African Journal of AIDS Research <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> NISC en-US African Journal of AIDS Research 1727-9445 Copyright for articles published in this journal is retained by the publisher. Level of adherence and associated factors among HIV-positive adolescents on antiretroviral therapy in Cameroon <p><strong>Aim</strong>: Globally, there were over 250 000 new HIV infections among adolescents in 2017, with a higher proportion of these in sub-Saharan Africa. In Cameroon, UNICEF estimated over 4 200 new HIV infections in adolescents in 2015; by 2016, there were over 40 000 adolescents who had HIV. Given that the number of adolescents living with HIV in Cameroon is on the increase, there is a need to better understand the factors influencing adherence to treatment. The objective of this study was to assess the factors associated with adherence among adolescents in Cameroon.<br><strong>Methods</strong>: A cross-sectional study was conducted. A total of 460 HIV+ adolescents who were receiving antiretroviral therapy were sampled randomly from nine health facilities. Questionnaires and data extraction forms were used to collect data. Descriptive (frequencies and proportions) and inferential (chi-square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p = 0.05 and 95% confidence level.<br><strong>Results</strong>: The level of adherence to antiretroviral therapy among the adolescents was 83%. Twelve out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In the multivariable logistic regression analyses, however, only two variables significantly predicted adherence — experiencing side effects (AOR = 2.63; 95% CI = 1.14, 6.09; p = 0.02), and internalized stigma (AOR = 2.51; 95%<br>CI = 1.04, 6.04; p = 0.04).<br><strong>Conclusion</strong>: Adherence to treatment among adolescents in Cameroon was found to be suboptimal. There is a need for more individualized, targeted medication counselling for adolescents and their guardians as well as strategies to reduce internalized stigma and improve adherence to antiretroviral treatment.</p> <p><strong>Keywords</strong>: ARVs, internalised stigma, medication counselling, side effects, sub-optimal </p> Mbuwir Charlotte Bongfen Kwasi Torpey John Ganle Augustine Ankomah Copyright (c) 2021-01-28 2021-01-28 19 4 269 275 Domestic stigmatisation: refocusing interventions for people living with HIV <p>Domestic stigmatisation serves as an umbrella term for acts of enacted or felt stigma experienced in a person’s domestic environment. This article reports on the term which transpired from a narrative inquiry in 2011 with people living with HIV (PLWH) who reported humiliation or segregation, experienced or perceived, within the domestic environment that rendered the individual disabled, diseased, unworthy, unhealthy, or deficient. A literature review about this form of stigma was conducted using the following inclusion criteria: 1) a peer-reviewed source; 2) published between 2011 and 2018; 3) access to full-text articles; 4) accessible in English; 5) reported from any country; and 6) using qualitative or mixed-method approaches. A total of 37 studies were included in the review — documenting 51 specific experiences of domestic stigmatisation (referred to as acts for the purpose of the review) across all studies. A matrix was developed detailing each study’s’ publication date, geographical context, participant gender (where possible) and the reported acts. A critical analysis is offered on the concept “domestic stigmatisation” and its relevance to domestic or family interventions. Deliberate attention to this concept can potentially refocus HIV stigma-reducing interventions to benefit families and promote coping strategies to reduce stigma-related stress associated with seropositive identities.</p> <p><strong>Keywords</strong>: HIV-related stigma, PLWH, self stigmatising, identities, support</p> Laura Ann Chubb Christa B. Fouché Copyright (c) 2021-01-28 2021-01-28 19 4 276 286 Assessing the willingness to pay for HIV counselling and testing service: a contingent valuation study in Lagos State, Nigeria <p>HIV/AIDS is a major health issue faced by the world, generally, but particularly sub-Saharan Africa. Nigeria ranked third in the world by number of people living with HIV/AIDS in 2019. Despite prominent HIV counselling and testing (HCT) intervention programmes, Nigeria faces serious challenges, such as inadequate funding and low utilisation rates. Paucity of research into such a critical topic has restricted the capacity of policy makers to address the problem adequately. Consequently, a cross-sectional study was carried out using the contingent valuation method to assess the economic quantum of payment and determining factors associated with people’s willingness to pay for HCT services. Data were collected from 768 people selected by convenience sampling of three local government areas — Alimosho, Ikorodu and Surulere in Lagos State, Nigeria. Data were analysed using descriptive statistics, chi-square, Mann–Whitney, and general linear regression model analysis. Findings show that 75% of respondents were willing to pay an average fee of N1 291 ($4.22) for HCT services. Significant determinants of willingness to pay were: income; knowledge of someone living with HIV or died of AIDS; worry about HIV infection; and fear of HIV-related stigma. The findings offer vital information germane to co-payment schemes aimed at financial sustainability of HCT and HIV/AIDS programmes in Nigeria.