African Journal of AIDS Research

Framing HIV and AIDS in competitive authoritarian democracies. Case study of the print press in Mozambique, 1986–2020

Araújo Domingos, Nina Wormbs, Urban Lundberg — Tue, 13 May 2025 00:00:00 +0000

Mozambique has the sixth highest prevalence of HIV in the world and ranks fourth in new infections. The government-owned print press Notícias has played an important role in the social construction of HIV and AIDS in the country as it was entrusted with the role of disseminating HIV and AIDS information to the public since the outbreak of the pandemic in the country in 1986. Using Notícias’ articles and frame analysis perspective, the article analyses the way Notícias has framed HIV and AIDS in the country since the late 1980s. The choice of media results from the fact that the way a phenomenon is constructed influences the way it is understood, as well as the way people may behave before it. The study found that Notícias’ frames on HIV and AIDS have suffered from a threefold tension: the need to maintain the Frelimo government’s former centralised and grassroots-orientated socialist ideology of health services in the context of the liberal market; the need to balance the influence of the global multilateral and bilateral actors and the Frelimo government’s political interest of translating HIV and AIDS response to the Mozambican context; and the need to portray a nationalist and positive image of the government’s performance in HIV and AIDS response before Mozambique’s non-fully plausible societal practices for an effective HIV and AIDS response. In a top-down approach, Notícias’ frames reflect not only the African post-independence ancillary and nationalist role of government-owned print press but also the power of global actors. Less is done from the societal bottom-up perspective.

The factor structure of the Centre for Epidemiological Studies Depression Scale (CESD-R-20) among South African antiretroviral therapy users

Mohamed Rawoot, Ashraf Kagee — Tue, 13 May 2025 00:00:00 +0000

Depression is a significant concern for people living with HIV and AIDS as it is associated with negative health outcomes and suboptimal adherence to antiretroviral therapy (ART). To this extent, screening for depression is essential for early detection. The CESD-R-20 is a revised four-factor questionnaire developed to assess depressive symptoms in adults. This study explored the factor structure and psychometric properties of the CESD-R-20 among 685 individuals receiving ART. Data were collected at the Infectious Diseases Clinic of a large public hospital outside Cape Town from participants who had been receiving ART for at least six months. Exploratory factor analysis (EFA) of the CESD-R-20 was performed to identify its underlying factor structure. The EFA revealed a one-factor solution termed “depressive affect,” comprising 19 items that encompassed the original factors. This finding suggests that depression is a cohesive construct rather than a collection of interconnected dimensions. The scale exhibited high internal consistency (Cronbach’s alpha = 0.95) among the sample of persons living with HIV and AIDS. Our findings indicate that the CESD-R-20 can effectively measure depressive affect as a one-factor scale in South Africans receiving ART. The scale demonstrated strong internal consistency and is suitable for screening for depressive symptoms among persons living with HIV and AIDS.

Understanding depression, anxiety and stress in young people living with HIV in Ghana

Tue, 13 May 2025 00:00:00 +0000

Ghanaians with perinatally acquired human immunodeficiency virus (HIV) infection now live into adulthood. It is known that adolescents and young adults living with HIV have a high risk of mental health comorbidity. Despite increasing global attention on HIV–mental health interactions, the field remains understudied in Ghana, with an attendant lack of national integrated care solutions. This study aimed to measure the burden and explore the context of depression, anxiety and stress symptoms among young people living with HIV receiving care at a tertiary care hospital in Ghana. This was an explanatory sequential mixed-methods study. Depression, anxiety and stress symptoms were measured using the Depression, Anxiety and Stress Scale, and their associations with quality of life (QoL), socioeconomic status, internalised stigma, disease stage and HIV-related risk-taking behaviours were explored. After preliminary quantitative data analysis, semi-structured interviews were conducted for those who screened positive for depression and/or anxiety to explore their experience with this comorbidity. This study found a low prevalence of depression and anxiety symptoms, which were associated with higher stigma scores and lower QoL. We believe this low prevalence to be attributable to the effect of several psychosocial interventional programmes, which were previously piloted with the study cohort that have gradually normalised mental health discussions. Participants also showed marked resilience and knowledge about their condition. The results of this study present an opportunity to advocate and scale up effective locally adapted and strength-based solutions to address the mental illness–HIV syndemic in Ghanaian young people living with HIV.

Factors associated with uptake of HIV testing among clients diagnosed with sexually transmitted infections in Chegutu District, Zimbabwe, 2021

Tue, 13 May 2025 00:00:00 +0000

HIV testing services (HTS) enable early linkage to HIV prevention, treatment and care. A review of Chegutu District Health Information System 2 sexually transmitted infection (STI)/HIV data revealed HIV testing rates among those infected with STIs were 41%, 48%, 50%, 51% and 68%, respectively, for the period 2016–2020 against a target of 100%. We investigated factors associated with the uptake of HTS among STI clients.

Methods: We conducted a 1:1 unmatched case–control study. We randomly selected cases from STI registers and controls from HTS registers. We defined a case as an individual 18–49 years old diagnosed with STI, unknown HIV status and no documented HIV test result from 01 August 2020 through 31 August 2021. We recruited 115 cases and 115 controls. We used questionnaires to collect data from cases and controls after obtaining written consent. Epi Info7 generated frequencies, proportions, odds ratios and confidence intervals (CIs) at a 0.05 significance level. We applied forward stepwise logistic regression to determine independent factors for HIV testing uptake.

Results: Independent factors for uptake of HIV testing among STI clients were: being employed [aOR 0.23; 95% CI(0.09–0.50)], having no stigma towards people living with HIV [aOR 0.19;95% CI(0.06–0.61)], preferring health facility for HIV testing [aOR 0.30;95% CI(0.13–0.65)], male head of family [aOR 2.95. 95% CI(1.25–6.95)], and confidence in clinic staff’s commitment to confidentiality [aOR 0.19; 95% CI(0.06–0.63)].

Conclusion: Male decision-makers may deter partner involvement in HTS. We recommended strengthening male involvement in HIV programming through community dialogues that address gender inequalities.

Training Social Network-Central Fishermen in Western Kenya to Distribute HIV Self-Test Kits and Health Facility Referral Vouchers

Tue, 13 May 2025 00:00:00 +0000

Low HIV testing among men, particularly highly mobile fishermen, is a persistent challenge. The Owete study (NCT#04772469) used social network-central men (Promoters) to promote testing and linkage to HIV services among social networks of fishermen in western Kenya. The Promoters and fishermen networks were randomised to intervention or control arms. We describe Owete’s interactive training approach and Promoters’ training experiences for implementation insights. The 146 Promoters trained (balanced across arms) were highly engaged, eager learners, and supportive of targeted health training sessions for men. Promoters felt the knowledge gained improved their understanding of health matters and elevated their social status. Promoters felt empowered knowing how to interpret self-testing results and how to address pre-exposure prophylaxis use questions and correct misconceptions. Offering capacity building for social network-central men to spearhead campaigns on health issues affecting fishermen can leverage established relationships and trust, expand knowledge, and help increase health-seeking practices among underserved, highly mobile men.

Giving adolescent girls and young women a foothold: Economic strengthening as a key protection strategy against HIV infection in South Africa

Andrew Hartnack, Jenny Mcloughlin, Anje Pretorius, Harry Hausler — Tue, 13 May 2025 00:00:00 +0000

This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff (n = 72) and economic strengthening beneficiaries (n = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain.