Retracted: Determinants of project success among HIV/AIDS nongovernmental organizations (NGOs) in Rakai,Uganda

The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross‐sectional study using face‐to‐face interviews in a mixed‐methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision‐making processes, organizational vision, mission and strategies, gender allocation in staffing, and beneficiary involvement. Copyright © 2010 John Wiley & Sons, Ltd.     

Interpersonal and structural contexts of intimate partner violence among female sex workers in conflict-affected northern Uganda

Intimate partner violence (IPV) is the most prevalent form of violence against women, yet remains under-researched among sex workers in sub-Saharan Africa. We explored the interpersonal and structural determinants of recent IPV among female sex workers in northern Uganda. This analysis drew on data from a community-based cross-sectional study (conducted May 2011–January 2012), involving 379 female sex workers in Gulu, northern Uganda. Using logistic regression and multivariable modeling, we examined the correlates of recent male-perpetrated physical or sexual IPV. Of 379 women with noncommercial partners, 59 percent reported having experienced recent moderate/severe physical or sexual IPV. Reporting recent client violence (adjusted odds ratio (AOR): 3.67; 95 percent confidence interval [CI]: 2.31–5.83), doing what their partner wanted (AOR: 2.46; 95 percent CI: 1.46–4.13), and forced sexual debut (AOR: 1.92; 95 percent CI: 1.20–3.05) were independently associated with moderate/severe IPV; recent police arrest and/or incarceration were/was marginally significantly associated with IPV (AOR: 2.25; 95 percent CI: 0.86–5.88, p = 0.097). Greater odds of IPV among sex workers were associated with recent workplace violence, forced sexual debut, and gendered power dynamics favoring male partner control. Programs and policies promoting the safety and health of marginalized women and addressing gender dynamics and violence are needed.     

Trends and correlates of hormonal contraceptive use among HIV-infected women in Rakai, Uganda, 1994-2006

Background

Little is known about what factors correlate with hormonal contraceptive (HC) use in HIV-infected women in sub-Saharan Africa.

Methods

We assessed the trends in HC use among HIV-infected women in Rakai, Uganda; determined factors associated with HC use and considered whether those factors changed over time.

Results

HC use among HIV-infected women in Rakai increased from 5.7% in 1994 to 19.2% in 2006, but nearly half of all pregnancies in this population were unintended. Variables associated with increased HC use included higher education, socioeconomic status, parity, sexual frequency, being currently married or in a relationship, discussion of family planning with a partner and receipt of HIV results. Variables negatively associated with HC use included symptoms suggestive of opportunistic infections, having no sex partner in the past year, condom use, breastfeeding and older age. Most associations remained stable over time.

Conclusion

Although contraceptive use by HIV-infected women has increased three-fold in this rural population, unintended pregnancies persist, placing women and their children at risk of adverse consequences.     

Gendered HIV risk patterns among polygynous sero-discordant couples in Uganda

Stable serodiscordant relationships and sexual concurrency are pathways that contribute to the HIV epidemic in sub-Saharan Africa. However whether polygyny imparts the same risks as informal concurrent relationships remains an open research question. Using data collected at enrolment from a cohort study of sero-discordant couples, this analysis investigates how polygynous relationships differ from those involving only a single female spouse and whether men involved in polygynous partnerships are more likely to report HIV-risk behaviour than those in single spouse partnerships. Of 444 enrolled couples, 111 (25%) were polygynous and 333 (75%) were single-spouse partnerships. We found that polygynous men were more likely to report controlling sexual decision-making and to report any unprotected sex with unknown sero-status partner. After controlling for potential confounders, polygynous men were still more likely to report unprotected sex with an unknown sero-status partner. In this sample of sero-discordant couples we found indication of excess HIV-risk behaviour among men involved in polygynous relationships.     

HIV and transgender women in Kampala,Uganda – Double Jeopardy

Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use.     

HIV vulnerability and sexual risk among African youth in Windsor,Canada

This paper examines how patients with HIV and their doctors jointly interpret 'viral load'. We show that the term 'viral load' is multiply coded: It calls up the idea of a biological property of the HIV positive body, but the term is also used as an indicator of drug treatment effectiveness, of patient compliance, and of overall wellness. Such multiple codings can be problematic because they index multiple and potentially conflicting discourses. Three distinct discourses which inform HIV medicine are identified: health measurement, health care, and health experience. These are described in terms of their semantic, lexicogrammatical and interactional patterns to illustrate how doctors and patients navigate their paths through them. In practice, what a viral load result is taken to mean depends on the alignment of patient and doctor in terms of their respective interdiscursive positions. The ability to recognize and flag discursive shifts should be considered a central component of doctors' professional expertise, particularly as a means of supporting patients in contributing their own expertise to clinical decision making.     

