HIV transmission risks of females and males in paired partner relationships

As the HIV/AIDS epidemic has evolved, heterosexual behaviors have come to be an increasingly important mode of transmission and rates of infection have increased faster among women generally and minority women in particular. Most of what we known about heterosexual risk taking is based on survey data collected from either women or men. These data have been useful for helping to understand different levels and types of risk taking by women and men. However, they provide little information about the levels of risk taking that exist for paired partners in main partner relationships, the types of risks each partner brings to the relationship and how the contribution of partner risks varies. Using data from the pretest of a pilot project designed to test a behavioral intervention to reduce HIV/AIDS transmission among main sex partners, the authors developed four subscales of sexual risk taking for each partner. The association between subscales within and between genders are examined and the subscales are combined to obtain measures of couple risks. Particular attention is given to the gender contribution of partners to couple risk and the differential contribution of types of risk to total risk. The data suggest that, even though men bring relatively higher risks to their main partner relationship than women, this varies inversely with the level of couple risk.     

HIV misconceptions among married women in Malawi: the role of household decision-making autonomy

Journal of Public Health - Married women face one of the highest HIV rates in Malawi. Although HIV misconceptions have been identified as a major contributor to HIV infection, we know very little...     

Myths and misconceptions about tuberculosis transmission in Ghana

Background

Myths and misconceptions about TB can serve as a barrier to efforts at reducing stigmatisation of people infected and affected by the disease. Understanding such drivers of myths and misconceptions is important for improving information, education and communication (IEC) efforts of national control and preventive interventions. This study therefore assesses the influence of interaction of spatial, socioeconomic and demographic characteristics on myths and misconceptions.

Methods

Data was drawn from male (N?=?4,546) and female (N?=?4,916) files of the 2008 Ghana Demographic and Health Survey. A myth and misconception variable was created from five-related constructs with internal consistency score of r?=?0. 8802 for males (inter-item correlation: 0.5951) and for females, r?=?0. 0.9312 (inter-item correlation: 0.7303). The Pearson Chi-square was used to test the bivariate relationship between the independent variables and the dependent variable. Logistic regression was subsequently used to explore the factors determining myths and misconceptions of TB transmission.

Results

Majority of Ghanaians (males: 66.75%; females: 66.13%) did not hold myths and misconceptions about TB transmission. Females resident in the Upper East (aOR?=?0.31, CI?=?0.17-0.55) and Upper West (aOR?=?0.41, CI?=?0.24-0.69) and males resident in the Northern (aOR?=?0.23, CI?=?0.13-0.39) and the Greater Accra (aOR?=?0.25, CI?=?0.16-0.39) regions were independently associated with no misconceptions about TB transmission. Significant differences were also found in education, ethnicity and age.

Conclusion

That spatial and other socioeconomic difference exists in myths and misconceptions suggest the need for spatial, socioeconomic and demographic segmentations in IEC on TB. This holds potentials for reaching out to those who are in critical need of information and education on the transmission processes of TB.

     

Contraceptive method and self-reported HIV status among women in Malawi

ObjectivesWe aimed to describe contraceptive methods used by women in Malawi and determine whether contraceptive use differed by self-reported HIV status. Effective contraception is a primary method of preventing mother-to-child transmission of HIV.Study designAnalysis is based on 12,658 nonpregnant, sexually debuted women ages 15–49 years in the 2010 Malawi Demographic and Health Survey. Analysis was restricted to respondents with contraceptive need (i.e., fecund and did not want a child in the next 12 months) who reported their last HIV test result. We accounted for the two-stage cluster sampling design by applying cluster, stratum and sample weights. We assessed differences in contraceptive method use by HIV status with χ² tests and multivariable logistic regression.ResultsA total of 893 (7.0%) of respondents reported being HIV positive. Use of long-acting reversible contraception (LARC) was low and did not differ between HIV-positive (1.4%) and HIV-negative (1.9%) women [adjusted odds ratio (aOR)=0.7, 95% confidence interval (CI), 0.4–1.4]. HIV-positive women (15.6%) were less likely than HIV-negative women (30.4%) to use progestin-only injectable contraception (aOR, 0.7; 95% CI, 0.5–0.8). Prevalence of female sterilization was higher among HIV-positive women (17.9%) compared to HIV-negative women (9.2%; aOR=1.7; 95% CI, 1.2–2.3).ConclusionsLARC use was low among adult women with contraceptive need in Malawi. HIV-positive women were less likely to report progestin-only injectable use but more likely to report having undergone female sterilization compared to their HIV-negative counterparts. Noncoercive interventions that provide highly effective methods of contraception to HIV-positive women with contraceptive need are valuable methods of vertical transmission prevention in Malawi.ImplicationsContraceptive use differed by self-reported HIV status among adult women with contraceptive need in Malawi. Female sterilization was significantly higher, and use of progestin-only injectables was significantly lower, among HIV-positive women compared to their HIV-negative counterparts. Use of long-acting reversible contraception was low among both HIV-positive and HIV-negative women.     

