African Journal of AIDS Research https://www.ajol.info/index.php/ajar <p><a href="https://www.nisc.co.za/products/1/journals/african-journal-of-aids-research" 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="http://www.nisc.co.za/products/1/journals/african-journal-of-aids-research" 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. AIDS and COVID-19 in southern Africa https://www.ajol.info/index.php/ajar/article/view/211669 <p>By the end of the first year of the COVID-19 pandemic, in February 2021, the numbers of cases and deaths in southern Africa were low in absolute and relative numbers. The BBC ran a story (which was later retracted) headlined “Coronavirus in Africa: Could poverty explain mystery of low death rate?”. A heading in the New York Post said: “Scientists can’t explain puzzling lack of coronavirus outbreaks in Africa”. Journalist Karen Attiah concluded: “It’s almost as if they are disappointed that Africans aren’t dying en masse and countries are not collapsing”. We wondered if the knowledge that southern African countries have acquired in their struggle against AIDS has contributed to a more effective approach against COVID-19. The viral origins of the diseases through zoonotic events are similar; neither has a cure, yet. In both diseases, behaviour change is an important prevention tool, and there are specific groups that are more vulnerable to infection. Equally, there are important differences: most people with COVID-19 will recover relatively quickly, while people living with HIV will need lifelong treatment. COVID-19 is extremely infectious, while HIV is less easily transmitted.</p> Arnau van Wyngaard Alan Whiteside Copyright (c) 2021-08-02 2021-08-02 20 2 117 124 Correlates of missed HIV appointments in low-resource settings: a study from Uganda https://www.ajol.info/index.php/ajar/article/view/211674 <p><strong>Aims:</strong> Alarming reports of antiretroviral treatment failure have recently emerged in sub-Saharan Africa. The onset of virologic failure has multiple causes but suboptimal treatment adherence is one of the leading causes. This study aimed to explore correlates of adherence to HIV appointments in community care patients living with HIV/ AIDS in Uganda.<br><strong>Methods:</strong> Two hundred and ninety-five people living with HIV (median age 37.0 years; interquartile range 16.0; female 67.8% [n = 200]) reported whether they had missed any of their four-weekly appointments during the past 24 weeks. They also completed the Internalized AIDS-Related Stigma Scale, Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, the Alcohol-Use Disorders Identification Test, and the Physical Activity Vital Sign.<br><strong>Results:</strong> Thirty-three (11.2%) patients missed at least one of their six scheduled appointments in the 24-week period. The adjusted odds ratio for missing at least one of six appointments was 3.03 (95% CI: 1.21–8.43, p = 0.01) for those who were physically inactive, and 2.29 (95% CI: 0.93–5.63, p = 0.046) for those with depression.<br><strong>Conclusions:</strong> Targeting future rehabilitation studies for PLHIV around feelings of depression and around physical inactivity could be important in achieving optimal HIV treatment adherence.</p> Davy Vancampfort Peter Byansi Philip B. Ward James Mugisha Copyright (c) 2021-08-02 2021-08-02 20 2 125 131 Prevalence and sociodemographic determinants of alcohol consumption among adults living with HIV in Eswatini https://www.ajol.info/index.php/ajar/article/view/211676 <p><strong>Aim</strong>: Alcohol consumption contributes to a significant burden of illnesses, health conditions and premature deaths globally. There is limited knowledge of alcohol consumption among people living with HIV (PLWH) in Eswatini. This study sought to determine the prevalence, and examine the sociodemographic determinants of alcohol consumption among adult people living with HIV in Eswatini.</p> <p><strong>Methods</strong>: Using the Swaziland HIV Incidence Measurement Survey 2, a recent national representative cross-sectional survey conducted in Eswatini between August 2016 and March 2017, a subsample of 2 832 adults (aged 18 and older) living with HIV was extracted. Multinomial logistic regression was used to assess the sociodemographic factors associated with alcohol consumption (i.e. use or misuse).