Family structure effects on early sexual debut among adolescent girls in Rakai,Uganda

This study assessed the association between household family structure and early sexual debut among adolescent girls, ages 15–19, in rural Rakai District, Uganda. Early sexual debut is associated with detrimental physical, emotional, and social outcomes, including increased risk of HIV. However, research on the family’s role on adolescents’ sexual risk behaviors in sub-Saharan Africa has been minimal and rarely takes into account the varying family structures within which African adolescents develop. Using six rounds of survey data (2001–2008) from the Rakai Community Cohort Study, unmarried adolescent girls (n = 1940) aged 15–17 at their baseline survey, were followed until age 19. Parametric survival models showed that compared to adolescent girls living with both biological parents, girls who headed their own household and girls living with stepfathers, grandparents, siblings, or other relatives had significantly higher hazards of early sexual debut before age 16. Adolescent girls were significantly more likely to debut sexually if neither parent resided in the household, either due to death or other reasons. In addition, the absence of the living biological father from the home was associated with a higher risk of sexual debut, regardless of the biological mother’s presence in the home. Our study’s findings suggest that family structure is important to adolescent girls’ sexual behavior. There is need for research to understand the underlying processes, interactions, and dynamics of both low and high-risk family structures in order to devise and strategically target interventions for specific types of family structures.     

HIV and identity: the experience of AIDS support group members who unexpectedly tested HIV negative in Uganda

Living with HIV, for many of those infected, has meant adjusting to life with a stigmatised condition and, until recently, the threat of looming death. We explore the adjustment of a group of long-term former clients of The AIDS Support Organisation (TASO) in Uganda who, when tested for HIV during the rollout of antiretroviral therapy in 2004, were found to be HIV negative. In-depth semi-structured interviews with 34 former TASO clients were conducted between 2005 and 2007. Their narratives reveal a great deal about the biographical disruption they have faced, and the biographical work that they have undertaken in both the personal and the social dimensions of their lives in order to manage their new-found HIV-uninfected status. After the negative test result, as they were no longer HIV-infected, they had to leave TASO and that support was sorely missed, as was the friendship of TASO members to whom they often felt reluctant to disclose their new status. The identity 'reversal' or change was often handled privately. Compared with their transition to an HIV-positive identity, they now lacked a social dimension to their identity transformation as they managed their new identity in the face of self- and public doubt.     

Masculinity and engagement in HIV care among male fisherfolk on HIV treatment in Uganda

This study explored the intersection of masculinity and HIV care engagement among fishermen and other male fisherfolk on antiretroviral therapy (ART) in Wakiso District, Uganda. We conducted 30 in-depth interviews with men on ART recruited from HIV treatment sites and used a thematic analysis approach. Since HIV diagnosis and ART initiation, men had adopted masculine identities more conducive to HIV care engagement. The masculine roles of worker and provider, husband and sexual partner and the appearance of physical strength were compromised by HIV, but restored by ART’s positive effects on health. Peers also emerged as facilitators to HIV care, with men supporting each other to seek testing and treatment. However, structural and occupational barriers to HIV care associated with the masculine role of worker remained a barrier to care engagement. Findings suggest that emphasising the benefits of ART in bolstering men’s ability to fulfil the roles important to them may improve the effectiveness of HIV testing and treatment messaging for men. Differentiated care models that address structural-level barriers to care, and community-level gender-transformative programming to help fishermen engage in HIV care, may be beneficial.     

No place is safe: violence against and among children and youth in street situations in Uganda

This article explores street children’s exposure to and responses to violence based on data collected in 21 major towns in Uganda. Findings show that violence among Ugandan street children is endemic, perpetuated by both street children against each other and adults. Both male and female children suffer outright abuse from police, occasional strangers, and from each other. Boys were more frequently physically abused while girls were more frequently abused emotionally and sexually. The study recommends policy-oriented actions linked to addressing the variations in the vulnerability to violence among children on the basis of gender, age and other risk factors and targeting the change of attitudes and behavior among duty bearers in various settings, which result in violence against children on the street.     

