Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho

Sub-Saharan Africa is most affected by the AIDS pandemic and Lesotho is no exception. In many countries, healthcare workers are at the forefront of the fight against AIDS. This study explores the difficulties facing healthcare workers in Lesotho using a combination of qualitative methods – focus group discussions and in-depth interviews. The findings suggest that healthcare workers are afraid of contracting HIV from their patients and this affects their delivery of services. In addition, the results revealed that poor infrastructure and shortage of supplies at the facilities hinder healthcare workers from performing their duties effectively. The other concern was the heavy workload and severe time constraints which puts enormous stress on healthcare workers. Stigma and discrimination emerged as major problems for healthcare workers. Addressing the challenges facing healthcare workers is essential in effectively managing the AIDS pandemic facing the continent.     

Re-focusing the Gender Lens: Caregiving Women,Family Roles and HIV/AIDS Vulnerability in Lesotho

Gender and HIV risk have been widely examined in southern Africa, generally with a focus on dynamics within sexual relationships. Yet the social construction of women’s lives reflects their broader engagement with a gendered social system, which influences both individual-level risks and social and economic vulnerabilities to HIV/AIDS. Using qualitative data from Lesotho, we examine women’s lived experiences of gender, family and HIV/AIDS through three domains: (1) marriage; (2) kinship and social motherhood, and (3) multigenerational dynamics. These data illustrate how women caregivers negotiate their roles as wives, mothers, and household heads, serving as the linchpins of a gendered family system that both affects, and is affected by, the HIV/AIDS epidemic. HIV/AIDS interventions are unlikely to succeed without attention to the larger context of women’s lives, namely their kinship, caregiving, and family responsibilities, as it is the family and kinship system in which gender, economic vulnerability and HIV risk are embedded.     

Food insecurity,HIV/AIDS pandemic and sexual behaviour of female commercial sex workers in Lagos metropolis,Nigeria

This study examined the role of hunger and food insecurity in the sexual behaviour of female commercial sex workers in Lagos metropolis, Nigeria within the context of HIV/AIDS. In addition, the study investigated the prevalence of sexually transmitted infections (STIs) and induced abortion among the respondents. Cross-sectional survey and in-depth interview research methods were adopted to generate both quantitative and qualitative data from the respondents. Findings of the study showed that 35.0% of the respondents joined the sex industry because of poverty and lack of other means of getting daily food. While all the respondents had knowledge about the existence of HIV/AIDS, 82.0% of them identified sexual intercourse as a major route of HIV transmission. There was a significant relationship between poverty, food insecurity and consistent use of condoms by female sex workers at P<0.01. Specifically, only 24.7% of the respondents used condoms regularly in every sexual act. Consequently, 51.6% had previous cases of STIs. The most prevalent STI among the respondents was gonorrhea, with 76.4% prevalence among ever infected female sex workers. This was followed by syphilis with a prevalence of 21.1%. In addition, 59.1% of the sample had become pregnant while on the job and 93.1% of these pregnancies were aborted through induced abortion. In conclusion, hunger and malnutrition were the factors that pushed young women into prostitution in Nigeria and these same factors hindered them from practicing safe sex within the sex industry. Thus, it is recommended that the Nigerian government should develop programmes that will reduce hunger and food insecurity, in order to reduce rapid transmission of HIV infection in the country.     

Factors associated with high media coverage of the HIV epidemic in Lesotho

Regional studies show that Lesotho outperforms other countries in southern Africa in terms of awarding coverage to HIV and AIDS. Through qualitative interviews, this study examines the motivations, experiences, and perceived challenges among media workers, which could explain the high coverage. While a high level of personal commitment seems to be the outcome of interrelated factors—such as media workers’ personal experience of the country's high HIV prevalence and high mortality rate—Lesotho's political leadership and various government initiatives, notably the unique ‘Know Your Status’ campaign, were singled out as a key factor behind the high coverage. Moreover, journalists and editors are often consciously exploiting the mass media's potential agenda-setting function in order to raise attention to HIV and AIDS. Although covering the HIV epidemic has become significantly easier in Lesotho because of government efforts, government and public officials are simultaneously identified as the main obstacle to more comprehensive coverage.     

