African Journal of AIDS Research 2021-05-28T11:10:03+00:00 Publishing Manager Open Journal Systems <p><a href="" target="_blank" rel="noopener"><em>African Journal of AIDS Research (AJAR)</em></a> is a peer-reviewed research journal publishing papers that make an original contribution to the understanding of social dimensions of HIV/AIDS in African contexts. <em>AJAR</em> includes articles from, amongst others, the disciplines of sociology, demography, epidemiology, social geography, economics, psychology, anthropology, philosophy, health communication, media, cultural studies, public health, education, nursing science and social work. Papers relating to impact, care, prevention and social planning, as well as articles covering social theory and the history and politics of HIV/AIDS, will be considered for publication.</p> <p class="MsoNormal">Subscriber information for this journal is available online <a href="" target="_blank" rel="noopener">here</a>.</p> Scientific HIV research in Africa and the Middle East: a socio-economic demographic analysis 2021-05-28T09:37:28+00:00 Marouane Menchi-Elanzi Hector Pinargote-Celorio Edy Nacarapa Gregorio González-Alcaide José-Manuel Ramos-Rincón <p><strong>Background:</strong> In Africa, HIV/AIDS research is concentrated in certain countries, particularly South Africa. This distribution may not accurately reflect the disease prevalence or the true research efforts of countries.<br><strong>Objectives:</strong> To identify HIV/AIDS research productivity of countries in Africa and the Middle East, in absolute terms and adjusted for people living with HIV, population size and economic development.<br><strong>Methods</strong>: We identified all the articles and reviews on HIV and AIDS in the Web of Science Core Collection in which African or Middle Eastern countries had participated. After determining the number of documents produced by each country, we adjusted the findings for the number of people living with HIV, number of inhabitants, gross domestic product and gross national income per capita.<br><strong>Results</strong>: African and Middle Eastern countries participated in 21.52% (n = 14 808) of all 68 808 documents analysed. East and Southern Africa produced 17.8% of all documents (n = 12 249), West and Central Africa accounted for only 3.34% (n = 2300), and the Middle East and North Africa, 1.18% (n = 814). South Africa produced 40.94% (n = 6 063) of all publications. Only two other African countries — Uganda (12.97%; n = 1 921) and Kenya (10.71%; n = 1 586) — produced more than 10% of these publications. The indices used for adjusting research productivity revealed the effort and contribution of other countries.<br><strong>Conclusion</strong>: Our study confirmed the leading role of South Africa in driving HIV/AIDS research, but also highlighted the contribution of countries such as Uganda, Malawi, Botswana, Zimbabwe and Mozambique.</p> <p><strong>Keywords</strong>: acquired immunodeficiency syndrome, bibliometrics, epidemiology, IDS, South Africa</p> 2021-05-28T00:00:00+00:00 Copyright (c) Exploring male condom use among women in South Africa: a review of the literature 2021-05-28T09:41:46+00:00 Rivesh Maharajh Firoza Haffejee <p>The male condom is the most cost-effective method for prevention of HIV and other sexually transmitted infections (STIs), yet in high-burden countries, promotion of its use remains difficult to achieve, especially among high-risk individuals. This review reports on women’s perspectives of male condom use and identifies outcome measures that will assist in understanding barriers to male condom use in a South African setting. The Boolean search method was used to retrieve literature, from which 18 studies met the inclusion criteria. The use of the male condom was generally low and inconsistent. Use was higher among women who engaged in transactional sex. Most women had difficulty in negotiating condom use with their partners, particularly if they were in male-dominated relationships or were financially dependent on their partner. Women with higher education levels were able to negotiate use more easily.&nbsp; Interventions for assertive negotiation skills were useful. However, the stigma of infidelity and HIV infection are barriers to condom use. Incorrect use further reduces protection. This review emphasises that women are a vulnerable group who are not always able to control their own protection. Further implementation of the health policies promoting interventions for condom use are required to assist women in taking control of their own protection. Intervention measures should be adapted to include the male population so<br>that they understand and accept condom use. Education to address unequal gender dynamics within relationships is also essential. Much work is required to make women feel less vulnerable in their relationships.