SAHARA-J: Journal of Social Aspects of HIV/AIDS <p>This journal publishes contributions in English and French from all fields of social aspects of HIV/AIDS (care, support, behaviour change, behavioural surveillance, counselling, impact, mitigation, stigma, discrimination, prevention, treatment, adherence, culture, faith-based approaches, evidence-based intervention, health communication, structural and environmental intervention, financing, policy, media, etc).</p><p>Le journal publie des communications en Anglais et en Français de tous les domains des aspects sociaux du VIH/SIDA (le soin, le soutien, le changement du comportement, la surveillance comportementale, la consultation, l'impact, la réduction, le stigmate, la discrimination, la prévention, le traitement, l'adhésion, la culture, les approches basées sur la foi, l'intervention évidence-basée, la communication sur la santé, l'intervention structurale et de l'environnement, le financement, la politique, le média, etc). </p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a></p> en-US SAHARA-J: Journal of Social Aspects of HIV/AIDS 1729-0376 Longitudinal analysis of HIV risk behaviour patterns and their predictors among public primary care patients with tuberculosis in South Africa <p>The goal of this study was to identify various HIV risk behaviours among tuberculosis (TB) patients in a longitudinal study design in South Africa. In 42 public primary healthcare facilities in three districts in three provinces, adult new TB and TB retreatment patients with hazardous or harmful alcohol use were interviewed within 1 month of initiation of anti-TB treatment and were followed up at 6 months. The total sample with a complete 6-month follow-up assessment was 853. At the follow-up assessment, several HIV risk behaviours significantly reduced from baseline to follow-up. In multivariate Generalized Estimating Equations logistic regression analyses, high poverty (odds ratio (OR): 2.68, 95% confidence interval (CI): 1.56–4.62), Posttraumatic Stress Disorder (PTSD) symptoms (OR = 1.55, 95% CI = 1.03–2.36), and sexual partner on antiretroviral therapy (ART) (OR = 1.84, 95% CI = 1.09–3.10) were associated with a higher odds, and excellent/very good perceived health status (OR: 0.61, 95% CI: 0.37–0.98), severe psychological stress (OR = 0.51, 95% CI = 0.34–0.77), and HIV non-disclosure to most recent sexual partner (OR = 0.40, 95% CI = 0.25–0.65) were associated with a lower odds of inconsistent condom use. Being HIV positive (OR = 4.18, 95% CI = 2.68–6.53) and excellent/very subjective health status (OR = 2.98, 95% CI = 1.73–5.13) were associated with a higher odds, and having PTSD symptoms (OR = 0.60, 95% CI = 0.36–0.99), being on ART (OR = 0.48, 95% CI = 0.25–0.95), having a sexual partner on ART (OR = 0.41, 95% CI = 0.18–0.96), and HIV status non-disclosure (OR = 0.25, 95% CI = 0.15–0.41) were associated with a lower odds of having sex with an HIV-positive or HIV status unknown person. High poverty index (OR = 1.97, 95% CI = 1.19–3.25) and having a sexual partner on ART (OR = 4.37, 95% CI = 1.82–10.48) were associated with a higher odds, and having a partner with HIV-negative status (OR = 0.29, 95% CI = 0.16–0.51) and inconsistent condom use (OR = 0.39, 95% CI = 0.24–0.64) were associated with a lower odds of HIV status non-disclosure at last sex. The study found that among TB patients with problem drinking over a 6-month TB treatment period, the frequency of some HIV risk behaviours (inconsistent condom use) declined (OR = 0.64, 95% CI = 0.41–0.98), but also persisted at a high-level calling for a strengthening and integration of HIV prevention into TB management.</p><p><strong>Keywords:</strong> sexual risk behaviour, TB patients, health status, mental health, longitudinal study, South Africa</p> Karl Peltzer Copyright (c) 2018-02-08 2018-02-08 15 1 1 6 HIV/AIDS and older adults in Cameroon: Emerging issues and implications for caregiving and policy-making <p>The burden of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) on the elderly population in three divisions within the Northwest Region of Cameroon was examined. Data for this paper were extracted from a larger study which had been conducted concerning the burden of HIV infection and AIDS on the older adults in the Northwest Region of Cameroon. Using in-depth interviews (IDIs) and focus group discussions (FGDs), data were collected from 36 participants who were purposively selected from the three divisions which had been chosen randomly. 6 FGD sessions were held with 30 women aged 60 years and above and who were affected by HIV infection and AIDS, while IDIs sessions were held with 6 male community leaders. The results revealed that HIV infection and AIDS has added another dimension to the role of older persons. HIV infection and AIDS affects older people in diverse ways, as they have to look after themselves, their sick children and are often also left to look after their grandchildren orphaned by HIV infection and AIDS. These emerging issues in their lives make them vulnerable to health, social, economic and psychological challenges, and place a burden on them as caregivers instead of being cared for in their old age. Apart from increased direct expenditures, taking care of victims of HIV infection and AIDS requires older people to stay away from social, religious and community activities. The results showed that the loss of a child to HIV infection and AIDS affects the economic/financial well-being, participation in social/religious interactions as well as the community activities of older people participants. The implications of these findings for caregiving and social policy are discussed.