Taking empowerment into account: the response of community-based organisations to the HIV care needs of men who have sex with men in West Africa (CohMSM ANRS 12324 – Expertise France)

ABSTRACT

Empowerment is an ongoing process through which individuals and communities appropriate power and acquire the capability to function autonomously. Research on empowerment in men who have sex with men (MSM) is lacking in community-based contexts. We investigated the relationship between willingness to be empowered and HIV care needs in West African MSM accessing community-based organisations’ (CBO) services. Fifty-three interviews were administered to HIV-negative MSM participating in the CohMSM study (Mali, Burkina Faso, Côte d’Ivoire, Togo). Five indicators of empowerment were identified from a discourse analysis: (i) motivation to access HIV services, (ii) willingness to improve HIV services, (iii) desire to be involved in new activities, (iv) desire to participate in such services, (v) willingness to collaborate in decision making. Based on these indicators, participants were classified into two profiles: high (19/53, 36%) and low (34/53, 64%) level of willingness to be empowered (HWE, LWE). Using a thematic analysis, HWE participants were focused on collective benefit (preventive follow-up, questions about MSM identity), while LWE participants were centred on individual benefit (medical care). CBOs should consider empowerment as a tool to advance collective health benefits for MSM. To improve empowerment in MSM, specific training on issues regarding sexual identity and stigma is needed for CBO providers.     

北京市建筑工地民工艾滋病知识认知情况和危险行为研究

目的了解北京市建筑工地民工艾滋病知识认知情况和危险行为。方法采取整群抽样,在北京市抽取2个建筑工地的1 000名工人,在知情同意原则下进行问卷调查和小范围的面对面访谈。结果被调查者对艾滋病不同传播途径的知晓率有非常大的差异。在艾滋病危险行为方面,有66.8%的被调查者知晓安全套能够降低感染艾滋病的可能,但仍有51.0%的人从未使用安全套。仅有2.3%的人曾与性服务小姐发生性行为。结论建筑工地民工对于艾滋病知识了解得很含糊,缺乏对艾滋病本质的认识。经济原因在很大程度上影响着他们的艾滋病相关危险行为。     

Willingness to participate in HIV vaccine trials among a sample of men who have sex with men, with and without a history of commercial sex, Rio de Janeiro, Brazil

The study objective was to assess willingness of men who have sex with men (MSM) enrolled in a vaccine preparedness study ('Projeto Rio') to participate in phase III anti-HIV/AIDS vaccine trials. Overall, 57% of Projeto Rio participants stated they would participate in a putative vaccine trial. MSM who reported commercial sex work were significantly (p < 0.05) more likely to engage in risky behaviours than others. In bivariate analysis, commercial sex workers (CSWs) were significantly (p < 0.05) more likely than non-commercial sex workers (NCSWs) to be willing to participate in vaccine trials (62.6% versus 51.4%). Among those willing, CSWs reported significantly more often (p < 0.05) (50.5%) than NCSWs (38.0%) that they would enroll to protect themselves from HIV. In multivariate analyses, variables associated with willingness to participate (WTP) were lower educational level, positive serology for syphilis, and 'engagement, under the influence of alcohol, in risky sexual practices that would normally be avoided', but not commercial sex work. The potential enrollment in vaccine trials of MSM CWSs, as well as participants of low socio-economic status and high risk, seems thus to be possible.     

AIDS and sexual practices: knowledge, attitudes, behaviors, and practices of health professionals in the People's Republic of China.

68 upper level health professionals from 20 provinces in China completed to a questionnaire while attending either a health education workshop in Guangzhou in August 1989 or a similar workshop in Beijing in December 1989. The aim of the study was to determine their knowledge and attitudes since they were opinion leaders and key players in future AIDS prevention programs and to learn about sexual practices. 90% knew that a pregnant woman can transmit HIV to her infant and that sharing unclean needles can transmit HIV, but only 82.1% knew that someone with HIV can transmit it to a partner during sexual intercourse. 29.9% thought one can tell if someone has AIDS by looking at him or her. Newspapers and professional journals provided most of them with information on AIDS (80.6% and 73.1% respectively), but friends and government only provided this information to 29.9% and 19.4%. Overall the participants viewed AIDS as a threat to others and not themselves or families. 85-95% believed certain population groups such as policy makers, high school students, and the public should undergo sex education. Only 43.3% believed elementary schools should provide sex education, however. Participants tended to approve premarital sex and sex between individuals with emotional or long term ties more than extramarital sex. Nevertheless considerable percentage did condone extramarital sex. 95.8% experienced their 1st sexual relationship with their spouses. Even though participants tended to feel condoms did not make sex enjoyable, 81.6% and 72.5% believed condoms prevent pregnancy and sexually transmitted diseases respectively. 82% thought they were easy to use. 35% used condoms for contraception. Before using these upper level health workers to conduct AIDS training for lower level workers, they need to have a more thorough understanding of HIV transmission and the signs and symptoms of AIDS.     

