural areas of 219 highly vulnerable districts across India.
Methods:Evaluation involved qualitative appraisal of LWS processes & quasi-experimental study of programme among High Risk Groups (HRG) across study and comparison districts in 12 Indian states selected on the basis of their vulnerability using HSS, 2006 data. Sample size was calculated using point estimation formula: n=t2 X p (1-p) X f /d2. Total sample of 15194 was covered in the survey conducted in July 2012 and analyzed using SPSS.
Results:Qualitative insights emerged for policy & strategy, financial systems, IEC, and linkages. Logistic regression using quantitative data generated predictors for enhancing knowledge, attitude and consistent condom use. HRGs in study districts received significantly (p<0.5) better care increasing their knowledge and reducing risky behaviour. Proportion confirming consistent condom (programme outcome) was higher in study district than comparison districts (88% vs 38%; p<.001).
Conclusion:Improvement in span of 3 years was possible by planned utilization of local resources.

Of the total number of refugees and immigrants accepted into Canada every year, around half originate from Asia. Today, South Asians have become the second largest and most diverse visible minority group in Canada. South Asia has been facing an HIV pandemic, and an estimated six million people have been infected and at least 60 percent of HIV+ people in Asia live in India alone. In Canada until 2009, 69,844 cases tested positive for HIV. The numbers who are HIV+ entering Canada from South Asia may be substantial. At present, however, little is known empirically or even anecdotally about the extent of this risk and its impact on health.

This research attempts to assess the perceptions of South Asians in Canada towards HIV and AIDS, and ascertain the prevention and treatment services that they are aware of, accessing, including community based care and the Canadian public system. At a bigger scale, this research seeks to identify the ways in which immigrants and refugees/refugee claimants who are HIV+ from South Asia are vulnerable to discrimination in Canada because of the following factors, which include but are not limited to: lack of information about HIV/AIDS incidence in the community; inability of the Canadian health system to respond appropriately with the lack of information; the community’s need for introspec

We evaluate Respondent Driven Sampling (RDS)’s claim of population representation with empirical data by exploring the network coverage in a RDS study of female sex workers (FSW) in China. We take advantage of unique information on the social networks of FSW obtained from two overlapping studies of FSWs --RDS and a venue-based sampling approach (PLACE) -- and use an exponential random graph modeling (ERGM) framework from local networks to construct the likely network from which our observed RDS is drawn. We then run recruitment chains over this simulated population and produce a sample with characteristics consistent with the observed RDS. We estimate population coverage rates by comparing population proportions and RDS sample proportions. We discuss the results in light of (a) potential estimation improvements implicit in network information, (b) strategies for improving coverage rates, and (c) multiple sources of potential variability in coverage.

Concurrent partnerships are often considered a primary driver of the HIV epidemic in Sub-Saharan Africa. Due to data constraints, however, few studies have been able to demonstrate its effect using empirical data. In this paper, we test whether HIV transmission rates are higher for individuals with concurrent partners - an effect that is ascribed to the higher viral load shortly after seroconversion. Data spanning a 14-year time period are pooled from two rural community sero-surveillance sites in south-Western Uganda. Sero-concordant negative married couples are followed over time, examining the risk of seroconversion for couples exposed to concurrency. A discrete-time hazard model is used to determine the risk of seroconversion among women whose husbands reported a concurrent partnership. We are unable to detect an effect of the husband’s concurrency on the HIV incidence of their wives. Our preliminary findings are in support of a growing body of literature that casts doubt on the role of concurrency for the spread of HIV.