</p><p><strong>Keywords:</strong> HIV/AIDS, older adults, African family, caregiving, Cameroon</p> Perpetua Lum Tanyi André Pelser Joseph Okeibunor Copyright (c) 2018-02-08 2018-02-08 15 1 7 19 Accounting for youth audiences’ resistances to HIV and AIDS messages in the television drama <i>Tsha Tsha</i> in South Africa <p>Theoretical debates and literature on E-E efforts in Africa have largely focussed on understanding how and why interventions on HIV and AIDS are effective in influencing behaviour change among target communities. Very few studies have sought to investigate and understand why a substantial number of targeted audiences resist the preferred readings that are encoded into E-E interventions on HIV and AIDS. Using cultural studies as its conceptual framework and reception analysis as its methodology, this study investigated and accounted for the oppositional readings that subaltern black South African youths negotiate from <em>Tsha Tsha</em>, an E-E television drama on HIV and AIDS in South Africa. Results from the study show that HIV and AIDS messages in <em>Tsha Tsha</em> face substantial resistances from situated youth viewers whose social contexts of consumption, shared identities, quotidian experiences and subjectivities, provide critical lines along which the E-E text is often resisted and inflected. These findings do not only hold several implications for E-E practice and research, they further reflect the utility of articulating cultural studies and reception analysis into a more nuanced theoretical and methodological framework for evaluating the ‘impact’ of E-E interventions on HIV and AIDS.</p><p><strong>Keywords:</strong> audience reception, cultural studies, entertainment-education, HIV and AIDS</p> Blessing Makwambeni Abiodun Salawu Copyright (c) 2018-03-09 2018-03-09 15 1 20 30 Achievement of interventions on HIV infection prevention among migrants in China: A meta-analysis <p>In China, migrants with acquired immunodeficiency syndrome (AIDS) have become a serious problem in the field of AIDS prevention. This study aimed to evaluate the efficacy of interventions for human immunodeficiency virus (HIV) infection prevention for migrants in China and to identify factors associated with intervention efficacy. A computerized literature search of the Chinese National Knowledge Infrastructure, Wan Fang, and PubMed databases was conducted to collect related articles published in China. Only self-control intervention studies or studies containing sections regarding self-control interventions wherein the method of intervention was health education were included. Rev Manager 5.3 software was used to analyze the intervention effects in terms of knowledge, attitude, and behavior indexes. Relative to pre-intervention, the HIV interventions showed statistically significant efficacy in terms of sexual transmission of HIV, condom use for HIV prevention, change in attitude towards HIV/AIDS patients, incidence of commercial sex behavior, and recent condoms use during sex (<em>P</em> &lt; .01). Moreover, the baseline rate of migrants, intervention time, peer education, region, and education background were factors influencing the efficacy of the intervention. Significant improvement in terms of knowledge of sexual transmission of HIV and attitudes and behaviors among migrants was observed; however, based on the findings of previous studies, the interventions should be customized for different people from different districts in China. Further research is needed to evaluate subgroups of migrants in China according to their baseline characteristics.</p><p><strong>Keywords:</strong> migrants, AIDS/HIV, intervention, meta-analysis, precision intervention</p> Rui Zhang Ling Chen Ya deng Cui Ge Li Copyright (c) 2018-04-11 2018-04-11 15 1 31 41 Understanding the role played by parents, culture and the school curriculum in socializing young women on sexual health issues in rural South African communities <p><strong>Background:</strong> the decline in South Africa’s HIV infection rates especially among young women is encouraging. However, studies show that the 15–24-year-old cohort remains vulnerable. As they still report early sexual debut, being involved in sexual partnerships with older men as well as having unprotected sex. These risky sexual behaviors may be linked to factors such as the parent–child sexual health communication and the timing of the first talk. The quality of sexual health information received in school may also be important for enhancing healthier sexual behaviors. Aims and</p><p><strong>Objectives:</strong> to investigate the <em>what</em>, <em>when</em> and <em>how</em> sexual health communication occurs in rural South African families and to determine whether such communication patterns have changed over time. We also wanted to get an in-depth understanding of the roles played by culture, sexual health education and peers in the socialization of young women on sexual matters.</p><p><strong>Methods:</strong> a purposive sample of (<em>n</em> = 55) women who were 18–35 years old was selected and interviewed in focus group discussions (FGDs).</p><p><strong>Results:</strong> the FGD findings show that parent–child communication on sexual matters in rural communities is limited to messages that warn against pregnancy. It is also laden with cultural idioms that are not well explained. The school sexual health curriculum also fails to adequately equip adolescents to make informed decisions regarding sexual matters. All this seems to leave room for reception of misguided information from peers.