HIV and AIDS surveillance among inmates in Maryland prisons

The prevalence of those with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is higher among inmates of correctional facilities than among the general population. This raises the need to identify inmates living with or at risk of HIV/AIDS and to provide counseling and appropriate survices for HIV treatment and prevention. The Maryland Division of Corrections (DOC) offers voluntary testing to all inmates on entry and tests inmates when clinically indicated. We reviewed all 1998 HIV antibody tests and confirmed AIDS cases in the Maryland DOC. Inmate demographics, testing acceptance, rates of seropositivity, and AIDS cases and comparisons based on gender, racelethnicity, and age were examined. Comparisons were also made to HIV testing and AIDS cases from the nonincarcerated Maryland population. Trends in DOC AIDS diagnoses and AIDS-related deaths over time were also examined. Of the inmates, 39% were voluntarily tested for HIV on entry to the Maryland DOC in 1998 (38% of males and 49% of females). Overall, HIV seropositivity was 33% (5% for females and 3% for males). The 888 cumulative AIDS cases diagnosed in the DOC inmate population were concentrated among males (90% vs. 77% statewide), African Americans (91% vs. 75% statevide), and among IDUs (84% vs. 39% statewide). Due to high rates of HIV and AIDS, inmate populations are a crucial audience for HIV/AIDS testing, treatment, and prevention efforts, especially women. Prison-based programs can identify significant numbers of HIV and AIDS cases and bring HIV prevention interventions to a population characterized by frequent high-risk behavior.     

中国维和军人艾滋病自愿咨询检测的调查

目的研究赴利比里亚维和的中国军人接受艾滋病自愿咨询检测的意向和检测结果告知范围。方法采用匿名问卷表调查518名23～51岁的男性中国赴利比里亚维和军人。结果在听说过HIV的476名调查对象中,407名（85.5%）有接受HIV检测的意向。其中,91.2%（371名）的人愿将结果告诉配偶,80.6%（328名）愿告诉家庭其他成员,42.8%（174名）愿告诉朋友,37.1%（151名）愿将结果告诉邻居。统计学分析提示,与接受检测意向有关联的因素为HIV/AIDS知识水平较高者。结论HIV/AIDS知识知晓程度影响中国维和人员接受HIV检查意向,应开展HIV/AIDS知识的健康教育,提高维和人员对AIDS的警觉性。     

Khat use among HIV voluntary counselling and testing centre clients in Ethiopia

Khat (Catha edulis, a natural stimulant), has been used in Ethiopia for centuries. Over the past few decades, however, its use has dramatically increased, with recent research linking khat use to HIV status. Using qualitative methods, we explored the individual and micro-environmental characteristics of khat use and the social and physical contexts influencing type, acceptability and consequences of khat use. Among khat chewers attending an HIV voluntary counselling and testing centre in Addis Ababa, Ethiopia, we found that chewing typically starts at an early age (15–18 years). The majority of users are young (aged 18–35) and chew for pleasure, primarily in social settings. Over 25 types of khat, with varying effects were reported. Approximately half of the participants perceived khat to enhance sexual desire, while the rest claimed the effect on sexual desire to be the opposite. Alcohol use among chewers was high. Our findings suggest the need for culturally appropriate interventions that highlight the factors associated with khat use and the potential interplay between khat, alcohol and risky sexual behaviour.     

Predicting intended use of voluntary HIV counselling and testing services among Tanzanian teachers using the theory of planned behaviour

The theory of planned behaviour (TPB) provides a conceptual model for understanding individual cognitions that influence behavioural intentions and enactment of the actual behaviours. This study examined the applicability of the TPB and the additional predictive role of perceived risk in predicting intended use of voluntary HIV counselling and testing (VCT) services. We conducted a cross-sectional questionnaire survey among 918 primary school teachers in the Mwanza region, Tanzania between September 2003 and November 2003. Analysis was based on 737 teachers (mean age 38.9) who had never tested for HIV. Results of the hierarchical regression analysis indicate that perceived behavioural control and attitude toward using VCT services were significant predictors of intention to use VCT services in the TPB model. Perceived behavioural control added 12% of variance to intention over and above attitudes and subjective norms, while perceived risk added 3% of variance. Socio-economic status did not moderate the predictive value of the TPB components. The present study demonstrates that the TPB is a useful conceptual framework for predicting intended use of HIV counselling and testing services among Tanzanian teachers. A theory-based VCT intervention programme among Tanzanian teachers should mainly focus on reducing social and psychological barriers related to the use of VCT services.     

HIV seroprevalence and the acceptance of voluntary HIV testing among newly incarcerated male prison inmates in Wisconsin.

In 1986-88, voluntary and blinded HIV testing was conducted among Wisconsin male prison entrants. The HIV seroprevalence was 0.30 percent in 1986, 0.53 percent in 1987, and 0.56 percent in 1988. The seroprevalence rates among entrants tested voluntarily did not differ from those tested blindly. Voluntary HIV testing was accepted by 71 percent of male prison entrants in 1988; among entrants reporting intravenous drug use 83 percent consented to voluntary HIV testing. Voluntary HIV testing of entrants appears to be an effective screening strategy in Wisconsin prisons.     

Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey

ABSTRACT: BACKGROUND: Voluntary HIV counselling and testing (VCT) is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing. METHODS: The study utilized data from the Ethiopian Demographic Health Survey (EDHS) 2005, which is a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 6,778 men aged 15-59 years were selected from all the eleven administrative regions in Ethiopia. Logistic regression was used to analyze potential factors associated with VCT utilization. RESULTS: Overall, 21.9% of urban men and 2.6% of rural men had ever tested for HIV through VCT and most of them had learned their HIV test result. Having no stigmatizing attitudes toward people living with HIV/AIDS was found to be strongly and positively associated with VCT utilization in both urban and rural strata. In rural areas HIV test rates were higher among younger men (aged [less than or equal to]44 years) and those of higher socio-economic position (SEP). Among urban men, risky sexual behaviour was positively associated with VCT utilization whereas being Muslim was found to be inversely associated with use of VCT utilization. Area of residence as well as SEP strongly affected men's level of stigmatizing attitudes toward people living with HIV/AIDS. CONCLUSIONS: VCT utilization among men in Ethiopia was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma. Targeting rural men with low SEP should be given first priority when designing, expanding, and implementing VCT services in the country. Key words: HIV testing, VCT utilization, stigma, knowledge, men, Ethiopia.     

2008年太原市艾滋病自愿咨询检测结果分析

目的了解对艾滋病病毒感染者和艾滋病病人开展艾滋病自愿咨询检测工作情况。方法对2008年在太原市疾病预防控制中心做艾滋病自愿咨询检测的人员进行艾滋病病毒抗体检测并登记相关信息。结果2008年1—12月共有2256人接受艾滋病病毒抗体检测,阳性15例,阳性率0．66％。结论应大力宣传艾滋病自愿咨询检测工作,使更多公众参与。     

Barriers and facilitators to voluntary HIV testing uptake among communities at high risk of HIV exposure in Chennai,India

In India, increasing uptake of voluntary HIV testing among ‘core risk groups’ is a national public health priority. While HIV testing uptake has been studied among key populations in India, limited information is available on multi-level barriers and facilitators to HIV testing, and experiences with free, publicly available testing services, among key populations. We conducted 12 focus groups (n?=?84) and 12 key informant interviews to explore these topics among men who have sex with men, transgender women, cisgender female sex workers, and injecting drug users in the city of Chennai. We identified inter-related barriers at social-structural, health-care system, interpersonal, and individual levels. Barriers included HIV stigma, marginalised-group stigma, discrimination in health-care settings, including government testing centres, and fears of adverse social consequences of testing HIV positive. Facilitators included outreach programmes operated by community-based/non-governmental organisations, accurate HIV knowledge and risk perception for HIV, and access to drug dependence treatment for injecting drug users. Promoting HIV testing among these key populations requires interventions at several levels: reducing HIV-related and marginalised-group stigma, addressing the fears of consequences of testing, promoting pro-testing peer and social norms, providing options for rapid and non-blood-based HIV tests, and ensuring non-judgmental and culturally competent HIV counselling and testing services.     

Home-based voluntary HIV counselling and testing found highly acceptable and to reduce inequalities

Background  

Low uptake of voluntary HIV counselling and testing (VCT) in sub-Saharan Africa is raising acceptability concerns which might be associated with ways by which it is offered. We investigated the acceptability of home-based delivery of counselling and HIV testing in urban and rural populations in Zambia where VCT has been offered mostly from local clinics.     

Surveillance of HIV infection and related risk behaviour in European prisons. A multicentre pilot study

BACKGROUND: In order to demonstrate the feasibility of human immunodeficiency virus (HIV) infection and related risk behaviour surveillance in European prisons, a multicentre pilot study was undertaken. METHODS: A cross-sectional survey was carried out in six European prisons (France, Germany, Italy, The Netherlands, Scotland and Sweden). Inmates were invited to complete a self-administered and anonymous questionnaire and to give a saliva sample in order to test for HIV antibodies. RESULTS: Eight hundred and forty-seven out of 1,124 inmates participated in the survey (response rate 75%). Saliva from 817 inmates (73%) was collected and processed for HIV antibodies. Twenty-seven per cent reported that they had ever injected drugs and 49% of these reported they had injected whilst in prison. Eighteen per cent of inmates reported that they had been tattooed whilst in prison, which was found to be higher among injecting drug users (IDUs). One and sixteen per cent reported that they had ever had homosexual and heterosexual intercourse in prison respectively. The HIV prevalence among IDUs was 4% (versus 1% among non-IDUs) (p = 0.02). The proportions of inmates previously tested for hepatitis C and vaccinated against hepatitis B were 24 and 16% respectively. CONCLUSION: This survey demonstrates the feasibility of cross-sectional surveys in European prison inmates and highlights the importance of surveillance of HIV prevalence and related risk behaviour among inmates. The continuing high HIV prevalence and potential for HIV spread in prisons should encourage decision makers in implementing or enhancing harm reduction and education programmes and substance abuse treatment services in prison.     

