Poster session on HIV/AIDS and STDs (1)

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.

Between 1989 and 2009, we annually collected data on pregnancies, family planning use, education level and marital status in 10,008 female adolescents aged 11-19 years, and obtained their HIV status. School attendance increased during the study period, with higher school enrolment observed among girls with educated parents. Fertility rates rose from 9/1000 in 14 year olds to 200/1000 in 19 year olds. Adolescent Fertility Rate (AFR) decreased from 0.7 in 1990-94 to 0.5 in 2005-09 due to fertility decrease among adolescents with secondary education from 0.7 to 0.3 in the same period, and increase in secondary school attendance. Higher fertility was among the ever married, those with lower education, and the HIV positives with AFR of 0.9 compared to 0.6 of HIV negative adolescents. By the age of 20 years, 2% of adolescent girls were HIV infected. The ever married (AFR=2.2) had 8 times the fertility of the never married (AFR=0.25). Of the self-reported sexually active adolescents, 20.4% used family planning (56%-condoms, 42%-injections, and 2.4%-pills), and 14% had unfavourable pregnancy outcomes. Inter-sectoral interventions are urgently needed to empower adolescent girls in preventing pregnancy, HIV infection, and early school drop-out during their initial sexual encounters.

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.

In this paper an attempt has been made to study the socio-economic attributes of the HIV positive cases in Mizoram- a state in India located close to the ‘Golden Triangle’. Vulnerability to HIV/AIDS in the state increases due to state’s geographical proximity to international boundary (Bangladesh in the West and ‘Golden Triangle’ – Myanmar, Thailand and Laos in the East), where there is high incidence of HIV/AIDS and the region which traditionally offers passage to drug and heroin. The study takes into account the demographic background of the infected persons including their age, sex, marital status as well as their family, educational status and religious persuasion etc. Their economic status and the mode of contracting the infection, level of awareness etc constitute the other aspects. The study through personal interviews of some 30 odd infected persons also investigates into the consequences they face in the society in terms of reaction of the family, discrimination faced etc.

Sexuality is an important human phenomenon which is influenced by interaction of biological, psychological, social, cultural or religious factors. Many studies in sub-Saharan Africa have shown that multiple sexual partnerships contribute to the spread of HIV despite the high knowledge of HIV/AIDS transmission routes. Past studies on sexual behaviours in Nigeria have focused on women and adolescents while men’s sexuality has not been adequately explored. This study used data extracted from 2007 National HIV/AIDS and Reproductive Health Survey of sexually active Nigerian men aged 15-64years to investigate correlates and pattern of sexual partnership among men in Nigeria using multilevel logistic regression models. The findings indicate that individual characteristics such as ever use of condom, occupation, marital status influenced sexual behaviour of men compared to their contextual characteristics. Compared to men in the poorest group, moderately rich men were more likely to have multiple (OR=1.10, 95%CI=0.93-1.30) and non-regular sexual partners (OR=1.05, 95%CI=0.89-1.25). To promote safe and healthy sexuality among Nigerian men, behavioural intervention on sexual partnership targeting on individuals especially those in the middle class should be incorporated in the reproductive health policies.

Background
HIV/AIDS pandemic has had devastating social, health, economic and psychological impacts on persons with AIDS and their parents. AIDS parents represent one of the largest groups of persons that are socially impacted by the epidemic. Yet, despite the fact that their adult children’s illness and death affect them in many consequential and adverse ways, they have attracted little attention from national and international agencies.

Methods
There were twenty four In-depth Interviews and four Focus Group Discussions with a purposive sample of participants. Group members discussed caregiving roles in households with PLWHIV/AIDS, health strains, social, economic and adherence to treatment by patients and caregivers. Analyses were carried out using Atlas.ti.

Results
Analysis revealed that despite key informants and participants being knowledgeable about caregiving roles, mothers were identified as main caregivers. The majority expressed unfavourable attitudes toward gender domination behaviours in caregiving situations. Since many parents were in older age, it made them particularly vulnerable to physical strains associated with caregiving.

Conclusions
Older people are rarely visible to government and NGO agencies, though caring for AIDS adult children has greater impact on health of caregivers

This study was to identify factors that affect survival of HIV/HBV co-infected patients. Data from TASO Uganda was used, and patients who registered with TASO between 2005 and 2010 were followed to determine their survival. The covariates of study were social-demographic and clinical factors. To estimate the survival function for every subgroup of each variable, the product- limit method developed by Kaplan and Meier was used and a log rank test to compare the survivorship functions across several groups. A proportional hazards model was used to examine the joint effect of the covariates on the duration of survival assuming a Gompertz distribution for the time variable. Results revealed the duration of survival for HIV/HBV co-infected patients increased with increasing weight. Patients who had Hepatocellular carcinoma or Cirrhosis at diagnosis were at an increased risk of death as compared to those who had chronic active hepatitis B. Patients on ARVs had an increased death rate as compared to their counter parts. Educated patients had a reduced death rate as compared to the uneducated ones. Therefore, emphasis should be on designing Information Education Communication (IEC) materials to sensitize the uneducated HIV/HBV co-infected patients on effects of non compliance and unbalanced diets.

The activities of non-state actors (NSAs) that work to prevent and mitigate HIV in Nigeria have grown dramatically, as funding has become more available. Increased opportunities, however, also mean an increasing opacity concerning the different sources of funding that NSAs access. In order to gather funding source information for NSAs, interviews with 533 NSA and 48 key informants provided a wealth of information on specific projects and donors.

This study shows that NSAs operate in a complex environment. NSAs both combine funding from multiple sources to carry out their activities and undertake an individual project with a single funding stream, particularly if funding originates with a major donor. A review of the projects analyzed for this report indicated that the donors providing most of the funding were:
• The US Government
• The Nigerian state, in partnership with the World Bank and Global Fund
• Nigerian NGOs

Many Abuja-based government and donor personnel interviewed were skeptical of the capacity and sincerity of many smaller NSAs. While the majority of project funds were not internally generated by NSAs, many NSAs have means of financing their activities through fundraising, income-generation, or other activities, pointing to a higher capacity for funding sustainability than is often believed.