</p><p><strong>Conclusions:</strong> findings highlight a need for designing interventions that can create awareness for parents on the current developmental needs and sexual behavior of adolescents. For adolescents programs would need to focus on providing skills on personal responsibility, and how to change behavior to enhance sexual health.</p><p><strong>Keywords:</strong> adolescents, rural communities, communication, culture, sexual health</p> Feziwe Mpondo Robert A.C. Ruiter Dilana Schaafsma Bart van den Borne Priscilla S. Reddy Copyright (c) 2018-04-11 2018-04-11 15 1 42 49 Disability and health outcomes – from a cohort of people on long-term antiretroviral therapy <p>Human-immunodeficiency virus (HIV)/Acquired immunodeficiency Syndrome (AIDS) remains a major health problem in South Africa – even after two decades since the introduction of antiretroviral therapy (ART). Long-term survival with HIV is associated with new health-related issues and a risk of functional limitation/disability. The aim of this study was to assess functional limitation associated with HIV/AIDS among people living with HIV (PLHIV) in South Africa. This study is a cross-sectional survey using a cohort in an urban area in Gauteng province, South Africa. Data were collected using questionnaires through an interview process. The information collected included aspects such as demographics, livelihood, the state of mental and physical health, adherence and disability. A total of 1044 participants with an average age of 42 ± 12 years were included in the study, with 51.9% of the participants reporting functional limitations (WHODAS ≥ 2). These were reported mainly in the domains of participation (40.2%) and mobility (38.7%). In addition, adherence to ART, symptoms of poor physical health and depression were strongly associated with their functional limitations/disability. HIV as a chronic disease is associated with functional limitations that are not adequately addressed and pose a risk of long-term disability and negative adherence outcomes. Therefore, wellness for PLHIV/AIDS needs to include interventions that can prevent and manage disability.</p><p><strong>Keywords:</strong> HIV, disability, depression, South Africa, adherence, antiretroviral</p> Hellen Myezwa Jill Hanass-Hancock Adedayo Tunde Ajidahun Bradley Carpenter Copyright (c) 2018-05-30 2018-05-30 15 1 50 59 Violence, abuse and discrimination: key factors militating against control of HIV/AIDS among the LGBTI sector <p>The Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) South Africans continue to face considerable challenges, including societal stigma, homophobic violence (particularly corrective rape), and high rates of sexually transmitted diseases and infections (particularly Human Immunodeficiency Virus (HIV)/AIDS) even when discrimination based on sexual orientation was outlawed by South African’s post-apartheid constitution. This study was conducted to ascertain violence, abuse and discrimination against the LGBTI sector as key factors that hinder the smooth implementation of HIV/AIDS programme among sexually minority (LGBTI) group in Walter Sisulu University, South Africa. The self-structured questionnaire was used to collect data. The study involved 3048 purposively selected participants (1285 male and 1763 female) aged 17–38 years. About 70.5% of the participants witnessed physical attack as a form of violence against people in same-gender relationship; 47.7% disagreed that violent targeted at this sexually minority group is justified. The LGBTI face challenges which include verbal insults (937, 32.4%), bullying (532, 18.4%) and namecalling (1389, 48%). Discrimination against members of the LGBTI sector was witnessed in various forms: non-acceptance (981, 33.9%), disapproval of act of homosexuals (1308, 45.2) and denial of rights (327, 11.3). Violence, abuse and discrimination which constitute stigmatisation among the LGBTI sector are received with mix feeling. Some respondents justified the use of one or more of these key elements of stigmatisation against the LGBTI (6.6%, supports violence), others condemned these acts of stigmatisation (28.8%), against discrimination). Social stigma which resulted from violence, abuse and discrimination exist in this institution and is responsible for the unwillingness of disclosure of sexual orientation among the LGBTI members. An enabling environment should be created where the LGBTI members could come out freely to access programmes targeted at the prevention and control of HIV/AIDS.</p><p> <strong>Keywords</strong>: Social stigma, LGBTI, students, HIV/AIDS</p> Dominic Targema Abaver Elphina Nomabandla Cishe Copyright (c) 2018-07-23 2018-07-23 15 1 60–70 60–70 Social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries: a multi-country cross-sectional study <p>While university students are potential human resources, this population group is particularly involved in health risk behaviours. Preventing risky sexual behaviours among them would contribute to prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancies, which have posed a great burden on population health. This study was therefore conducted to identify social and behavioural factors associated with risky sexual behaviours among university students in nine ASEAN countries. A multi-country, crosssectional study was conducted in 2015 among university students by a network of researchers in the selected countries. A convenient sampling method and stratified random sampling procedures were employed to select universities and students, respectively. A structured questionnaire was translated into national languages of the participating countries and used to collect data from the selected students in the classrooms. Using STATA, Chisquare test was used to test differences in proportions, and multinomial logistic