Misconceptions about HIV prevention and transmission in Botswana

Misconceptions about how HIV can be transmitted or prevented often prevent individuals from making informed choices and taking appropriate action. The purpose of the research was to explore the socio-demographic and behavioural factors in Botswana that are associated with misconceptions about HIV prevention and transmission. The data used were from the Botswana AIDS Impact Survey II conducted in 2004, which constitutes a nationally representative sample. Results from bivariate and multivariate analyses show that young people, males, the less educated, those who did not use a condom during their last instance of sexual intercourse, and those who believe that nothing can be done to reduce HIV infection are most likely to harbour misconceptions about how HIV can be prevented and transmitted. Since misconceptions may prevent people from making informed choices, intervention programmes aimed at HIV prevention should aim to dispel misconceptions about HIV and AIDS as an important part of their strategy. Targeted HIV prevention and education programmes are needed in an effort to dispel such misconceptions and likewise to address the needs of different population sub-groups.     

Modelling the relationship between antiretroviral treatment and HIV prevention: limitations of the Spectrum AIDS Impact Model in a changing policy environment

This paper shows how two publicly available epidemiological modelling packages, namely the Spectrum AIDS Impact Model and the ASSA2003 AIDS and Demographic Model, predict very different impacts from rolling out highly active antiretroviral treatment (HAART) on new HIV infections. Using South Africa as a case study, it shows that the ASSA2003 model predicts a significant drop in new HIV infections as HAART is rolled out, whereas the Spectrum model assumes that HAART does not have a preventative impact (and in fact generates a small increase in new HIV infections). Users will thus draw different conclusions about the public health benefits of HAART depending on which modelling package they use. Despite being presented as a policy-oriented modelling tool capable of exploring 'what if' questions about the impact of different policy choices, the Spectrum model is illequipped to do so with regard to a HAART rollout. Unlike Spectrum, ASSA2003 is more flexible and its assumptions are clear. Better modelling and more information (including about the relationship between HAART and sexual risk behaviour) is required to develop appropriate public-policy modelling for the HAART era.     

Childcare in poor urban settlements in Swaziland in an era of HIV/AIDS

This paper explores the role of the family in caring for orphans and other children in poor urban communities having some of the highest levels of HIV/AIDS prevalence in the world. A range of family forms in Swaziland was found to be caring for orphans. Child-headed households and lone-elderly carers were not the most common; maternal kin played a more important role in orphan care than did paternal kin, indicating both stresses due to AIDS and the dynamic nature of the family. Women of all ages were bearing the brunt of the extra care responsibilities caused by the epidemic. There was limited involvement in children's well-being by agencies of any kind and orphan care remained largely situated within kin structures. The AIDS epidemic was impacting on families in a variety of ways, with a corresponding increase in poverty and vulnerability. Carers did not perceive orphans as a separate category of children requiring assistance over and above any other vulnerable child. Families require assistance at the household, community and national level. Meanwhile, community-based initiatives were poorly developed. Welfare sector policies should strengthen the family model of childcare by increasing support to the poorest families rather than treating orphans as a separate category of vulnerable children and thereby excluding other needy children.     

Muted voices: HIV/AIDS and the young people of Burkina Faso and Senegal

This article explores the discrepancies between the vocal public discourse on HIV/AIDS and sexuality as generally encouraged by policy-makers and donor communities in Africa, and the often hushed voices of their target groups: young people in African communities. Based on fieldwork among urban youth in Senegal and Burkina Faso, we describe the silence of young people with regard to HIV/AIDS and sexuality as a social phenomenon, with focus given to family relations, peer relations and gender aspects in partnerships. Drawing on Foucault and Morrell, an inability and unwillingness to speak about HIV/AIDS and sexuality are analysed as a response to an everyday life characterised by uncertainty. This response represents a certain degree of resistance, while it constitutes a major barrier to any HIV/AIDS prevention effort. Finally, we stress that despite great constraints in their everyday lives, young people have some room to manoeuvre and are able to apply some negotiating strategies to reduce sexually-related health risks.     

HIV/AIDS,childhood and governance: sundering the bonds of human society

There is a disharmonious resonance between the length of HIV infection in the individual human host and the length of a human generation. In brief, an infected person may have children, these may be orphaned and grow up to become infected, and afterwards they themselves may have children, who can be orphaned in turn. Hence, a basic unit of social structure in most human societies, the three-generation bond between grandparents, parents and the current generation — and on into the future — is repeatedly torn apart in the absence of treatment, a vaccine or behaviour change. This situation should be read against the threat of growing viral resistance. Certain implications of these processes for the future are outlined and discussed. The paper notes the uncertain future confronting societies that already have a relatively high number of orphans, and considers some otherwise unexpected possibilities, as well as the dangers of assuming that large-scale orphaning necessarily leads to social unrest and disorder.     

Young Malawians on the interaction between mental health and HIV/AIDS

Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e.depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these 'interruptions' and 'disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.     

Perception of risk of HIV infection in marital and cohabiting partnerships

The purpose of this paper is to understand how married and cohabiting men and women define risk and to identify the factors that influence risk perceptions in a setting with a high prevalence of HIV infection. A combination of qualitative and quantitative methods was used during a cross-sectional survey conducted among 248 men and 289 women in KwaZulu-Natal, South Africa. Forty in-depth interviews were conducted with sexually-active men and women in the same population. The majority of men and women perceived themselves at risk of HIV infection. Women were more likely than men to report a higher risk of HIV infection. Nearly 46% of women and 28% of men perceived themselves at medium or high risk of HIV infection. The qualitative and quantitative data show that perception of risk of HIV infection was influenced both by a person's own sexual behaviour and a partner's sexual behaviour. Men were significantly more likely to perceive themselves at risk because of their own risky sexual behaviour (P < 0.01). In general, few women reported engaging in risky sexual behaviour. However, women were more likely to report that their partners had other sexual partners. Thus, women were significantly more likely to perceive themselves at risk because of their partner's sexual behaviour (P < 0.05). Also, rural women were significantly more likely than urban women to perceive a high risk of HIV infection (P < 0.05). Prevention programmes have an important role to play in creating awareness of the risk of HIV, especially among men. The belief that they are not at risk of HIV infection may result in their failure to adopt self-protective behaviour.     