</p> <p><strong>Keywords:</strong> behavioural intervention, contraception, female sexual behaviour, HIV prevention, sexual intercourse </p> 2021-05-28T00:00:00+00:00 Copyright (c) Demography of remarriage and fertility desire among women receiving antiretroviral therapy in South West Nigeria 2021-05-28T09:46:52+00:00 Joshua O. Akinyemi Rotimi F. Afolabi Olutosin A. Awolude E. Afolabi Bamgboye <p><strong>Background</strong>: In view of sociocultural norms surrounding marriage and childbearing in South West Nigeria, fertility desire may be stronger among remarried women living with HIV. This article describes the characteristics of remarriage and its relationship to fertility desire.<br><strong>Method:</strong> A cross-sectional study was conducted among HIV-positive women aged 18–49 years at the Antiretroviral Treatment (ART) clinic, College of Medicine/University College Hospital, Ibadan, Nigeria between November and December 2015. Data were analysed using descriptive statistics and generalised linear models.<br><strong>Results:</strong> Overall, 123 (17.3%) of 711 women had experienced remarriage. Significant factors among remarried women were a lack of formal education (ORadj = 3.35, CI: 1.46–7.72); polygamous family (ORadj = 2.65, CI: 1.71–4.12), and serodiscordant union (ORadj = 1.97, CI: 1.14–3.41). Fertility desire was expressed by 410 women (57.7%). After controlling for demographic, socio-economic, and HIV-care characteristics, remarried women were 2.5 times as likely to have fertility desire compared to their counterparts who never remarried (ORadj = 2.49, CI: 1.43–4.33). Younger age was significantly associated with higher odds of fertility desire. Other factors negatively associated with fertility desire were education (ORadj = 0.30, CI: 0.12–0.74) and number of surviving children (ORadj = 0.28,<br>CI: 0.22–0.34).<br><strong>Conclusion:</strong> HIV-care and treatment programmes need to pay attention to reproductive concerns, especially among women in second and higher order marriages.</p> <p><strong>Keywords:</strong> childbearing, fertility intention, HIV/AIDS, marital dissolution, marriage order </p> 2021-05-28T00:00:00+00:00 Copyright (c) Depressive symptoms among older adults with HIV in Namibia: the role of social support and spirituality 2021-05-28T09:55:26+00:00 Eveline Ndinelao Kalomo Jung Sim Jun Kyoung Hag Lee Mgori Nuru Kaddu <p><strong>Background:</strong> More than 60% of older adults living with HIV reside in sub-Saharan Africa. Namibia has one of the highest HIV/AIDS prevalence rates. This study examined the association between social support, spirituality and depressive symptoms.<br><strong>Method and results</strong>: The sample consisted of 147 Oshiwambo-speaking older adults (mean age = 61 years, SD = 6.92 years) with HIV in Namibia. By utilising a hierarchical multivariate regression method, this study found that social support from friends and spirituality showed a significant negative relationship to depressive symptoms. In addition, self-rated health status and alcohol use were significant sociodemographic predicitive factors of depressive symptoms.<br><strong>Conclusion</strong>: This study suggests the need to develop interventions and support programmes that incorporate peer support and spiritual practice to promote health and well-being among older persons living with HIV in Namibia.</p> <p><strong>Keywords</strong>: depression, HIV-positive seniors, social aspects, spiritual outlook</p> 2021-05-28T00:00:00+00:00 Copyright (c) Motivating people living with HIV to initiate antiretroviral treatment outside national guidelines in three clinics in the HPTN 071 (PopART) trial, South Africa 2021-05-28T10:12:19+00:00 Constance Mubekapi-Musadaidzwa Dillon Wademan Neshaan Peton Portia Hendricks Gabriela Carolus Rheiner Mbaezue Karen F. Kelley James Kruger Karen Jennings Nelis Grobbelaar Francoise Louis Nulda Beyers Helen Ayles Sarah Fidler Richard Hayes Peter Bock Graeme Hoddinot for the PopART Study Team <p><strong>Background:</strong> The HPTN 071 (PopART) trial implemented universal test and treat (UTT) in three clinics in the Western Cape, South Africa at a time when antiretroviral treatment (ART) was only offered by CD4 threshold and World Health Organization clinical staging. This required a concomitant shift in the way health workers communicated ART initiation messages. We provide insight into front-line ART initiation communication pre-national policy shift.