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> en-US Copyright for articles published in this journal is retained by the publisher. (Publishing Manager) (Editorial Office) Fri, 13 May 2022 16:56:26 +0000 OJS 60 The potential effect of pre-exposure prophylaxis (PrEP) roll-out on sexualrisk behaviour among adolescents and young people in East and southern Africa <p>Pre-exposure prophylaxis (PrEP) is an HIV-prevention strategy recommended for those at high-risk of infection, including adolescents and young people (AYP). We explored how PrEP roll-out could influence sexual risk behaviour among AYP in East and southern Africa. Twenty-four group discussions and 60 in-depth interviews were conducted with AYP between 13 and 24 years old, recruited from community settings in Uganda, Zimbabwe and South Africa, from September 2018 to January 2019. Participants perceived that PrEP availability could change sexual behaviour among AYP, influencing: (1) condom use (increased preference for condomless sex, reduced need and decrease in use of condoms, relief from condom use discomfort, consistent condom use to curb sexually transmitted infections and pregnancies); (2) sexual activities (increase in sexual partners and sexual encounters, early sexual debut, sexual experimentation and peace of mind during risky sex, sexual violence and perversion); (3) HIV risk perception (neglect of other HIV prevention strategies, unknown sexual partner HIV status, adoption of PrEP). PrEP initiation may be associated with increased interest in sexual activities and risky sexual behaviour among AYP. PrEP should be included as part of a combination package of HIV prevention strategies for AYP with methods to prevent other sexually transmitted infections and unwanted pregnancies.</p> Andrew Sentoogo Ssemata, Richard Muhumuza, Lynda Stranix-Chibanda, Teacler Nematadzira, Nadia Ahmed, Stefanie Hornschuh, Janan Janine Dietrich, Gugulethu Tshabalala, Millicent Atujuna, Denis Ndekezi, Phiona Nalubega, Esther Awino, Helen A Weiss, Julie Fox, Janet Seeley Copyright (c) Thu, 12 May 2022 00:00:00 +0000 “I prefer to take pills when I plan to have sex”: Perceptions of on-demand versus daily oral pre-exposure prophylaxis among adolescents in Kampala, Uganda <p>There is limited information about the use of on-demand and daily pre-exposure prophylaxis (PrEP) among adolescents and young people (AYP) in sub-Saharan Africa. We explored perceptions of both regimens among 14- to 19-year-olds perceived to be at high risk of HIV infection in Kampala, Uganda, using qualitative data collection methods. Data were analysed by theme and interpreted based on constructs from the framework of acceptability. Although there were no noticeable gender differences in preferences for a particular regimen, acceptability of PrEP depended on individual AYP sexual behaviour at the time of the study. Those who perceived themselves to be at increased risk of acquiring HIV preferred using daily PrEP, citing the consistency that comes from taking a pill daily and which they considered to be efficacious and safe. AYP who had less frequent sex preferred on-demand PrEP because it would enable them to “plan for sex”. However, both groups perceived taking daily PrEP to be a burden, which was an impediment to acceptance of this form of PrEP. AYP anticipated that daily pill taking would be very stressful, requiring a lot of effort and would interrupt their daily routine. Therefore, while both on-demand and daily PrEP were acceptable and beneficial to these AYP, preferences for either regimen depended on self-perceived risk. Thus, oral PrEP use should be tailored to end-user preferences and risk profiles.</p> Rachel Kawuma, Zam Nabalwanyi, Janet Seeley, Yunia Mayanja Copyright (c) Thu, 12 May 2022 00:00:00 +0000 Quality of life and its predictors among clients visiting antiretroviral therapy clinics in Addis Ababa, Ethiopia <p>This study assessed the quality of life (QoL) and associated factors among a group of clients visiting ART clinics in Addis Ababa, Ethiopia. A multi-site cross-sectional study was conducted from 1 to 30 August 2020. Adults with HIV and who fulfilled the inclusion criteria were considered. A systematic random sampling technique with proportional size allocation was employed. Data were collected using a modified EQ-5D and EQ-VAS tool. The analysis was done using SPSS version 26. Non-parametric statistical analyses were done using Mann–Whitney U, Kruskal–Wallis and Spearman’s correlation tests. A p-value ≤ 0.05 and 95% confidence level were considered for analysis. The majority of the clients were from health centres (58%), were 43 years old or less (54%), and were males (63%). Pain/discomfort and depression/anxiety were the most prominent dimensions in the age group above 43 years. The mean score of EQ-5D index values was 0.87 (SD 0.05; 95% CI 0.86–0.87) and that of EQ-VAS<br>was 81 (SD 15; 95% CI 80–83). About 38% and 43% of the clients showed an altered health state of some degree in functional and current overall status respectively. Comorbidity, history of current substance use, facility type, social support and sleep disturbance showed a statistically significant association with both outcomes. A considerable proportion of clients have altered functional and overall health status, with pain/discomfort and depression/anxiety most affected. Inclusion of multidisciplinary treatments for HIV and the highlighting of psychosocial issues that are likely among this group are warranted.