regression analyses were performed to obtain relative risk ratios and 95% confidence intervals. Multivariate logistic regression analysis was performed with to identify independent social and behavioural factors associated with non-condom use at last sexual intercourse. In total, 8,836 students with a mean age of 20.6 (SD = 2.0) participated in the study. Most of them (98.5%) were unmarried. In all countries, male students were significantly more likely to have two or more sexual partners in the past 12 months compared to female students (4.8% vs. 1.1%, p &lt; 0.001). Female students were significantly more likely to report unprotected sex compared to male students (50.5% vs. 58.8%, p = 0.01). Results of multivariable logistic regression analyses showed that students who reported having two or more partners in the past 12 months were significantly more likely to be male, be aged between 20–30, be current tobacco smokers, be binge drinkers, have severe depressive symptoms, and have been in a physical fight in the past 12 months, compared to students who reported having less than two sexual partners in the past 12 months. Health intervention programmes to prevent and control STIs, especially HIV infection, should focus on university students having the social and behavioural characteristics that are associated with risky sexual behaviours.</p><p><strong>Keywords:</strong> Risky sexual behaviours; unprotected sex; multiple sexual partners; university students; ASEAN</p> Siyan Yi Vannarath Te Supa Pengpid Karl Peltzer Copyright (c) 2018-08-02 2018-08-02 15 1 71 79 Effect of a multicomponent behavioural PMTCT cluster randomised controlled trial on HIV stigma reduction among perinatal HIV positive women in Mpumalanga province, South Africa <p><strong>Background:</strong> We evaluate the impact a multicomponent, behavioural, prevention of mother to child transmission (PMTCT), cluster randomised controlled trial on HIV stigma reduction among perinatal HIV infected women in rural South Africa.</p><p><strong>Methods:</strong> In a cluster randomised controlled trial, twelve community health centres (CHCs) in Mpumalanga Province, South Africa, were randomised; pregnant women living with HIV enrolled received either: A Standard Care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; <em>n</em> =357), or an Enhanced Intervention (EI) condition of SC PMTCT plus the ‘Protect Your Family’ intervention (EI; 6 CHCs; <em>n</em> =342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions; those in the EI, four antenatal and two postnatal group PMTCT sessions, including stigma reduction, led by trained lay health workers. Maternal PMTCT, HIV knowledge and HIV related stigma were assessed. The impact of the EI was ascertained on stigma reduction (baseline, 12 months postnatally). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention.</p><p><strong>Results:</strong> In all, 699 women living with HIV were recruited during pregnancy (8–<br />24 weeks), and assessments were completed prenatally at baseline and at 12 months (59.5%) postnatally. Baseline scores of overall HIV related stigma and the four scale factors (personalised stigma, disclosure concerns, negative self-image, and concern public attitudes) decreased at follow-up in the intervention group, while baseline scores of overall stigma and three scale factors (personalised stigma, negative self-image, and concern public attitudes) increased at follow-up in the control group. Using longitudinal analyses, Model 1, which included time-invariant predictors of stigma assessed over the two time periods of baseline and 12 months, increases in stigma from baseline to 12 months were associated with being unemployed, having been diagnosed with HIV before the current pregnancy, and alcohol use. In Model 2, which included time-varying predictors, lower stigma scores were associated with participation in the intervention, greater male partner involvement, and consistent condom use.</p><p><strong>Conclusion:</strong> The enhanced PMTCT intervention, including stigma reduction, administered by trained lay health workers had a significant effect on the reduction of HIV related stigma. Trial registration: number NCT02085356.</p><p><strong>Keywords:</strong> Randomized controlled trial; behavioural intervention; stigma; Prevention of Mother to Child Transmission of HIV (PMTCT); South Africa</p> Karl Peltzer Suat Babayigit Violeta J. Rodriguez Jenny Jean Sibusiso Sifunda Deborah L. Jones Copyright (c) 2018-08-27 2018-08-27 15 1 80 88 ‘It’s not good to eat a candy in a wrapper’: male students’ perspectives on condom use and concurrent sexual partnerships in the eastern Democratic Republic of Congo <p>This paper reports on fieldwork carried out in 2011 with aim to investigate young men’s perspectives about condoms use, concurrent sexual partnerships and sex in the context of HIV/AIDS. This study employed a qualitative approach to collect data from 28 boys aged 16–20 from two urban and two rural high schools in South Kivu province. Four focus group discussions and 20 individual interviews were conducted among them. The findings showed that most students identified condoms as unsafe and untrustworthy. Reasons given for the mistrust of condoms were related to the belief that condoms do not give enough protection from Sexually Transmitted Infections, HIV and pregnancies. Most participants believe that condoms have a ‘small hole’ or are unreliable and are therefore not effective in prevention. They also mentioned that condoms encourage inappropriate sexual activity. They prefer flesh-to-flesh sex rather than protected sex using a condom. However, a few participants acknowledged the importance of condom use. Despite the risk of HIV transmission, boys believe that it is appropriate for them to have concurrent sexual partnerships. They justified the concurrent sexual partnerships as a way of ensuring that they cannot miss a girl to satisfy their sexual desire. Given the boys’ failure to use condoms and their strong inclination to concurrent sexual partnerships, there is a need for heath groups and stakeholders within the area to increase awareness about condoms’ effectiveness and improve knowledge dissemination on Sexually Transmitted Diseases and how they are prevented.