</p> <p><strong>Results</strong>: The prevalence of alcohol misuse (hazardous drinking) was 10.9% (23% male vs 4.5% female), whereas alcohol use (moderate drinking) was estimated at 8.5% (14.7% male vs 5.2% female). Men were more likely to engage in alcohol use (adjusted relative risk ratio [aRRR] = 3.46 [95% CI 3.46–6.62]) and misuse (aRRR = 6.12 [95% CI 6.12–11.47]) than females. Those who reported HIV stigma had a higher likelihood of alcohol misuse compared to those who did not report HIV stigma (aRRR = 1.43 [95% CI 1.04–1.98]).</p> <p><strong>Conclusion</strong>: Our findings highlight a notable prevalence of alcohol use or misuse among PLWH in Eswatini. Males, those with no education, never married and those who reported HIV stigma were more likely to report alcohol misuse. The study thus recommends innovative policies and strategies to curb alcohol-related harm in the Eswatini population, specifically among PLWH.</p> Garikayi B. Chemhaka Maswati S. Simelane Stanzia Moyo Mduduzi C. Shongwe Copyright (c) 2021-08-02 2021-08-02 20 2 132 140 The impact of trauma on South African women with HIV: The role of anxiety and physical symptomology https://www.ajol.info/index.php/ajar/article/view/211678 <p>Rates of trauma and HIV are high in South Africa, and those who experience more trauma have higher levels of psychological distress. This cross-sectional study examined trauma, physical, and mental health among black South African women living with HIV (WLH). We&nbsp; hypothesised that WLH would have higher rates of trauma than women not living with HIV (WNLH). We also hypothesised that there would be a relationship between trauma, anxiety, and physical symptoms, such that anxiety would mediate the relationship between&nbsp; trauma and physical symptoms for WLH. This study enrolled 242 women, 99 WLH. Women were individually interviewed, completing the Life Stressor Checklist (trauma history), the Physical Symptom Inventory, and the IPAT Anxiety Scale. WLH reported significantly more traumatic life events (M = 3.69, SD = 2.32) than WNLH (M = 3.06, SD = 2.42), t = −2.07, p = 0.04. Additionally, traumatic life events were positively associated with physical symptoms. Further, there was an indirect effect of trauma history on physical symptoms through anxiety, b = 0.97, 95% BC CI [0.29, 1.89], such that the direct effect of trauma on physical symptoms was no longer significant, b = 0.87, 95% BC CI [−0.83, 2.56] when anxiety was added to the model. This pattern of findings suggests that anxiety is a key mechanism through which trauma history is associated with more physical symptoms in WLH. Future research should focus on the effect of interventions alleviating the impact that trauma may have on the mental and physical health of WLH.</p> Abigail S. Robbertz Martha N. Ishiekwene Olivia L. Hucks Lisa Armistead Copyright (c) 2021-08-02 2021-08-02 20 2 141 148 “I did not plan…that is what hurts”: Pregnancy intentions and contraceptive use among pregnant young women in KwaZulu-Natal, South Africa https://www.ajol.info/index.php/ajar/article/view/211679 <p>Unintended pregnancy impacts many young women in South Africa, and rates of consistent contraceptive use among this population are suboptimal. Limited empirical work has investigated reasons for inconsistency between pregnancy intention and contraceptive use&nbsp; behaviour with data collected during pregnancy. We explored pregnancy intentions and discordance between intentions and contraceptive use prior to conception among young pregnant women in KwaZulu-Natal, South Africa. In-depth qualitative interviews were conducted with 35 women during pregnancy (mean age = 19.3; range = 18–21) in 2011 and 2012. Data were analysed using content&nbsp; analysis. All participants reported unintended pregnancies; almost half were not using contraception near conception. Reasons for not intending to become pregnant spanned personal, social, health, and economic domains. Participants living with HIV (n = 13) expressed specific concerns related to impacts of pregnancy on HIV disease management and fear of transmission of HIV to the infant. Discordance between pregnancy intentions and contraceptive use prior to conception was attributed to personal, social, health and structural domains. Findings indicate a need for interventions that address barriers to contraceptive use in order to minimise unintended pregnancy and&nbsp; support safe, desired pregnancies among young women.