<br><strong>Method:</strong> The design of this study was exploratory with a case descriptive analysis of ART initiation in three clinics. To characterise their demographic profiles, we reviewed 134 randomly selected patient clinical folders of people who initiated ART at CD4 counts greater than the recommended standard. Further, we conducted 12 key informant interviews with health workers at these facilities and thematically analysed health workers’ responses.<br><strong>Results:</strong> The median age of patients initiating ART regardless of CD4 count (above the threshold level) was 33 years and most were women (73.9%), married (76.1%), and unemployed (48.5%). The median CD4 count of patients initiating outside guidelines was 566.5 cells/µl. Contrary to expectations, key informants indicated no radical shift in messaging to explain ART initiation regardless of CD4 count. Rather, they encouraged people living with HIV (PLHIV) to initiate ART while they still “feel well”. The reduced risk of onward HIV transmission did not factor significantly in how health workers motivated clients.<br><strong>Conclusion:</strong> Motivating PLHIV to initiate ART regardless of CD4 count in high burden settings is possible. However, there are still opportunities to improve messaging about immediate ART initiation or at high CD4 counts for the prevention of onward transmission.</p> <p><strong>Keywords</strong>: ART initiation, immediate ART, treatment as prevention, universal testing and treatment (UTT)</p> 2021-05-28T00:00:00+00:00 Copyright (c) The psychosocial determinants of the intention to test for HIV among young men in KwaZulu-Natal province, South Africa 2021-05-28T10:19:14+00:00 Thabang Manyaapelo Robert A.C. Ruiter Sibusiso Sifunda Anam Nyembezi Bart van den Borne Priscilla Reddy <p><strong>Background</strong>: Voluntary counselling and testing is one of the effective prevention strategies against the HIV/AIDS epidemic. This study investigated the psychosocial determinants of the intention to be tested for HIV among young men in South Africa’s KwaZulu-Natal province using the theory of planned behaviour as the guiding framework.<br><strong>Method</strong>: A facilitator-administered questionnaire was used to collect data among 350 isiZulu-speaking men between the ages of 18 and 35.<br><strong>Results</strong>: Results show that 24% reported ever having tested. Intention to test showed strong positive correlations with subjective norm to test (r = 0.67), intention to use condoms (r = 0.65), intention to reduce alcohol use (r = 0.60), subjective norm to reduce alcohol use (r = 0.54), and subjective norm to use condoms (r = 0.51). For multiple regression, attitude, subjective norm and perceived behavioural control explained 43% of the variance in intention to test, with subjective norm and perceived behavioural control making significant unique contributions. An additional 12% of the variance was explained by intention to reduce alcohol and drug use, and use condoms.<br><strong>Conclusion</strong>: Behavioural interventions to encourage HIV testing among men should target normative and control beliefs but also other risky behaviours (e.g. alcohol abuse and condom use) as reductions in these behaviours appear to be positively associated with&nbsp; motivation to undergo HIV testing.</p> <p><strong>Keywords</strong>: antiretroviral therapy (ART), HIV testing, psychosocial determinants, theory of planned behaviour, voluntary counselling and testing (VCT) </p> 2021-05-28T00:00:00+00:00 Copyright (c) The dapivirine vaginal ring from the perspective of married men in Uganda 2021-05-28T10:27:19+00:00 Anita Kabarambi Sylvia Kusemererwa Emily Krogstad Philippe Mayaud Janet Seeley Joseph Mugisha Mitzy Gafos <p><strong>Background:</strong> Men play a key role in influencing uptake of women’s health products, such as female condoms and vaginal microbicides used for family planning and HIV prevention.<br><strong>Method:</strong> We explored men’s perceptions of the dapivirine vaginal ring (DVR), a vaginal microbicide, in Kalungu District, rural south-western Uganda. In June/July 2018, we conducted in-depth interviews with 10 partners of women participating in the DREAM study, a phase 3B open-label extension trial of the DVR. Data were analysed thematically, drawing on the socio-ecological model theoretical framework.<br><strong>Results:</strong> Influencing factors such as individual and interpersonal characteristics, perception of HIV risk, lack of knowledge about the DVR, misconceptions, and product characteristics acting at different levels (individual, societal and organisational) affected men’s knowledge, attitudes and perceptions towards the DVR, which in turn impacted on their willingness to allow their partners to use it. Above all, men wanted to be involved in the decisionmaking process about the use of the DVR. All the men were happy that there was a new HIV prevention option in the pipeline and were not concerned about the degree of effectiveness, saying it was better than nothing.