</p><p><strong>Keywords:</strong> Condoms; concurrent sexual partnerships; girlfriend; young men; HIV/AIDS</p> Maroyi Mulumeoderhwa Copyright (c) 2018-09-27 2018-09-27 15 1 89 102 Health care users’ knowledge, attitudes and perceptions of HIV self-testing at selected gateway clinics at eThekwini district, KwaZulu-Natal province, South Africa <p>Progress in promoting knowledge of HIV status has been made globally, but half of all people living with HIV are still unaware of their HIV status. It is argued the new innovative HIV selftesting strategy could increase the uptake of HIV testing among the people. The aim of the study was to assess outpatients’ health care user’s knowledge, attitudes and perceptions towards HIV self-testing (HIVST) at selected Gateway clinics at eThekwini District, KwaZulu-Natal Province, South Africa. The objectives of the study were to determine health care users’ knowledge of HIVST, assess health care users’ attitudes and perceptions towards HIVST and establish if there is any relationship between knowledge, attitudes and perceptions of health<br />care users towards HIVST. A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three purposefully selected Addington, R. K. Khan and Prince Mshiyeni Memorial Hospital Gateway clinics at eThekwini Health District. A convenience sampling of 442 respondents were sampled from the three study sites. Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they could use it if it can be made freely available to the public and be properly regulated. Generally, health care users indicated positive attitudes towards HIV self-testing. Nevertheless, issues of lack of pre and post-test counselling, false negative results and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated in South Africa.</p><p><strong>Keywords:</strong> HIV self-testing; oral HIV testing; South Africa</p> Sibongiseni Daphney Gumede Maureen Nokuthula Sibiya Copyright (c) 2018-09-27 2018-09-27 15 1 103 109 Health-related quality of life and associated factors in adults living with HIV in Rwanda <p>In Rwanda, as in other sub-Saharan African (SSA) countries, life expectancy of people living with HIV (PLWH) has increased dramatically as a result of combined antiretroviral therapy (cART). People living with HIV can now live longer but with increasing rates of non-communicable diseases (NCDs). Thus, prevention of NCD comorbidities in PWLHI is crucial to maintain and gain health-related benefits and to maximise the health-related quality of life (HRQOL) in the long-term management of PLWH. This study determines the association between physical and mental health-related dimensions of quality of life (QOL) with behavioural and biological risk factors, after controlling socio-demographic and HIV-related factors in adults living with HIV in Rwanda. A cross-sectional study using the WHO STEPwise approach and Kinyarwanda version of the MOS-HIV Health Survey, risk factors for NCDs and HRQOL were analysed for 794 PLWH, both HIV+ on ART and ART-naïve. Multiple regression analysis was used to examine the relationship between CMD risk factors and physical health and mental health summary scores. A total of 794 participants were interviewed. The mean age of the sample was 37.9 (±10.8) years and the majority of the participants were women (<em>n</em> = 513; 64.6%). About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits while 26.1% reported being physically inactive. 18.4% were overweight 43.4% had abdominal obesity, i.e. waist-hip-ratio (WHR) ≥0.95 in males and 0.85 in females. High blood pressure (HBP), i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. The results reveal that mean physical health summary and mental health summary score values were 63.96 ± 11.68 and 53.43 ± 10.89, respectively. While participants indicated that tobacco users and those who had abdominal obesity reported poor mental HRQOL, physical inactivity and hypertension have a negative impact on physical HRQOL. In addition, certain sociodemographic and HIV-related variables – specifically being unmarried, lack of HIV disclosure and low CD4 count (less 350 cell counts /mm<sup>3</sup>) – were associated with significantly lower mental and physical dimensions of quality of life. The results of this study reveal that behavioural and biological risk factors for NCDs were significantly associated with a lower HRQOL. These research findings also suggest that the assessment of the association between behavioural and biological risk factors for NCDs and a HRQOL provides opportunities for targeted counselling and secondary prevention efforts, so that health care providers can implement strategies that have a significant impact on the HRQOL.