HIV infection among paediatric in-patients in Blantyre, Malawi

To investigate the impact of HIV infection on hospital admission and death we studied children admitted to paediatric medical and surgical wards in Blantyre, Malawi, in March 2000. Unselected children whose parents or guardians consented to HIV testing of the child were recruited and HIV infection was determined by serology, with confirmation in children aged 15 months or less by PCR. We assessed the prevalence of HIV infection by age, clinical diagnosis and outcome of admission. Of 1064 admissions, 991 were tested for HIV infection, and 187 (18.9%) were infected. HIV was most common in children aged less than six months, 53 of 166 (32%). Parents of HIV-infected children were better educated, and more likely to have died, than those of uninfected children. Clinical symptoms and signs were not adequately sensitive or specific to be used for diagnosis of HIV. HIV was common in children with malnutrition (prevalence 40%), lower respiratory tract infection (29%) and sepsis (28%), and less prevalent among children with malaria (11%) or surgical admissions (11%). Almost 30% of HIV-infected children died, compared with 8.9% of uninfected children, and HIV-infected children constituted over 40% of in-patient deaths.     

Prevalence of smoking among currently married Kuwaiti males and females

A structured questionnaire was administered to a random sample of 608 Kuwaiti couples through a household face-to-face interview. Both spouses were non-smokers in more than half (50.8%) of all the couples, and there was a single couple (0.2%) with both spouses currently smoking. Only 0.5% of the wives reported current smoking. The prevalence of smoking was 3.2% among divorced/widowed women from the same households. The difference between the two groups of women remained significant upon controlling for the confounding effect of age. Among the husbands, frequencies of current and ex-smokers were 37% and 11%, respectively. Younger respondents consumed more tobacco and were initiated to smoking at an earlier age. Logistic regression showed that people with one to 11 years of formal education were more likely to be current smokers as compared to the rest of the respondents (adjusted relative risk: 2.07, 95% confidence interval (CI): 1.46–2.93). Reasons for the observed findings have been discussed.     

Tuberculosis transmission attributable to close contacts and HIV status, Malawi

We conducted the first molecular study of tuberculosis (TB) to estimate the role of household contact and transmission from HIV-positive putative source contacts (PSCs) in a high HIV-prevalence area. TB patients in a long-term population-based study in Malawi were asked about past contact with TB. DNA fingerprinting was used to define clusters of cases with identical strains. Among 143 epidemiologically defined PSC-case pairs, fingerprinting confirmed transmission for 44% of household and family contacts and 18% of other contacts. Transmission was less likely to be confirmed if the PSC were HIV positive than if he or she was HIV negative (odds ratio 0.32, 95% confidence interval [CI] 0.14-0.74). Overall, epidemiologic links were found for 11% of 754 fingerprint-clustered cases. We estimate that 9%-13% of TB cases were attributable to recent transmission from identifiable close contacts and that nearly half of the TB cases arising from recent infection had acquired the infection from HIV-positive patients.     

Prevention of mother-to-child transmission of HIV infection: Views and perceptions about swallowing nevirapine in rural Lilongwe,Malawi

Background  

In 2006 the World Health Organization described the status of prevention of mother to child transmission (PMTCT) service implementation as unacceptable, with an urgent need for a renewed public health approach to improve access. For PMTCT to be effective it needs to be accessible, acceptable and affordable; however research in Africa into accessibility, uptake and acceptability of PMTCT services has been predominately urban based and usually focusing on women who deliver in hospitals. The importance of involving other community members to strengthen both PMTCT uptake and adherence, and to support women emotionally, has been advocated. Urban men's and rural traditional birth attendants' (TBAs) involvement have improved uptake of HIV testing and of nevirapine.     

Assessing factors associated with HIV testing among adolescents in Malawi

Despite being at high risk of HIV/AIDS, most young people do not know their HIV status. Using survey data (n?=?2428) and applying multilevel models, this paper assesses factors associated with HIV testing among adolescents in Northern Malawi. The results show that among both boys (OR?=?0.39) and girls (OR?=?0.47), orphan status is associated with low likelihood of HIV testing. Correct knowledge about HIV/AIDS (OR?=?2.55) and having secondary education (OR?=?3.24) are associated with HIV testing among boys and girls, respectively. At the household level, living in a household whose head has secondary or higher education is positively associated with testing for boys (OR?=?2.63), while residing together with biological siblings predicts higher odds of testing (OR?=?2.67) for girls. Notably, orphaned girls’ disadvantage regarding HIV testing loses significance when residential arrangement is controlled. At the community level, having HIV testing facility (OR?=?2.70) or post-test club (OR?=?1.40) is positively associated with HIV testing for boys, while girls from areas where religious leaders hold judgmental views about HIV/AIDS are less likely (OR?=?0.45) to test. These findings suggest that efforts to scale up HIV testing among youth could benefit greatly from an understanding of how individual and community factors operate to influence adolescents to know their sero-status.     