<br><strong>Conclusion:</strong> The use of the DVR in an environment where men expect to make decisions about sex on behalf of women may affect its usage and success. Given this context, women may not always be able to independently choose to use it. If the DVR is approved and rolled out, increased sensitisation of men about it will be critical to ensure its uptake.</p> <p><strong>Keywords:</strong> Africa, decision-making, HIV prevention, microbicide ring, socio-ecological framework </p> 2021-05-28T00:00:00+00:00 Copyright (c) Women’s perspectives on relationship dynamics with their partners and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use 2021-05-28T10:41:57+00:00 John C. Chapola Kendra Hatfield-Timajchy Agatha K. Bula Stacey Hurst Lameck Chinula Athena P. Kourtis Jennifer H. Tang <p><strong>Background:</strong> Limited information exists about relationship dynamics and their role in HIV acquisition, HIV disclosure, hormonal contraceptive uptake, and condom use among women in Malawi.<br><strong>Methods:</strong> Ninety-seven women aged 18–45 years were randomly assigned to initiate the depot medroxyprogesterone acetate injectable or levonorgestrel implant from May 2014 to April 2015 in Lilongwe, Malawi. Women were recruited after randomisation to participate in semi-structured interviews about HIV and family planning using purposive sampling. Interviews were thematically analysed using within and between group comparisons.<br><strong>Results:</strong> We conducted individual interviews and/or focus group discussions with 41 women: 30 (73%) women living with HIV and 11 (27%) women not living with HIV. Most women living with HIV who participated in in-depth interviews disclosed their status to their partners, and most partners agreed to get HIV tested only after disclosure. Nearly all women said their partners agreed to use condoms, but few used them consistently. Nearly all women believed their current and former partners had outside partners. Most women living with HIV who participated in in-depth interviews believed their current or other serious partners were the source of their infection. Some women thought their partner’s infidelity was due to their partner’s disinterest in sex with them during menstrual/<br>breakthrough bleeding. Some women included their partners in contraceptive decision-making when the partner was supportive.<br><strong>Discussion:</strong> Relationship dynamics affected decision-making for contraceptive and condom use, as well as serodisclosure for the women living with HIV in the study. All women reported challenges with consistent condom use with their male partners, although contraceptive use was generally more acceptable. Women included their partners in their decision-making concerning contraceptive use when they were supportive.</p> <p><strong>Keywords:</strong> concurrent partnerships, condom acceptability, contraceptive use, HIV acquisition, HIV disclosure, relationship dynamics</p> 2021-05-28T00:00:00+00:00 Copyright (c) Strategies of coping with the effects of HIV/AIDS in Chinamhora communal lands, Goromonzi rural district, Zimbabwe 2021-05-28T10:44:38+00:00 Wilberforce Kurevakwesu <p>This qualitative study assesses the impacts of HIV/AIDS on rural households in Chinamhora communal lands, explores the coping strategies of these rural households and establishes possible interventions towards improving their coping strategies. The study comes at a time when deaths from HIV/AIDS have reduced dramatically in Zimbabwe and beyond, yet people in rural areas continue to be highly predisposed to HIV-related illness and death. A case study design was used in this study and the researcher selected a sample of 61 household heads using convenience sampling. Participants were interviewed and the collected data were analysed through the&nbsp; NVivo software package. The findings were then presented in line with the themes that emerged from data analysis. Participants of the study highlighted various impacts of HIV/AIDS on their households, particularly in line with their agricultural activities, the decline in household income and social marginalisation. They also illustrated the strategies that they use to cope with the effects of HIV/AIDS. The research, in response, identified feasible interventions towards strengthening these coping strategies, with the reinforcement of informal home-based care and the expansion of social protection programmes to the rural community being some of them.