</p> Tariku Shimels, Gelila Bogale, Rodas Asrat Kassu, Teferi Gedif Copyright (c) Thu, 12 May 2022 00:00:00 +0000 Uptake of HIV testing among aging adults in Agincourt, South Africa: perception of community, social network, and individual characteristics <p>This cross-sectional study examined the impact of perception of community, social network and individual variables on the likelihood of voluntary HIV testing of people 40 years and older living in Agincourt, South Africa. The data came from <em>Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in SA (HAALSI) Cohort from Agincourt</em>. We applied three logistic regression models. Results showed that voluntary uptake of HIV testing was significantly associated with two network factors, namely friendships within the network and frequency of fighting in the network. At the community level, attachment to place was significantly associated with voluntary testing, while at the individual level, education, sexual behaviour, employment and age were significantly associated with the voluntary uptake of HIV testing. The implications of these findings are that age-appropriate interventions must be devised to sensitise older people in Agincourt about HIV risks. Also, leadership at the<br>community level and in social networks must encourage members to consider voluntary testing for their own and community interests.</p> Ami R Moore, Anh Ta, Megan Lawson, Foster Amey Copyright (c) Thu, 12 May 2022 00:00:00 +0000 Parental decision-making in infant and child male circumcision: a case study in two townships in Gauteng, South Africa <p>Parental decision-making in infant and child male circumcision is influenced by complex, interrelated factors on many levels. Several studies have highlighted reasons for the acceptance and non-acceptance of child male circumcision. This study investigates the factors that influence parental decision-making in this matter and proposes a parental decision-making framework. The study was conducted in the townships of Diepsloot and Diepkloof in Gauteng, South Africa, using 48 in-depth interviews with parents, grandparents and uncles of the boys, as well as government officials and members of civil society as part of an explorative case study. Purposive and snowball sampling were used to select the participants. Thematic analysis was used to analyse the data by applying the conceptual framework of Bronfenbrenner’s ecological systems theory. Three main themes emerged from the data: microsystem factors related to health and hygiene, the father’s circumcision status, cultural expectations, pain, the child’s autonomy and the extended family; mesosystem factors related to early childhood development centres; and exosystem factors related to circumcision policies and financial considerations.</p> Eurica Palmer, Lochner Marais, Michelle Engelbrecht Copyright (c) Fri, 13 May 2022 00:00:00 +0000 Factors associated with HIV testing among youth in a generalised hyperendemic setting: findings from a national survey in Eswatini <p><em>Aim</em><strong>:</strong> Even though Eswatini was the first country in Africa to achieve the UNAIDS 95-95-95 targets among people living with HIV nationally, youth aged 15–24 years lag behind in HIV testing. This study determined the overall prevalence of HIV testing among the youth and the factors associated with HIV testing.<br><em>Methods:</em> Data were analysed for 1 834 young people from the 2016–2017 Swaziland HIV Incidence Measurement Survey (SHIMS2) using multivariable logistic regression.<br><em>Results:</em> Overall, 66% of the young people had tested for HIV in the past 12 months before SHIMS2. Lower odds of HIV testing were observed among males, among those aged 15–17 years, the never married/cohabited, those with primary and secondary education, and among those who had high perceived stigma towards people living with HIV and AIDS. Youth from households classified in the poor and middle quintiles had higher odds of testing for HIV compared to those from rich households.<br><em>Conclusion:</em> Efforts to increase HIV testing should consider the sociodemographic and behavioural factors identified as determinants of HIV non-testing in this age group.</p> Maswati S Simelane, Garikayi B Chemhaka, Mduduzi Colani Shongwe, Mfundi PS Motsa, Lindelwa P Dlamini Copyright (c) Fri, 13 May 2022 00:00:00 +0000 Frequency of exposure to the media is associated with levels of HIV-related knowledge and stigmatising attitudes among adults in Ghana <p>Studies show that increased knowledge of the human immunodeficiency virus (HIV) is achieved through exposure to mass media, which then contributes to positive attitudes and behaviours towards people living with HIV and acquired immune deficiency syndrome (AIDS). This study examined the relationship between the frequency of exposure to the media and the level of HIV-related knowledge and stigmatising attitudes towards HIV and AIDS among adults in Ghana. A weighted sample of 13 484 men and women 15 to 59 years old took part in the study. The main outcome variable was the HIV-related knowledge score, calculated based on responses to eight questions about general HIV concepts and HIV transmission modes. The frequency of exposure to the media was the primary explanatory variable. The relationship between the frequency of media exposure and the level of HIV-related knowledge was investigated using Poisson regression methods in Stata 13.0. Of the 13 484 respondents analysed, 25%, 88.2% and 79.7% reported reading print media, listening to the radio and watching TV at least once a week respectively. The average HIV-related knowledge score was 4.9 (SD 1.6), with 22.9% of respondents correctly answering five questions and about 2.0% correctly answering all eight questions. The frequency of exposure to the media, particularly print media and television, was associated with an increase in the level of HIV-related knowledge. When compared to having a low level of HIV-related knowledge, having a moderate and high level of HIV-related knowledge reduced the score of stigmatising attitude by 0.065 and 0.277 points, respectively. The adult population in Ghana has a very low level of HIV or AIDS knowledge, as well as a significant level of stigma associated with HIV or AIDS, which could stymie HIV prevention efforts. The media, on the other hand, provide a platform for these issues to be addressed.