Age of partners at first intercourse among Danish males and females

In 1984–1985 a representative sample of 286 Danish women (response rate = 75.3%) and 336 Danish men (response rate = 77.8%), ages 16–20 years, was interviewed about their first sexual intercourse. A cumulative frequency function was constructed and the median age at sexual debut was estimated at 16.8 years for both male and female. Generally the age difference between the partners at first intercourse was only a few years. However, the young women almost never reported their first sexual partner as younger than themselves. A cross-check was made of the information given by two homogeneous subsamples of the 47 young women and 80 young men who had their first sexual intercourse with a partner who was also a debutant. Self-reported age among the males differed significantly from the age of the first sexual partner as stated by the females in these subsamples. Therefore, there is bias in the reporting of age of partner at first intercourse. As the self-reported age at first sexual intercourse by young women agrees with the age of first partner as stated by young men, the bias seems to manifest itself predominantly as a systematic misreporting in the age of male partners of debutant females.This work supported by a research grant from Sygekassernes Helsefond.     

Concern and practice among men about HIV/AIDS in low socioeconomic income areas of Lilongwe, Malawi

The HIV prevalence rate in Malawi, currently estimated to be 15%, is among the highest in the world. There is a growing realization that in order to understand the underlying causes and devise more effective prevention strategies focus should be placed on economic, political, social, and cultural forces as well as perceptions of individual risk to HIV/AIDS. During 2003 we conducted field work in Lilongwe, the capital city of Malawi, to examine perceptions of individuals as to their risk to HIV infection using the structured interviews and the focus group discussions with men from five areas of Lilongwe. The discussion in this paper focuses on the perception of risk to HIV infection among men in low socioeconomic income areas that we interviewed. Our findings indicate that while knowledge about HIV/AIDS and the best ways in which one can protect oneself from getting HIV is very high, people continue to engage in at-risk behaviors without using the necessary protection. Many of the men in our sample indicated that they were indeed at risk of getting infected with HIV. In spite of this, some of the respondents in both the structured interviews and the focus group discussions pointed out that some people had began taking measures to protect themselves, such as using condoms with nonregular partners, women leaving their husbands where cheating was obvious, and, for men, reducing the number of extra-marital sexual relations.     

Relationship between lifestyle and hemorheology among university students--comparisons between females and males

OBJECTIVES: To determine the relationship between lifestyle and hemorheology among young people, a study was conducted among healthy university students. Because few investigations have been reported on the relationship between lifestyle factors and hemorheology by gender in young people, we analyzed the effects of lifestyle on hemorheology by administering an assessment questionnaire and by measuring whole blood passage time using MC-FAN (Micro Channel array Flow ANalyzer) and hematological and blood biochemical variables for female and male university students. METHODS: The study was conducted with 40 healthy nonathlete subjects (20 females aged 19.9+/-1.3 years and 20 healthy males aged 20.6+/-1.4 years) who volunteered to participate in the study. The smoking, alcohol drinking, eating, and other habits of the subjects were investigated using a questionnaire. Blood was obtained to determine whole blood passage time and hematological and blood biochemical variables. RESULTS: The mean value of whole blood passage time was significantly shorter in females (43.4+/-5.2 sec/100 microl) than in males (58.2+/-13.6 sec/100 microl). The mean values of RBC, Hb, Ht, MCHC, Alb, TG, Cr, UA, K, Ca, Fe, AST and ALT were significantly lower in females than in males, and the mean value of HDL-C was significantly higher in females than in males. In females, Spearman's correlation coefficient showed a positive correlation between whole blood passage time and RBC, and a negative correlation between whole blood passage time and TG It also showed a positive correlation between whole blood passage time and Plt, and a negative correlation between whole blood passage time and Alb in males. Among the lifestyle factors, the mean value of whole blood passage time in females who consumed salt lightly was significantly longer than that in females who consumed salt moderately. The mean value of whole blood passage time in males who liked sweets was significantly longer than that in males who were neutral to sweets. CONCLUSIONS: The present study showed that whole blood passage time is shorter in females than in males for young people. This conforms to the pattern shown in previous studies which investigated blood passage time among the elderly and people in their prime of life. It is conceivable that females have a higher fluidity than males in all age brackets. Regarding the effects of lifestyle on hemorheology, the present study suggests that several lifestyle factors are related to whole blood passage time and their effects differ according to gender.     