</p> Jessica N. Coleman Cecilia Milford Nzwakie Mosery Karmel W Choi Letitia Rambally Greener Lynn T. Matthews Abigail Harrison David R. Bangsberg Steven A. Safren Jennifer A. Smit Christina Psaros Copyright (c) 2021-08-02 2021-08-02 20 2 149 157 Effectiveness of the Sista2Sista programme in improving HIV and other sexual and reproductive health outcomes among vulnerable adolescent girls and young women in Zimbabwe https://www.ajol.info/index.php/ajar/article/view/211681 <p><strong>Background:</strong> In Zimbabwe, adolescent girls and young women (AGYW) experience high rates of HIV and other sexual and reproductive health challenges. In 2013, the Zimbabwe Ministry of Health and Child Care partnered with the United Nations Population Fund to implement the Sista2Sista programme, a structured peer group intervention aimed at improving health outcomes among vulnerable in- and out-of-school AGYW.<br><strong>Methods</strong>: Programme data was analysed for 91 612 AGYW aged 10–24 years old who participated in Sista2Sista from 2013 to 2019. Logistic regression was used to determine odds ratios (OR) and evaluate programme exposure as a factor in a set of defined variables.<br><strong>Results:</strong> 58 471 AGYW (63.82%) graduated from the Sista2Sista programme by completing at least 30 of 40 exercises. Graduates were more likely to take an HIV test (2.78 OR 95% CI 2.52–3.10), less likely to get married (0.63 OR 95% CI 0.55–0.73) and less likely to drop out of&nbsp; school (0.60 OR 95% CI 0.53–0.69). At higher thresholds of programme completion, additional positive outcomes were observed. Participants who completed all 40 exercises were more likely to return to school (1.41 OR 95% CI 1.18–1.69), more likely to use&nbsp; contraception (1.38 OR 95% CI 1.21–1.56), more likely to report sexual abuse (1.76 OR 95% CI 1.17–2.66), and less likely to become pregnant as adolescents (0.41 OR 95% CI 0.24–0.72). Individual counselling improved the likelihood of programme graduation.<br><strong>Conclusions</strong>: The Sista2Sista programme had a positive effect on HIV and other sexual health outcomes among vulnerable AGYW in Zimbabwe. Strategies to improve graduation rates should be explored.<br><br></p> Gemma Oberth Tamisayi Chinhengo Tendayi Katsande Rudo Mhonde Dagmar Hanisch Pennelope Kasere Beverley Chihumela Bernard Madzima Copyright (c) 2021-08-02 2021-08-02 20 2 158 164 The role of pharmacy personnel in promoting adherence to antiretroviral therapy in the Eastern Cape: communication barriers and breakthroughs https://www.ajol.info/index.php/ajar/article/view/211682 <p><strong>Background:</strong> Many people living with HIV struggle to adhere to their antiretroviral therapy, leading to suboptimal health outcomes and increased costs to the healthcare system. Due to their unique training and position in the health care system, South African pharmacists and pharmacy support personnel have the potential to improve adherence through effective patient counselling. However, they are often underutilised and face multiple barriers to providing these services. The aim of this study was to examine how pharmacists and pharmacy personnel view their impact upon the medication adherence behaviours of people living with and receiving medication therapy for HIV.<br><strong>Methods</strong>: The study used an exploratory qualitative research design. Our research team conducted in-depth interviews with 24 pharmacy personnel working in public health clinics in the Eastern Cape of South Africa, then used thematic analysis of the qualitative research data to determine the results.<br><strong>Results:</strong> Pharmacy personnel identified three key sets of communication challenges that limited effective patient counselling on&nbsp; antiretroviral therapy. These included environmental barriers presented by clinic design, language barriers between patients and pharmacy personnel, and varying communication styles and education levels of pharmacy staff and patients. Additionally, pharmacy personnel described innovative strategies they use to improve patient-provider communication and address adherence issues.