Validity of the Household and Leisure Time Activities questionnaire (HLTA) in a multiethnic HIV-positive population

As individuals with HIV/AIDS continue to have longer life expectancies, it is vital that other health outcomes, such as functional status, be considered. The purpose of this study was to explore the psychometric properties of a new functional status measure, the Household and Leisure Time Activities (HLTA) questionnaire, in a multiethnic low-income HIV/AIDS population. The HLTA is an 11-item questionnaire consisting of two scales designed to assess an individual's ability to perform routine home activities (household functioning scale) and to participate in leisure time activities (leisure-time functioning scale). The HLTA was administered, in the form of self-report questionnaires, to 385 consecutive patients seen at a comprehensive HIV/AIDS care facility serving low-income residents of Houston, Texas. Various psychometric procedures were then performed to assess properties, including reliability, construct validity, and concurrent validity. Reliability, assessed by Cronbach's alpha, was good for both scales (0.92, household functioning; and 0.94, leisure-time functioning). Validity was supported by findings from the confirmatory factor analysis and findings from the concurrent validity analyses. Overall, the results indicated that the HLTA has satisfactory psychometric properties and is appropriate for use with multicultural low-income HIV/AIDS patients.     

Pilot Study Assessing HIV Vaccine Trial Readiness Among Female Sex Workers, Injection and Non-injection Drug Users, and Men Who Have Sex with Men in Spain

The purpose of this study was to assess HIV risk and willingness to participate in HIV vaccine trials in three high risk populations in Spain. Eight hundred and forty-four participants, comprising female sex workers, injection and non-injection drug users (IDUs and NIDUs, respectively), and men who have sex with men were tested for HIV and surveyed for risk and willingness to participate in future preventive HIV vaccine trials. HIV seroprevalence was 3.8% (95% CI: 2–11). HIV infection was associated with transgender identification, IDU in the past year, and sex with an IDU or other drug-using partner. The majority (82%) expressed their willingness to participate in HIV vaccine trials. Substantial sexual and parenteral risk in all groups and concomitant willingness to participate in vaccine trials was found, particularly among women and IDUs. Additional longitudinal cohort studies in Spain are needed to plan future vaccine efficacy trials.     

Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin

OBJECTIVES: Male clients of female sex workers have rarely been specific targets for HIV/sexually transmitted diseases (STD) interventions in sub-Saharan Africa. We assessed the effectiveness of outreach methodology for contacting sexual partners of female sex workers for purposes of HIV/STD prevention in Cotonou, Benin. DESIGN AND METHODS: In collaboration with owners/managers, outreach personnel and female sex workers, 404 clients were recruited on-site at prostitution venues, and provided urine samples for leukocyte esterase dipstick (LED), STD and HIV testing before having sex with female sex workers. After having sex they underwent an interview and physical examination. No payment was made for study participation. Prostitution site personnel (n = 41) and boyfriends of female sex workers (n = 56) were also recruited. RESULTS: In all 68% of the clients approached agreed to participate. On-site LED testing and free STD treatment were important factors in participation. HIV-1 prevalence was several-fold higher than in the general population in Cotonou, at 8.4, 12.2 and 16.1% in clients, personnel and boyfriends respectively, and was associated with increasing age and lack of condom use with female sex workers. Condom use rates by clients with female sex workers were non-negligible but sub-optimal, and low with regular partners. Approximately one-third of clients with regular partners also had other non-female sex worker sex partners. Boyfriends of female sex workers are of particular concern due to high numbers of partners, very low condom use rates and high HIV prevalence. CONCLUSIONS: Study findings indicate that male sex partners of female sex workers form a 'bridging population' for HIV/STD transmission both to female sex workers, as well as from female sex workers to the general population of women, particularly regular female partners.     