Livelihood outcomes in a cohort of youth with disabilities following participation in an economic empowerment programme in rural Uganda

BackgroundLittle evidence exists on the livelihoods of young people with disabilities in low- and middle-income settings.ObjectiveThis study examined employability and livelihood outcomes among a cohort of youth with disabilities who participated in an economic empowerment programme in rural Uganda.MethodsProspective cohort of youth with disabilities participating in an economic empowerment programme in rural Uganda. Livelihood outcomes of participants were assessed through structured interviews at baseline (n = 297) and again at 12 months (n = 252) and analysed using chi-squared tests and generalized estimating equations.ResultsOf 297 participants at baseline, 144 (48%) were women and the mean age was 21.7 years. At 12 months follow-up, participants were significantly more likely to have a job (OR 3.04, 95% CI 2.10–4.39); to have accessed finance (OR 5.52, 95% CI 3.18–9.56); and experienced community support (OR 2.23, 95% CI 1.51–3.29) compared with baseline. There were no statistically significant changes in having enough money for food or in having experienced community discrimination.ConclusionsThe findings suggest that targeted vocational skills training, apprenticeships scheme and a start-up financial package may improve the livelihoods of young people living with disabilities in rural African settings.     

Challenging Pentecostal moralism: erotic geographies,religion and sexual practices among township youth in Cape Town

Research on constructions of sexuality in Pentecostalism often struggles with the fact that the research setting is defined ex ante in terms of church communities, which imposes upon ethnographic accounts the same limitations Pentecostal morality imposes upon church members' discourse. Taking young Pentecostals operating in a space that is not explicitly religious as the methodological entrance to the field, this paper explores negotiations over sexuality, intimate relationships and love among Xhosa-speaking township youth. It introduces the notion of erotic geographies to consider how possible influences of religious discourses on sexuality are refracted by alternative cultural orientations and material contexts. Findings suggest that premarital abstinence appears as a highly exceptional ideal for youth. Even among Pentecostal youth, notions of sexuality are largely severed from religiosity and faithfulness and romanticism are dominant ideals. Future research on Pentecostalism and sexuality should be less religious-centric and rooted more firmly in ethnographies of youth sexual cultures.     

Retraction statement: Determinants of project success among HIV/AIDS NGOs in Rakai,Uganda

The following article from The International Journal of Health Planning and Management, Determinants of Project Success among HIV/AIDS NGOs in Rakai, Uganda by Stevens Bechange published online in Wiley Online Library ( http://onlinelibrary.wiley.com/doi/10.1002/hpm.1025/abstract ) on 11 January 2010 and in volume 25, issue 3, pp. 215–230 (Bechange, 2010), has been retracted by agreement between the author, the journal Editor in Chief, Calum Paton, and Blackwell Publishing Ltd. The retraction has been agreed because of substantial unattributed overlap with previously published qualitative research methodology, findings, and ideas by Susan Walker (Walker, 2004). REFERENCES Bechange S. 2010. Determinants of project success among HIV/AIDS nongovernmental organizations (NGOs) in Rakai, Uganda. Int J Health Plann Mgmt 25 : 215–230. DOI: 10.1002/hpm.1025 Walker S. 2004. Strong voices, hopeful futures: enhancing leadership capacities for determining and sustaining health initiatives with young people in Uganda; final report. http://idl‐bnc.idrc.ca/dspace/handle/10625/31044 .     

HIV epidemic and human rights among men who have sex with men in sub-Saharan Africa: Implications for HIV prevention,care, and surveillance

Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a ‘health in all policies’ approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness.     

Sexual risk associated with gambling among the youth in Rubaga Division,Kampala

The status of sexual and reproductive health of youths and adolescents in urban areas across the globe is alarming. Evidence from Uganda Aids Indicator Survey 2011 indicates that over 31% youths who have never married are engaged in sexual intercourse but have never tested for HIV. Gambling is clearly on the increase in major towns and cities drawing in several youths. However, the risk that this practice poses on the youth's sexual behavior has not been investigated in Uganda. This study intended to fill this gap. This study examined the sexual risk associated with gambling among youths in Rubaga Division of Kampala Capital City of Uganda. The study employed a quantitative cross sectional design to survey 397 youths aged 15 to 24 years. It employed a systematic sampling scheme in selecting households with youths who responded to the household survey questionnaire. Results showed that more male than female youths are engaged in gambling, majority of whom start gambling below 18 years. Most of the gambling youths are pulled by competition with peers and desire to earn money. Compared with nongambling youths, gambling youths have more sexual encounters, initiate sexual activity at a young age, have unprotected sex, have sex with more than one partner whom they do not know their HIV status, and have sex under the influence of alcohol. The study recommends for government to form and enforce policies to regulate gambling with a view of minimizing its associated risks especially unsafe sex. Through the ministry of health and civil society organizations, government can create programs to reach the gambling youths with sexual reproductive health services.