</p> <p><strong>Keywords:</strong> agriculture, coping strategies, communal areas, HIV and AIDS, household income, rural households </p> 2021-05-28T00:00:00+00:00 Copyright (c) “Out there it’s YOLO”: Youth perspectives on a mass media HIV- and gender-based violence campaign in South Africa 2021-05-28T10:47:16+00:00 Gavin Robert Walker <p>Gender-based violence continues to be a leading determinant of South Africa’s HIV/AIDS epidemic. As such, gender socialisation and de-normalisation of gender inequality and violence remain principal objectives for public health organisations. This article discusses youth reception of a mass media HIV/AIDS prevention campaign targeting gender inequality. Applying social cognitive theory to the analysis of focus group data highlights three interrelated challenges to encouraging positive self-efficacy in gender-based violence and HIV prevention: (1) HIV/ AIDS-related media saturation; (2) AIDS messaging fatigue; and (3) challenges reconciling popular youth culture with gender equity messaging. The article recommends public health and social justice organisations consider a flexible approach to the ideological or behavioural congruence of potential celebrity ambassadors and/or media to maximise youth appeal and reduce messaging fatigue.</p> <p><strong>Keywords</strong>: celebrity advocacy, gender inequality, HIV/AIDS messaging fatigue, mass media campaigns, popular culture, public health promotion</p> 2021-05-28T00:00:00+00:00 Copyright (c) Mobile applications for sexual encounters accessed by men who have sex with men: Information on sexually transmitted infection 2021-05-28T10:52:08+00:00 Janice França Queiroz Kleyton Santos de Medeiros Ayane Cristine Alves Sarmento Ana Luisa Fernandes Vital Beatriz Stransky Ana Katherine Gonçalves <p>We evaluated existing mobile applications (apps) on both Android and iOS (Apple) platforms that are used by men who have sex with men (MSM) to obtain sexual encounters. The word “gay” was used to search for apps in the Apple and Google Play virtual stores. The 10 most downloaded apps were analysed concerning safe sexual practices (SSP) messages. Out of 245 apps selected, 213 were evaluated — 102 for Android and 111 for iOS. Mostly social networks were accessed by MSM of which 112 allow access to people aged 14 and over. Most of the apps could be downloaded in more than two languages. Of the 10 most downloaded and evaluated apps, 5 had no HIV/STI and SSP messages, only 3 contained HIV/STI and SSP messages, and 2 had information about one or the other. Several social networking apps are available, however, there is no information on HIV/STI in the most accessed apps.</p> <p><strong>Keywords:</strong> men who have sex with men, mobile app, sex education, sexual health, sexually transmitted infections </p> 2021-05-28T00:00:00+00:00 Copyright (c) Determinants of loss to follow-up among people living with HIV on antiretroviral therapy in Nigeria 2021-05-28T10:56:26+00:00 Farouq Muhammad Dayyab Fahad Mukhtar Garba Iliyasu Abdulrazaq Garba Habib <p><strong>Background:</strong> Considerable success has been recorded in the global fight against the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Retention in care is the key to the attainment of set goals in the fight against the disease. We aim to determine the factors associated with loss to follow-up (LTFU) among people living with HIV on antiretroviral therapy (ART) in a limited resource setting.<br><strong>Method:</strong> This was a retrospective cohort study that included adult patients who accessed ART at the study site between January 2005 and October 2018. A multivariate logistic regression model was used to obtain adjusted odds ratios and 95% confidence intervals of independent determinants of LTFU.<br><strong>Results:</strong> Of the 8 679 patients included in the study, 3 716 (43%) were males, 4 009 (46%) were enrolled during the years 2005 to 2008, 8 421 (97%) spent less than two hours travelling from their residence to the treatment centre, and 3 523 (41%) had their first-line ART regimen changed. Among the characteristics that determine LTFU were male patients (OR = 1.167, 95% CI: 1.071–1.272), and World Health Organization clinical stage 3 (OR = 2.091, 95% CI: 1.485–2.944).<br><strong>Conclusion:</strong> In our study, male gender, enrolment year 2005 to 2008, no change in first-line ART and nevirapinebased therapy were more likely to be associated with LTFU.