Protection and participation: an interactive programme introducing the female condom to migrant sex workers in Cambodia

The female condom has received much attention for its potential to empower users in negotiating safer sex. Studies demonstrate that the process used to introduce the method can influence subsequent use rates, resulting in calls for comprehensive documentation of introduction activities. This paper details an intervention study introducing the female condom to Vietnamese sex workers in Cambodia. Part of a wider community mobilization approach to reducing HIV/AIDS transmission, the intervention emphasized informed debate, group skills building and collective support. Research methods included both quantitative and qualitative data collection to evaluate the introduction's effect on sex workers' negotiation skills and social support networks. The findings show that approximately 16% of sex workers tried the female condom. Ever-use was significantly associated with participation in intervention workshops, and with indicators of both individual and community empowerment. Sex workers who incorporated the female condom into their work were also more likely to feel a sense of community identity. Introduced through an appropriate process, the female condom can serve as an 'entry point' to building community capacity. It can support sex workers in achieving protected sex and developing cooperative relationships, even in severely restrictive settings.     

Correlates of HIV Knowledge and Sexual Risk Behaviors Among Female Military Personnel

Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Multivariate logistic regression analysis revealed that level of education and knowing someone infected with HIV/AIDS were significant (P < 0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P < 0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P < 0.05) associated with number of children, annual income, and number of sexual partners. Data indicates the importance of incorporating these predictor variables into intervention designs.     

Individual and community-level tolerance of spouse abuse and the association with the circumstances of first sex among youth from six sub-Saharan African countries

Youth who engage in early and premarital sex are at risk of HIV and sexually transmitted infections. Most prevention programs ignore the mediating influence of the threat and experience of violence on these outcomes. Using nationally representative data from Lesotho, Malawi, Zimbabwe, Kenya, Tanzania, and Uganda, multivariate analyses examined the association between individual- and community-level tolerance of spouse abuse on the age and circumstances of sexual debut among female youth. The youth sample sizes ranged from a high of 5007 in Malawi to a low of 3050 in Lesotho. In the study countries, there were between 521 and 367 communities included in the analysis. Youth who approved of spouse abuse were more likely to have sexually debuted at each age. In Kenya, youth from communities with high female spouse abuse tolerance were more likely to have initiated sex at each age. In Malawi and Zimbabwe, youth from high tolerance communities were less likely to have sexually debuted at each age or to have had premarital sex; the same effect on premarital sex was found for men's tolerance in Kenya and Tanzania. Programs are needed to reduce violence risk and increase youth negotiating power and delayed sexual debut, with the objective of reducing young people's risk of negative outcomes.     

2012年柳州市嫖客艾滋病哨点监测结果分析

目的了解柳州市嫖客人群艾滋病（AIDS）相关行为与艾滋病病毒（HIV）感染状况。方法2012年4—7月,对市区部分嫖客进行调查,分析AIDS知识知晓率、性行为、吸毒行为、既往HIV检测情况,以及HIV、梅毒和丙型肝炎病毒（HCV）感染状况。结果调查的400名嫖客中,AIDS知识知晓率为51．00％,最近一年与暗娼发生商业性性行为中坚持使用安全套的比例为45．83％,最近一年与固定性伴发生性行为时每次都使用安全套的比例仅为1．25％,既往接受HIV检测并知道检测结果的比例为4．75％。HIV阳性率为2．25％（9／400）,梅毒阳性率为8．00％（32／400）,HCV阳性率为8．00％（32／400）。危险因素分析显示,嫖客中HCV的感染与注射吸毒史有关（P=0．000）,嫖客中HIV的感染与安全套使用呈负相关（P=0．007）。结论市区嫖客人群AIDS相关危险行为暴露风险较大,亟须进一步探讨社区嫖客流行病学调查和有效行为干预方法。     

Perceptions about the acceptability and prevalence of HIV testing and factors influencing them in different communities in South Africa