</p><p><strong>Keywords:</strong> Non-communicable diseases; risk factors; HIV; healthrelated quality of life; physical health; Rwanda</p> Juvenal Biraguma Eugene Mutimura José M. Frantz Copyright (c) 2018-09-27 2018-09-27 15 1 110 120 Factors associated with knowledge and awareness of HIV/AIDS among married women in Bangladesh: evidence from a nationally representative survey <p>Women in Bangladesh share a greater risk of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) infection compared to men. Levels of knowledge and awareness largely contribute to the prevalence of the HIV epidemic and its consequences. So, it is required to conduct studies based on most recent data to explore the determinants of HIV awareness. Therefore, we aimed to find the awareness level and factors influencing HIV related awareness among the married women in Bangladesh. We used data from 2014 Bangladesh Demographic and Health Survey (BDHS). About two-third of total respondents who heard about the HIV/AIDS were selected and interviewed successfully (<em>n</em> = 12,593) about<br />11 basic questions related to individual’s awareness. A score of the respondent’s knowledge and awareness was determined based on these questions. We used logistic regression models for analysing the data. We found about 62% of the respondents had an adequate knowledge and consciousness about the HIV/AIDS. Respondents’ education status, massmedia access, place of living, and working status played significant role on the awareness. As expected, respondents with higher education were more aware than those with no education (odds ratio (OR) = 3.56, 95% confidence interval (CI): 2.99–4.23). Moreover, respondents who had access to the mass media were more likely to be aware compared to those who did not have the access (OR = 1.14, 95% CI: 1.04–1.26). Although a sizeable proportion of women had an adequate knowledge and awareness regarding the HIV/AIDS, we recommend implementing educational programmes related to HIV/AIDS in the curriculum to ensure a standard level of awareness throughout the nation. Since the respondents from rural areas scored significantly lower than the urban areas, awareness through mass media, particularly in rural areas, is of prime concern for raising awareness.</p><p><strong>Keywords:</strong> Risk; HIV/AIDS infection; knowledge score; mass media; education;<br />demographic and health survey</p> Md. Ashiqul Haque Md. Sha Newaj Hossain Muhammad Abdul Baker Chowdhury Md. Jamal Uddin Copyright (c) 2018-09-27 2018-09-27 15 1 121 127 Exploring the acceptability of Option B plus among HIV-positive Nigerian women engaged and not engaged in the prevention of mother-to-child transmission of HIV cascade: a qualitative study <p>The acceptability of lifelong antiretroviral therapy (ART) among HIV-positive women in highburden Nigeria, is not well-known. We explored readiness of users and providers of prevention of mother-to-child transmission of HIV (PMTCT) services to accept lifelong ART -before Option B plus was implemented in Nigeria. We conducted 142 key informant interviews among 100 PMTCT users (25 pregnant-newly-diagnosed, 26 pregnant-in-care, 28 lost-to-follow-up (LTFU) and 21 postpartum women living with HIV) and 42 PMTCT providers in rural North-Central Nigeria. Qualitative data were manually analyzed via Grounded Theory. PMTCT users had mixed views about lifelong ART, strongly influenced by motivation to prevent infant HIV and by presence or absence of maternal illness. Newly-diagnosed women were most enthusiastic about lifelong ART, however postpartum and LTFU women expressed conditionalities for acceptance and adherence, including minimal ART side effects and potentially serious maternal illness. Providers corroborated user findings, identifying the postpartum period as problematic for lifelong ART acceptability/adherence. Option B plus scale-up in Nigeria will require proactively addressing PMTCT user fears about ART side effects, and continuous education on long-term maternal and infant benefits. Structural barriers such as the availability of trained providers, long clinic wait times and patient access to ART should also be addressed.</p><p><strong>Keywords:</strong> Nigeria; HIV; adherence; Option B plus; PMTCT; rural</p> Salome C. Erekaha Llewellyn J. Cornelius Melissa L. Bessaha Abdulmumin Ibrahim Gabriel D. Adeyemo Mofoluwake Fadare Manhattan Charurat Echezona E. Ezeanolue Nadia A. Sam-Agudu Copyright (c) 2018-09-27 2018-09-27 15 1 128 137 Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study <p>Evaluations of community-based antiretroviral therapy (ART) programmes have demonstrated positive outcomes, but little is known about the impact of tapering community-based ART. The objective of this study was to assess 24-month HIV retention outcomes of a community-based ART programme and its tapered visit frequency in Koidu City, Sierra Leone. This retrospective, quasi-experimental study compared outcomes of 52 HIV-infected persons initiated on community-based ART against 91 HIV-infected persons receiving the standard of care from November 2009 to February 2013. The community-based ART pilot programme was designed to strengthen the standard of care through a comprehensive, patient-centred case management strategy. The strategy included medical, educational, psychological, social, and economic support. Starting in October 2011, the frequency of home visits was tapered from twice daily every day per week to once daily three days per week. Outcomes were retention in care at 12 and 24 months and adherence to ART over a three-month time period. Participants who received community-based ART had significantly higher retention than those receiving standard of care. At 12 months, retention rates for community-based ART and standard of care were 61.5% and 31.9%, respectively (p &lt; .01). At 24 months, retention rates for community based ART and standard of care were 73.1% and 44.0%, respectively (p &lt; .01). Significant differences in levels of adherence were observed when comparing community-based ART against persons receiving standard of care (p &lt; .05). No differences in adherence levels were observed between groups of people receiving various frequencies of home visits. Our pilot<br />programme in Koidu City provides new evidence that community-based ART has the potential to improve retention and adherence outcomes for HIV-infected persons, regardless of the frequency of home visits. Overcoming the barriers to HIV care requires a comprehensive, patient-centred approach that may include clinic-based and community-based interventions.