</p> <p><strong>Keywords:</strong> adherence, adult, cohort studies, retention in care </p> 2021-05-28T00:00:00+00:00 Copyright (c) Women living with HIV in Nigeria: Predictive influence of hardiness on perceived stress 2021-05-28T11:00:40+00:00 Aliyu Adamu Gugu Mchunu Joanne Rachel Naidoo <p><strong>Background:</strong> Women living with HIV experience severe HIV-related stress in sub-Saharan Africa. But evidence shows that individuals with high levels of the psychological hardiness characteristic who accept stressful situations as meaningful experience may withstand psychological stress. However, the literature on associations between hardiness and HIV-related stress among women living with HIV is scarce. The objective of this study was to investigate the relationship between hardiness and HIV-related stress among women living with HIV in Niger State, Nigeria.<br><strong>Methods</strong>: This study used a cross-sectional design. A systematic sampling technique was used to recruit 748 participants from three selected hospitals in Niger State. The perceived stress scale and the health-related hardiness scale were used for data collection. A total of 676 questionnaires were returned in usable form and were analysed using hierarchical regression analysis.<br><strong>Results:</strong> Pearson’s correlation analysis showed that there is a statistically significant association between perceived stress and subscales of hardiness (p &lt; 0.001). Hierarchical regression analysis results showed that hardiness significantly predicted perceived stress among the study sample with R<sup>2</sup> = 0.286, F(3, 669) = 90, p &lt; 0.001.<br><strong>Conclusion</strong>: The finding of this study that higher hardiness is associated with lower perceived stress suggests the potential helpfulness to women living with HIV of this personality for coping. The finding also suggests that nurses and other health care workers may facilitate the development and/or improvement of hardiness characteristics through cognitive behavioural interventions among women living with HIV to ameliorate HIV-related stress.</p> <p><strong>Keywords</strong>: adversity, coping, resilience, sub-Saharan Africa, traits </p> 2021-05-28T00:00:00+00:00 Copyright (c) HIV and aging among adults aged 50 years and older on antiretroviral therapy in Eswatini 2021-05-28T11:08:01+00:00 Tiffany G. Harris Sarah Flören Joanne E. Mantell Rejoice Nkambule Nomthandazo G. Lukhele Bongiwe Prudence Malinga Rhinos Chekenyere Altaye Kidane <p><strong>Background:</strong> Antiretroviral therapy (ART) has decreased HIV-related morbidity and mortality and increased life expectancy of people living with HIV (PLHIV). Globally, the number of older PLHIV (OPLHIV; ≥50 years) is growing and predicted to increase substantially in coming years. In sub-Saharan Africa, where the majority of OPLHIV reside, there are limited data on the health and well-being of OPLHIV.<br><strong>Methods</strong>: We conducted an exploratory descriptive study that included structured interviews with 50 OPLHIV receiving ART at an outpatient HIV clinic in Eswatini and in-depth qualitative interviews (IDIs) with a sub-set of ten participants to elicit their experiences of living with HIV as an older adult, including quality of life, physical health, and mental health. Quantitative analyses were performed to obtain both descriptive statistics and cross-tabulations. A thematic analysis of IDI narratives was conducted based on three levels of the socio-ecological model to identify sub-themes and response patterns.<br><strong>Results</strong>: All study participants were virally suppressed. Self-reported non-communicable disease (NCD) risk factors and markers were common, with 40% (n = 20) reporting being current or former smokers, 0% consuming the recommended servings of fruits and&nbsp; vegetables per day, and 57% (n = 28 of 49 reporting screening) reporting having hypertension. However, the majority (88%; 44 of 50) had sufficient physical activity; most of the activity was in the work domain. Slightly more than one-third (38%; 13 of 34 tested) had a high random blood sugar level. Barriers to living with HIV were primarily structural (food insecurity, unemployment, access to transportation and health care).<br><strong>Conclusions:</strong> OPLHIV should be screened for NCDs, and services for NCDs should ideally be integrated with HIV services. While all participants had controlled HIV, this study highlights the need for strategies that facilitate OPLHIV’s HIV service utilisation. With the increasing numbers of OPLHIV, these issues cannot be ignored.</p> <p><strong>Keywords</strong>: Africa; barriers to medical care; mixed-methods research; non-communicable diseases </p> 2021-05-28T00:00:00+00:00 Copyright (c)