<br><strong>Conclusions</strong>: Pharmacy personnel working in public health clinics face daily communication challenges as they attempt to provide counselling to patients with HIV. Both the clinic environment and the complex nature of HIV treatment serve as barriers to patient comprehension. In the face of these challenges, pharmacy personnel do their best to implement strategies that enhance patient counselling and address concerns about adherence. Increased attention should be paid to reducing the barriers to pharmacy-based patient counselling and utilising pharmacy personnel to enhance patient understanding and adherence to antiretroviral therapy.</p> Elizabeth Rattine-Flaherty Sue Burton Copyright (c) 2021-08-02 2021-08-02 20 2 165 171 Life in a child-headed household: Exploring the quality of life of orphans living in child-headed households in Zimbabwe https://www.ajol.info/index.php/ajar/article/view/211683 <p>The overwhelming rate of HIV-related mortality in the past decades has eroded traditional safety nets for orphans, of which the extended family is the most critical. This has led to the formation of new household structures, i.e. child- and youth-headed households, as children and youths are left to live alone and look after themselves. These types of households are a growing phenomenon in many African&nbsp; countries and are increasingly being recognised as household structures. However, in the absence of an economically active adult,&nbsp; orphans living in these households experience numerous challenges. The socio-economic challenges in Zimbabwe could further exacerbate the conditions of child-headed households. This article discusses findings of an ethnographic inquiry on orphans living in child- and youth-headed households in Zimbabwe. We identified parentification, lack of income and social isolation as risk factors affecting quality of life. Social capital and agency were identified as protective factors enhancing children’s quality of life. Our findings suggest that orphans living in child- and youth-headed households are not only victims but are also resilient and can exercise agency. Therefore,&nbsp; interventions to support this vulnerable group should build on their existing resilience and agency.</p> Kudzai Emma Chademana Brian van Wyk Copyright (c) 2021-08-02 2021-08-02 20 2 172 180 Integration of family planning services into HIV services in Nigeria: Evidence from the Performance Monitoring and Accountability 2020 survey in seven states https://www.ajol.info/index.php/ajar/article/view/211684 <p>Despite global calls for stronger linkages between family planning and HIV, a growing body of evidence in sub-Saharan Africa suggests that the integration of family planning and HIV service delivery is suboptimal in some countries. In this study, we assess the integration and quality of family planning services in health facilities that provide HIV-related services in Nigeria. This study analysed secondary data from the Performance Monitoring and Accountability 2020 cross-sectional survey conducted between May and July 2016 in seven states in Nigeria. Our study sample was restricted to 290 health facilities providing HIV services. We performed descriptive statistics and binary logistic regression analyses. Ninety-five per cent of the health facilities reported offering family planning counselling, provision of family planning methods, and/or referral for family planning methods to clients accessing HIV services. About 84% of these health facilities with integrated family planning and HIV services reported that they discussed the preferred method, dual methods, instructions and side effects of the chosen method, and the reproductive intentions with clients during an HIV consultation. None of the health facilities’&nbsp; characteristics was significantly associated with the integration of family planning services into HIV services. Private health facilities (aOR 0.3, 95% CI 0.07–0.92), urban health facilities (aOR 3.8, 95% CI 1.64–8.76), and provision of postnatal care (aOR 3.9, 95% CI 1.10–13.74) were statistically associated with the quality of family planning services provided to clients accessing HIV services. Family planning services were integrated into HIV services in a majority of the health facilities in our study. However, our findings indicate the need for improvement in the quality of family planning services provided to clients accessing HIV services. </p> Babayemi O. Olakunde , Daniel A. Adeyinka Funmilola M. OlaOlorun Tolulope T. Oladele Hidayat Yahaya Chinwendu D. Ndukwe Copyright (c) 2021-08-02 2021-08-02 20 2 181 188