</p><p><strong>Keywords</strong>: HIV/AIDS; community-based ART programme; adherence; retention in care; Sierra Leone</p> J. Daniel Kelly Raphael Frankfurter Gregoire Lurton Sulaiman Conteh Susannah F. Empson Fodei Daboh Brima Kargbo Thomas Giordano Joia Mukherjee M. Bailor Barrie Copyright (c) 2019-02-18 2019-02-18 15 1 Effects of adolescent exposure to behaviour change interventions on their HIV risk reduction in Northern Malawi: a situation analysis <p>Understanding adolescents’ translation of HIV and AIDS-related behaviour change interventions (BCI) knowledge and skills into expected behavioural outcomes helps us appreciate behaviour change dynamics among young people and informs evidence-based programming. We explored the effects of adolescents’ exposure to BCI on their HIV risk reduction in selected schools in Nkhatabay and Mzimba districts and Mzuzu city in Northern Malawi. The study used questionnaires as instruments. Data were collected between January and April 2017. Adolescent boys and girls [n = 552], ages 11–19 were randomly sampled to participate. Data analysis was through multiple regression and content analysis. Respondents included 324 female [58.7%] and 228 male [41.3%]. Multiple regression analysis indicated that exposure to BCI did not affect risk reduction in the study area. The best stepwise model isolated sexual experience ([Beta = .727, p = .0001, p &lt; .05]) as having the strongest correlation with the dependent variable – risk reduction. BCI exposure was stepwise excluded ([Beta = −.082, p = .053, p &gt; .05]). There was therefore no evidence against the null hypothesis of no<br />relationship between adolescent exposure to BCI and their HIV risk reduction. Overall there was limited BCI knowledge and skills translation to behavioural risk reduction. The study points to the need to evaluate and redesign adolescent BCI in line with current behavioural dynamics among young people in Malawi. The findings have been used to inform the design<br />and programming of a model to be tested for feasibility through a quasi-experiment in the second phase of our project.</p><p><strong>Keywords</strong>: Adolescent; risk reduction; intervention; BCI; HIV and AIDS; Malawi</p> M. Mwale A.S. Muula Copyright (c) 2019-02-18 2019-02-18 15 1 Determinants of disclosure and non-disclosure of HIV-positive status, by pregnant women in rural South Africa <p>Disclosure of HIV status remains one of the major challenges to the effectiveness of the prevention of mother to child transmission of HIV in rural areas in South Africa. This study aimed at assessing the determinants of HIV status disclosure among HIV infected pregnant women who have disclosed their HIV status to someone, as well as among those who have<br />disclosed to their partners. Cross-sectional data was collected from 673 HIV sero-positive pregnant women receiving antenatal care services at 12 Community Health Centers in Mpumalanga province. Results indicated that over two-thirds (72.1%) disclosed their status to someone, while just over half (58.4%) disclosed to their partners. Multivariate analysis showed that both disclosure of ones HIV status to someone and to their male partners was significantly associated with increase in antiretroviral therapy (ART) adherence, the known HIV positive status of their partner, and male involvement during pregnancy. Participants who were diagnosed HIV positive during this current pregnancy were less likely to disclose their HIV status to someone. Non-disclosure during current pregnancy highlights a need for interventions that will encourage disclosure among HIV positive women, with a particular focus on those who are newly diagnosed. The findings also need to integrate male partner involvement and partner disclosure during pregnancy.</p><p>La divulgation du statut sérologique reste l’un des principaux obstacles à l’efficacité de la prévention de la transmission du VIH de la mère à l’enfant dans les zones rurales d’Afrique du Sud. Cette étude visait à évaluer les déterminants de la divulgation du statut VIH chez les femmes enceintes infectées par le VIH qui ont révélé leur statut VIH à quelqu’un, ainsi que<br />parmi ceux qui ont divulgué à leurs partenaires. Des données transversales ont été recueillies auprès de 673 femmes enceintes séropositives pour le VIH recevant des soins prénatals dans 12 centres de santé communautaire de la province de Mpumalanga. Les résultats indiquaient que plus des deux tiers (72,1%) révélaient leur statut à quelqu’un, alors qu’un peu plus de la<br />moitié (58,4%) divulguaient à leur partenaire. L’analyse multivariée a montré que la révélation de son statut VIH à quelqu’un et à ses partenaires masculins était significativement associée à une augmentation de l’adhésion au traitement antirétroviral (ARV), au statut séropositif connu de leur partenaire et à la participation masculine pendant la grossesse. Les<br />participants qui ont été diagnostiqués séropositifs pendant cette grossesse étaient moins susceptibles de révéler leur statut sérologique à quelqu’un. La non-divulgation au cours de la grossesse actuelle souligne le besoin d’interventions qui encourageront la divulgation chez les femmes séropositives, en mettant particulièrement l’accent sur les personnes nouvellement diagnostiquées. Les résultats doivent également intégrer l’implication des partenaires masculins et la divulgation des partenaires pendant la grossesse.