</p> <p><strong>Keywords</strong>: contingent valuation, HCT, HIV/AIDS, Lagos State, Nigeria, willingness to pay</p> Felix Oluyemi Adekunjo Rajah Rasiah Maznah Dahlui Chiu Wan , Ng Copyright (c) 2021-01-28 2021-01-28 19 4 287 295 Loss to follow-up among female sex workers in Zambia: findings from a five-year HIV-incidence cohort <p>HIV-incidence studies are used to identify at-risk populations for HIV-prevention trials and interventions, but loss to follow-up (LTFU) can bias results if participants who remain differ from those who drop out. We investigated the incidence of and factors associated with LTFU among Zambian female sex workers (FSWs) in an HIV-incidence cohort from 2012 to 2017. Enrolled participants returned at month one, month three and quarterly&nbsp; thereafter. FSWs were considered LTFU if they missed six consecutive months, or if their last visit was six months before the study end date. Of 420 FSWs, 139 (33%) were LTFU at a rate of 15.7 per 100 person years. In multivariable analysis, LTFU was greater for FSWs who never used alcohol, began sex work above the age of consent, and had a lower volume of new clients. Our study appeared to retain FSWs in most need of HIV-prevention services offered at follow-up.</p> <p><strong>Keywords</strong>: alcohol, incidence studies, prevention trials, risk behaviour</p> Kalonde Malama Luis Sagaon-Teyssier Andréa Gosset Rachel Parker Kristin M. Wall Amanda Tichacek Tyronza Sharkey William Kilembe Mubiana Inambao Matt A. Price Bruno Spire Susan Allen Copyright (c) 2021-01-28 2021-01-28 19 4 296 303 The initiation of human immunodeficiency virus treatment for children at different levels of care <p><strong>Background</strong>: The human immunodeficiency virus (HIV) pandemic increased the demand for health care resources in South Africa. To decrease the burden on specialised facilities, the Department of Health decentralised antiretroviral (ARV) management. In the uMgungundlovu district, adult HIV primary care services reported lower rates of HIV viral load (VL) suppression after initiation of ARVs compared to other levels of care. The aim of the<br>study was to evaluate paediatric HIV services in the same district.<br><strong>Methods</strong>: Four ARV clinics, at different levels of care, initiating and monitoring paediatric HIV infection treatment in uMgungundlovu district, KwaZulu Natal, were selected: primary healthcare services, general practitioner services, general paediatric services and subspecialist infectious diseases services were included. Paediatric patients newly diagnosed between January 2014 and June 2015 were included in the study. The rate of HIV VL suppression at one year after treatment initiation was the primary outcome measure. A total of 377 patients were included, 35 at the nurse-led primary care clinic, 25 at the general practitioner-led primary care clinic, 156 at the paediatrician-led secondary care clinic, and 161 at the HIV paediatric subspecialist-led tertiary care clinic. Of the 377 patients, 154 (59.9%) achieved VL suppression at one year, with 75% (18/24), 61.9% (13/21), 51.7% (60/116) and 66.7% (63/96) achieving HIV VL suppression at the four clinic types, respectively.<br><strong>Conclusion</strong>: HIV VL suppression rates were variable, but did not differ statistically across levels of health care. Outcomes were not improved by initiation in specialist or subspecialist-led clinics, which supports the strategy of increasing access by decentralising HIV care for paediatric patients.</p> <p><strong>Keywords:</strong> HIV, initiation of treatment, medical services, paediatrics, South Africa,</p> Wayne Sheldon Rajah Kevin Bryant Spicer Tyrone Nicholas Rajah Jaques Johan van Heerden Copyright (c) 2021-01-28 2021-01-28 19 4 304 311 “Growing up and growing old with HIV”: HIV+ adolescents’ experiences of disclosing statuses to romantic partners in Bulawayo, Zimbabwe <p>This article explores the experiences of HIV-positive adolescents disclosing their status to romantic partners in Bulawayo, Zimbabwe. Disclosure of HIV status continues to be one of the most pressing issues facing adolescents, especially those in relationships, yet health care workers have minimal tailored guidance on how to approach this except to encourage full disclosure. Motives for disclosure were: guilty conscience; legal and ethical obligations; preventing partners being infected; and supportive people, honesty and trust. Disclosure was done on a one-onone basis in public spaces such as roadsides where the adolescents usually met, or in health care facilities through the help of health care workers, and through mobile phones using WhatsApp. Results revealed that disclosure was associated with negative and positive outcomes ranging from disruption of relationships, depression, breaches of confidential information and, in some instances, relationship and marriage assurance. However, results clearly showed that adolescents living with HIV struggle with disclosure because the process is complex and loaded with emotions and the outcomes can be unpredictable and difficult to handle. Optimism towards treatment, social support, rationalisation, and social comparison through attributing new meanings to the disease were employed to deal with negative outcomes of disclosure. Therefore, the development and implementation of evidence-based initiatives to raise awareness and train the youth to disclose is recommended. Through their experiences, we can<br>learn what works well and what needs to be strengthened.</p> <p><strong>Keywords</strong>: adolescence, disclosure, intimate, partner, perspective, relationship status, young persons </p> Philani Mlilo Cowen Dziva Vuyisile Precious Moyo Nonhlanhla Lindelwe Ndondo Zanele Ndlovu Nkosinathi Muyambo Copyright (c) 2021-01-28 2021-01-28 19 4 312 322