</p> Michael Boah, Daudi Yeboah, Mary Rachael Kpordoxah, Martin Nyaaba Adokiya Copyright (c) Fri, 13 May 2022 00:00:00 +0000 Giving condoms to school children: educators’ views on making condoms available in South African schools <p>One of the policy goals of the South African Department of Basic Education’s National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses streetlevel bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or “street-level bureaucrats” is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.</p> Leah D Junck, Gavin George Copyright (c) Fri, 13 May 2022 00:00:00 +0000 Risk and protective factors for depressive symptoms among the youth living with HIV in Namibia <p><em>Background</em>: Namibia has one of the highest HIV prevalence rates among young people living with HIV and AIDS. The study of mental well-being among this vulnerable population is emerging as an important area of public health<br>research.<br><em>Methods:</em> This study examined how gender, social support, food insecurity, HIV-related stigma, HIV treatment adherence and HIV transmission knowledge are related to depressive symptoms among young people living with HIV in rural northern Namibia. Data were collected from 188 participants from the Zambezi region.<br><em>Results:</em> The hierarchical regression analysis revealed that being a female infected with HIV, having perceived food insecurity, experiencing more HIV-related stigma and having low levels of social support can exacerbate the severity of depressive symptoms in this sample of Namibian youth.<br><em>Discussion</em>: Our findings point to the need to expand social support interventions, enhance socio-economic programmes and reduce HIV-related stigma among young people living with HIV, especially those residing in rural, HIV endemic, resource-limited communities in developing countries.</p> Eveline Ndinelao Kalomo, Dasha Shamrova, Jung Sim Jun, Mgori Nuru Kaddu, Amy Amy Kalb Copyright (c) Fri, 13 May 2022 00:00:00 +0000 Determinants of antiretroviral treatment adherence among patients attending secondary health care facilities in north-east and south-west Nigeria: a comparative study <p><em>Background</em>: Four decades after its discovery, HIV continues to be a major global public health issue, even with antiretroviral therapy (ART). Strict adherence to ART remains a challenge, with attendant implications for treatment success. This study aimed at comparing ART adherence between north-east and south-west Nigeria.<br><em>Methods</em>: A comparative cross-sectional study was conducted in two regions in Nigeria among 400 HIV/AIDS patients on ART. Data were collected using a pre-tested, semi-structured interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of ART adherence in the regions. The level of significance was set at 0.05.<br><em>Results</em>: The majority of respondents from both the north-east (87.5%) and south-west (92.5%) of Nigeria had good knowledge about ART. The self-reported adherence level was 90.0% in the north-east and 87.5% in the south-west. Predictors of ART adherence in the north-east were knowledge about ART (AOR 9.949; 95% CI 2.009–49.284) and transport costs to the clinic (AOR 0.177; 95% CI 0.047–0.661). In the south-west, education (AOR 0.198; 95% CI 0.047–0.832) and knowledge of ART (AOR 8.945; 95% CI 1.749–45.751) were identified as predictors of ART adherence.<br><em>Conclusion:</em> In both regions, knowledge about ART was appreciable, but adherence was sub-optimal. Strategies to support adherence should be tailored to specific predictors in each region.</p> Sonnen Atinge, Oluchi J Kanma-Okafor, Temitope W Ladi-Akinyemi, Iorhen E Akase, Adebayo T Onajole Copyright (c) Fri, 13 May 2022 00:00:00 +0000 Perspectives on academic mentorship, research collaborations, career advice and work–life balance: a masterclass conversation with Professor Salim Abdool Karim <p>Mentorship and collaboration are fundamental to ensure success in research, particularly health research. In this article, we summarise a conversation between the Master’s in Biostatistics students at Stellenbosch University and<br>Professor Salim Abdool Karim, the head of the Centre for the AIDS Programme of Research in South Africa. In May 2021, Professor Abdool Karim was invited to share some of his expertise and knowledge on successful mentorship and collaboration with researchers in the early stages of their careers. Passion, hard work and always trying one’s best were some of the key values he highlighted as what a young researcher would need to succeed in today’s world. In this candid and open discussion, Professor Abdool Karim provides valuable insight pertaining to the intricacies of a career in research, in terms of collaboration, mentorship and personal lessons drawn from his own life experience.</p> Faheema Kimmie-Dhansay, Jawaya Shea, Seyi Amosun, Xan Swart, Lehana Thabane Copyright (c) Fri, 13 May 2022 00:00:00 +0000