</p><p><strong>Keywords</strong>: Disclosure; HIV; AIDS; Woman; Pregnancy </p> Shandir Ramlagan Gladys Matseke Violeta J. Rodriguez Deborah L. Jones Karl Peltzer Robert A.C. Ruiter Sibusiso Sifunda Copyright (c) 2019-02-18 2019-02-18 15 1 An evaluation of the innovative potentials of a HIV pilot exploring medical pluralism in rural South Africa <p>This article reflects on an internal evaluation undertaken to estimate the potentials of a community-university pilot project to be developed into a bonafide innovation that can be applied at scale. The focus of the community-university partnership has been to reduce the unintended consequences of medical pluralism on the HIV and AIDS epidemic in Waterberg district, Limpopo Province, South Africa. Despite promising outputs from the partnership – including an increase in adherence to antiretroviral therapy and a reduction in stigma among traditionalists living with HIV – the partnership wished to establish whether further funding should be applied for to take the pilot from its current prototype status to a more established innovation. In order to evaluate the innovative potentials of the pilot, the opportunity vacuum model of innovation was adapted and applied. The findings indicate that (1) the application of the opportunity vacuum model of innovation to evaluate the potentials of the pilot to be developed into a bonafide innovation was fit for purpose and (2) the pilot contains the key ingredients that are associated with innovations in the making. The discussion reflects on the social potentials of the pilot to contribute to 90-90-90 from a global, national and local perspective. The reflection concludes by suggesting that the opportunity vacuum model of innovation is a versatile heuristic that could be applied in other contexts and the community-university pilot represents a nascent innovation which<br />has sufficient potential to justify further development.</p><p><br /><strong>Keywords</strong>: Adjacent possible; community-university partnership; innovation; HIV/makgoma conflation; opportunity vacuum model</p> Christopher J. Burman Copyright (c) 2019-02-18 2019-02-18 15 1 ‘Why would you promote something that is less percent safer than a condom?’: Perspectives on partially effective HIV prevention technologies among key populations in South Africa <p>New biomedical prevention technologies (NPTs) for HIV, including oral Pre-Exposure Prophylaxis, and vaginal and rectal microbicides and HIV vaccines in development, may contribute substantially to controlling the HIV epidemic. However, their effectiveness is contingent on product acceptability and adherence. We explored perceptions and understanding of partially effective NPTs with key populations in South African townships. From October 2013 to February 2014, we conducted six focus groups and 18 individual interviews with Xhosaspeaking adolescents (n = 14), adult men who have sex with men (MSM) (n = 15), and adult heterosexual men (n = 9) and women (n = 10), and eight key informant (KI) interviews with healthcare workers. Interviews/focus groups were transcribed and reviewed using a thematic approach and framework analysis. Overall, participants and KIs indicated scepticism about NPTs that were not 100% efficacious. Some participants equated not being 100% effective with not being completely safe, and thus not appropriate for dissemination. KIs expressed<br />concerns that promoting partially effective NPTs would encourage substitution of a more effective with a less effective method or encourage risk compensation. Educational and social marketing interventions that address the benefits and appropriate use of partially effective NPTs, including education and support tailored for frontline service providers, are needed to prepare for successful NPT implementation in South Africa.</p><p><br /><strong>Keywords</strong>: Biomedical HIV prevention; translational research; qualitative methods</p> Clara Rubincam Peter A. Newman Millicent Atujuna Linda-Gail Bekker Copyright (c) 2019-02-18 2019-02-18 15 1 The pull of soccer and the push of Xhosa boys in an HIV and drug abuse intervention in the Western Cape, South Africa <p>There is growing interest in engaging men and boys in health and development programmes targeting the intersection of HIV risk, substance abuse, and violence. Understanding the conceptualisations of masculinities or masculine identities that shape both behaviours and opportunities for intervention is central to advancing the global agenda to engage men in<br />health and development interventions. This paper examines an intervention using soccer and job training to engage and deliver activities for HIV prevention, substance abuse, and gender-based violence in a South African township. A literature review provides theoretical, historical and social context for the intersection of gender, masculinity, soccer, violence, and sexual relationships. Qualitative data from in-depth interviews and focus groups is analysed using theoretical and contextual frames to elucidate the negotiation of shifting, contradictory, and conflicting masculine roles. Results highlight how changing risky, normative behaviours among young men is a negotiated process entailing men’s relationships with women and with other men.</p><p><strong>Keywords</strong>: HIV/AIDS; South Africa; masculinity; soccer; drugs; gender; violence</p> Melissa Medich Deborah Mindry Mark Tomlinson Mary Jane Rotheram- Borus Jason Bantjes Dallas Swendeman Copyright (c) 2019-02-18 2019-02-18 15 1