Abstract

HIV counselling and testing (HCT) is considered important because it is an entry point to a comprehensive continuum of care for HIV/AIDS. The South African Department of Health launched an HCT campaign in April 2010, and this reached 13,269,746 people by June 2011, of which 16% tested HIV positive and 400,000 of those were initiated into antiretroviral treatment. The overall objective of this project was to gain insight into the general perceptions about HIV testing in the different South African communities. Factors influencing testing in these communities were also explored. Discussions with twelve focus groups (FG) of 8–12 participants each were conducted with male and female participants recruited from both urban formal and informal communities in Cape Town and Durban. Participants included four racial groups represented by different age groups as follows: adolescents (12–17 years), youth (18–24 years) and adults (25 years and older). Data were analyzed using thematic coding. Among the key themes that emerged from the findings were the inaccurate perception of risk, fear of testing HIV positive, stigma and discrimination. Participants from both African and Indian FGs reported being less likely to do self-initiated HIV testing and counselling, while those from the FG consisting of young whites were more likely to learn about their HIV status through blood donations and campus HIV testing campaigns. Most FGs said they were likely to test if they understood the testing process better and also if the results are kept confidential. The present findings reiterate the importance of spreading positive messages and ensuring confidentiality for HIV testing in a society where there is still some stigma associated with people living with HIV/AIDS. This can partly be accomplished by the continuation of the national HCT campaign, which has been a considerable success in the fight against HIV/AIDS in South Africa during the past two years.     

Courting success in HIV/AIDS prevention: the challenges of addressing aconcentrated epidemic in Senegal

This article presents findings from a study of HIV/AIDS programmes for urban sex workers in Dakar, Senegal. The objective of the research was to assess HIV prevention and treatment efforts to date, and to identify challenges that must be overcome in the long term to reduce the spread of HIV in Senegal. The research team organised four day-long community dialogues, in June 2008, with registered and unregistered sex workers in the Senegalese capital. In addition to these sessions, we conducted interviews with physicians employed by the Senegalese Ministry of Health, leaders of sex-worker organisations, and directors and staff at non-governmental organisations whose programmes target sex workers and other vulnerable groups. Our findings indicate that Senegal's public health strategies have been largely effective at containing the country's HIV epidemic, but not at addressing the social drivers of HIV transmission or protecting the rights of sexual minorities, such as sex workers and men who have sex with men. For Senegal's HIV/AIDS response to continue on a successful path, it must expand to include structural interventions and incorporate a human-rights approach.     

Acceptability of HIV/AIDS counseling and testing among premarital couples in China.

Premarital counseling is required for couples wishing to be married in China. The counseling primarily provides information about contraception. We evaluated adding premarital HIV/AIDS counseling and voluntary HIV testing to the standard counseling. The test was offered free to one group and at the standard cost to the other. The proportion of those accepting HIV testing among all participants receiving premarital counseling was used as a measure of acceptability. Sixteen percent of participants not charged chose to accept testing versus 1.4% of those charged ( p < .001). Lack of HIV/AIDS knowledge and charging for the test were correlated with refusal. Over 5% of participants admitted to premarital sex, most with their fianceé, and a significantly higher portion was female. Only 22% used condoms. Study participants were randomized for 1-year follow-up. Only four participants reported extramarital sexual activity during that year. Acceptance of HIV testing was disappointingly low. Implementing strategies to reduce stigmatization and increase knowledge of HIV/AIDS, in addition to not charging for testing, may increase the acceptance of HIV testing.     

Exploring gender perceptions of risk of HIV infection and related behaviour among elderly men and women of Ga-Rankuwa,Gauteng Province,South Africa

The literature shows that there are important differences between women and men in the underlying mechanisms of transmission of HIV infection and AIDS, as well as in the social and economic consequences of HIV/AIDS. These stem from sexual behaviour and socially constructed ‘gender’ differences between women and men in roles and responsibilities. Despite the fact that numerous gender-related sociocultural factors influence HIV/AIDS protective behaviours, little gender specificity is included in HIV prevention among the elderly. In order to close this gap, this study explored gender-related perceptions of risk of HIV infection among elderly men and women of Ga-Rankuwa in Gauteng Province, South Africa. This qualitative study used purposive sampling to conduct three focus group interviews with 22 women and 10 men who were above 60 years of age. Findings revealed that both genders blame each other for the spreading of HIV/AIDS. Male participants displayed the tendency to have multiple partners, whereas females accepted that males are promiscuous. Mixed perceptions about disclosure of HIV status were found. Condom use was a challenge, as men did not know how to introduce it with their wives, and some female participants indicated that men are resistant to using condoms. The elderly men also believed that women will have sex in exchange for money. It is concluded that there is a need for substantial behaviour change among both elderly males and females, which should address gender power relations. More in-depth and extensive research in this area is recommended.