The voluntary HIV counselling and testing service in Kenema District, Sierra Leone, 2004-2006: a descriptive study

Background  

Voluntary counselling and testing (VCT) is an important component of national HIV programs, which are necessary to realize the right to health. VCT data also provide valuable information on regional HIV epidemiology.     

HIV risk factors, HIV antibody testing, and AIDS knowledge among African Americans age 55 years and older

This study uses data from the 1992 AIDS Knowledge and Attitudes Supplement to the National Health Interview Survey to assess AIDS knowledge, prevalence of HIV testing, and HIV risk factors among 745 African Americans age 55 years and older. The results revealed that only one of the six respondents who reported an HIV risk factor had been tested for HIV. Overall, the respondents were very knowledgeable about the major modes of transmission, but they still had misconceptions about the likelihood of transmission through casual contact. Prevention programs aimed at African Americans age 55 years and older should focus on dispelling misconceptions about the transmission of HIV through casual contact, and enhancing their knowledge about the effectiveness of condoms in preventing the spread of AIDS.     

Ethnicity and HIV risk behaviour,testing and knowledge in Guatemala

Objectives. To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes.

Design. Data on 16,205 women aged 15–49 and 6822 men aged 15–59 from the 2008–2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only).

Results. The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage.

Conclusions. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes.     

Assessing the cost and willingness to pay for voluntary HIV counselling and testing in Kenya

OBJECTIVE: Voluntary counselling and testing (VCT) should be an important component in a country's HIV/AIDS prevention and care strategy. However, the high cost of VCT raises concerns about the affordability of VCT in low-income countries. This study was designed to assess the costs of VCT and to identify potential ways of introducing VCT more affordably. METHODOLOGY: An economic evaluation was performed of VCT services in two rural health centres in Thika District and an urban health centre in Nairobi, Kenya. A contingent valuation study was also performed among VCT clients. Estimates were developed regarding the national cost of offering VCT services in Kenya. RESULTS: VCT added US dollars 6800 per year to the average cost of providing services at each of these three health centres. The evaluation revealed that the incremental cost, from the government's perspective, of adding VCT is approximately 16 dollars per client. The estimated incremental cost per client is significantly less than a previous cost estimate in Kenya which estimated a cost per client of 26 dollars. The difference in cost estimates is in part attributable to the emphasis of this project on integrating VCT services into existing health centres, rather than creating stand-alone sites. The cost of VCT services might be further reduced to as little as 8 dollars per client if a government health worker could perform the counselling. A contingent valuation study indicated that most VCT clients would be willing to pay at least 2 dollars for the service. However, if the full cost of the service were charged to the client, less than 5% of clients indicated they were willing and able to pay for the service. CONCLUSIONS: Integrating services into existing health centres can significantly reduce the cost of VCT. Additional cost reductions may be feasible if health centre staff are hired to perform the counselling. Furthermore, it appears that some level of cost recovery from VCT clients is feasible and can contribute to sustainability, although it is very unlikely that the full cost of the service could be recovered from the clients. The national provision of VCT in all Kenyan health centres is likely to be an affordable option, although additional operational research is required to determine the most appropriate way of scaling up VCT services throughout the country.     

Rapid operation assessment of voluntary HIV counselling and testing services in three cities in China, 2009

Objectives

To assess the operation of voluntary counselling and testing (VCT) services for human immunodeficiency virus (HIV) in three cities in China.

Study design

A cross-sectional study using mixed methods, including focus group discussions, in-depth interviews, field assessment, archive checking and structured questionnaire interviews, was conducted to assess different aspects of VCT services.

Methods

Surveys were undertaken in six counties of three China Global Fund AIDS Program (Round Five) cities, including 11 VCT clinics, 38 counsellors, 83 clients and 332 individuals at risk for HIV infection.

Results

All counsellors were trained and approved for providing counselling. As there were adequate numbers of clinics and counsellors, VCT services ran smoothly. Clients were generally satisfied with VCT services and considered service operation to be adequate. Problems with the VCT programme included fewer VCT services in general hospitals, lack of a referral mechanism, and long delays between testing and receipt of results.

Conclusions

The operation of VCT services in the three cities was generally adequate, but referral services were poor. More attention needs to be paid to HIV testing and counselling in general hospitals, and referral networks need to be strengthened.     

Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia

Background  

To benefit from available care and treatment options, patients should first be counselled and tested for HIV. Our aim was to assess the acceptability of HIV testing among tuberculosis patients under routine care conditions in south Ethiopia.     

A critical assessment of the WHO responsiveness tool: lessons from voluntary HIV testing and counselling services in Kenya

Background  

Health, fair financing and responsiveness to the user's needs and expectations are seen as the essential objectives of health systems. Efforts have been made to conceptualise and measure responsiveness as a basis for evaluating the non-health aspects of health systems performance. This study assesses the applicability of the responsiveness tool developed by WHO when applied in the context of voluntary HIV counselling and testing services (VCT) at a district level in Kenya.