Changes in sexual behavior among young males and females between 1960–1970

On the basis of results of three West German sex surveys of a total of 4568 men and women born between 1936–1954, an analysis is made of the changes in youth sexuality in the 60s. Comparisons were made for boys and girls of high educational level (school attendance 13 years or more) and low educational level (school attendance 9 years or less). The following results were found: (1) The age at first masturbation for boys of both educational levels dropped only slightly; for girls of high educational level, the age dropped markedly during the last decade; there was no change among girls of low educational level. (2) The age at first coitus decreased markedly. This is especially true for the moreeducated boys and girls. (3) The age level at which sociosexual activities are started (dating, kissing, petting) decreased markedly among the less-educated boys and girls. (No data are available for more-educated boys and girls.) (4) These changes in behavior do not correspond to any radical change in sexual standards or sexual philosophy. (5) The ability to experience the first coitus positively and free from conflict increased in the less-educated groups. (No data are available for more-educated boys and girls.) Translated by David Harris, Berlin.     

Prevalence of cigarette smoking among subsequent cohorts of Italian males and females

Prevalence of cigarette smoking among successive cohorts of Italian males and females born between 1890 and 1969 was estimated from data of the 1983 National Health Survey (based on 89,765 persons randomly selected within strata of geographical area, size of place of residence, and size of household), opportunely corrected for excess mortality of smokers. The overall participation rate for the original sample was 93.6%; impossibility of tracing or refusal of the interview led to substitution of 2,058 households. Among males, smoking prevalence in the young and middle-aged increased steadily up to the generation born in 1920-1929, which, in its 30s, showed the highest absolute smoking prevalence (68.3% in 1960). Moderate declines followed, chiefly on a calendar-period basis (i.e., between 1970 and 1980 in each birth cohort). These declines occurred later and at a lower rate than in several other Western countries. Among females, cigarette smoking was extremely rare for those generations born at the turn of the century (only about 3% of Italian females born in 1890-1899 ever smoked), but increased steadily in each birth cohort and calendar period to reach a rate only about one-third lower than that of males in the 1960-1969 cohort.     

Epidemic cholera among refugees in Malawi,Africa: treatment and transmission.

Between 23 August and 15 December 1990 an epidemic of cholera affected Mozambican refugees in Malawi causing 1931 cases (attack rate = 2.4%); 86% of patients had arrived in Malawi < 3 months before illness onset. There were 68 deaths (case-fatality rate = 3.5%); most deaths (63%) occurred within 24 h of hospital admission which may have indicated delayed presentation to health facilities and inadequate early rehydration. Mortality was higher in children < 4 years old and febrile deaths may have been associated with prolonged i.v. use. Significant risk factors for illness (P < 0.05) in two case-control studies included drinking river water (odds ratio [OR] = 3.0); placing hands into stored household drinking water (OR = 6.0); and among those without adequate firewood to reheat food, eating leftover cooked peas (OR = 8.0). Toxigenic V. cholerae O1, serotype Inaba, was isolated from patients and stored household water. The rapidity with which newly arrived refugees became infected precluded effective use of a cholera vaccine to prevent cases unless vaccination had occurred immediately upon camp arrival. Improved access to treatment and care of paediatric patients, and increased use of oral rehydration therapy, could decrease mortality. Preventing future cholera outbreaks in Africa will depend on interrupting both waterborne and foodborne transmission of this pathogen.     

HIV Status,Gender, and Marriage Dynamics among Adults in Rural Malawi

Awareness of and responses to HIV health risks stemming from relations between sexual partners have been well documented in sub‐Saharan Africa, but few studies have estimated the effects of observed HIV status on marriage decisions and outcomes. We study marriage dissolution and remarriage in rural Malawi using longitudinal data with repeated HIV and marital status measurements. Results indicate that HIV‐positive individuals face greater risks of union dissolution (via both widowhood and divorce) and lower remarriage rates. Modeling studies suggest that the exclusion of HIV‐positive individuals from the marriage or partnership pools will reduce the spread of HIV.     

Selecting HIV infection prevention interventions in the mature HIV epidemic in Malawi using the mode of transmission model

Background  

Malawi is reassessing its HIV prevention strategy in the light of a limited reduction in the epidemic. No community based incidence studies have been carried out in Malawi, so estimates of where new infections are occurring require the use of mathematical models and knowledge of the size and sexual behaviour of different groups. The results can help to choose where HIV prevention interventions are most needed.