Developmental vulnerabilities and strengths of children living in child-headed households: a comparison with children in adult-headed households in equivalent impoverished communities

This pilot study addresses the need to clarify specific developmental vulnerabilities and strengths that characterise children living in child-headed households in comparison to children living in adult-headed households in equivalent impoverished communities. Samples of 10 each of these two categories of household were randomly selected from impoverished communities around Pietermaritzburg, South Africa (involving a total of 22 children from a child-headed households and 41 from an adult-headed households). Fourteen child-participatory, quantitative and/or qualitative measures were investigated over six indicative themes. Differences between the child-headed and adult-headed households were statistically or thematically analysed as appropriate to the data collected. Specific areas of vulnerability in the former households were access to institutional/social services, income (cash or kind) and resource generation, unresolved grief, lack of attainable long-term goals, poor self-worth, and poor internal locus of control. Specific strengths of children in those households were demonstrated in social networking, time and money management, and family interactions.     

Lover,mother or worker: women's multiple roles and the HIV/AIDS and reproductive health agenda in Tanzania

International and national campaigns to prevent HIV/AIDS and efforts to promote reproductive health remain separate in terms of conceptualisation and implementation. Local negotiations around reproductive health issues similarly seem to lack explicit attention to HIV/AIDS. This paper argues that even in reproductive health clinics a gap exists between the extent of knowledge of HIV/AIDS and AIDS talk. There also appears to be a mismatch between collective knowledge of the behavioural and biomedical context of HIV/AIDS and the socio-economic context of AIDS as a lived experience. Using an ethnographic account, I explore how one woman's lived experience and her knowledge of AIDS can teach us to take HIV/AIDS into account when theorising, promoting or providing services for improving African women's reproductive health. The background for this ethnography comes from data collected during 25 months of fieldwork at 10 maternal and child health/family planning (MCH/FP) clinic sites in the Morogoro, Ruvuma and Kilimanjaro regions of Tanzania. Rehema's story shows that AIDS, like other diseases, is significantly linked to host-susceptibility and economic vulnerability. Separate and competing vertical programmes on AIDS and MCH/FP, as commonly encountered throughout Africa, cannot meet the needs of women in countries like Tanzania. Yet, we still hear most often of abstinence, anti-retrovirals and condom use as the primary focus of HIV/AIDS prevention and intervention in Africa.     

'But where are our moral heroes?' An analysis of South African press reporting on children affected by HIV/AIDS

Messages conveyed both explicitly and implicitly in the media play an important role in shaping the public's understanding of issues, as well as in shaping associated policy, programmes and popular responses to these issues. This paper applies discourse analysis to a series of articles about children affected by HIV/AIDS published in 2002/2003 in the English-language South African press. The analysis reveals layers of moral messaging present in the reporting, the cumulative effect of which is the communication of a series of moral judgements about who is and who is not performing appropriate roles in relation to children. Discourses of moral transgression, specifically on the part of African parents and 'families' for failing in their moral responsibilities towards their children, coalesce with discourses on anticipated moral decay among (previously innocent) children who lack their due care. A need for moral regeneration among South Africans (but implicitly black South Africans) contrasts with accolades for (usually white), middle-class individuals, who, it is implied, have gone beyond their moral duty to respond. The article argues that in each instance the particular moralism is questionable in light of both empirical evidence and the principles of human dignity that underlie the South African constitution. Children — and particularly 'AIDS orphans' — are often presented in the press as either quintessential, innocent victims of the epidemic or as potential delinquents. While journalists' intentions are likely to be positive when representing children in these ways, the paper argues that this approach is employed at a cost, both to the public's knowledge and attitudes around the impact of HIV/AIDS, and, more importantly, to the lives of children affected by the epidemic.     

Vulnerability to HIV infection among Luo female adolescent orphans in Western Kenya

Large-scale surveys have reported that about 55% of orphans worldwide are adolescents. In Kenya, the majority of HIV-infected adolescents are females. The current study used the anthropological methods of in-depth case studies to analyse how migratory life situations of individual female adolescent orphans in the Luo community of Western Kenya may increase their exposure to HIV. The study shows that the ability of the female adolescent orphans to adopt risk-preventive behaviour in relation to HIV is determined by a range of factors beyond their control of individual sexual behaviour. Although analysis of a single case study limits generalisation of the findings, the results provide insights into the reason for sex differentials in HIV infection rates among adolescents as reported in some large-scale surveys. The paper recommends that HIV prevention strategies for adolescents should examine the specific life situations of female orphans by focusing on the impacts of HIV and AIDS and poverty on the protective role of the family. It also recommends that keeping female adolescent orphans in school or in vocational training can be an effective HIV prevention strategy for them.     

The protective effect of male circumcision on HIV infection in a sample of Kenyan men

This article examines the association between male circumcision and HIV infection in a national sample. The analysis is based on the 2003 Kenya Demographic and Health Survey (KDHS), a nationally representative household-based population survey of adults, in which male respondents self-reported their circumcision status. In addition, in some households eligible for individual interview, blood samples were subsequently anonymously obtained for HIV testing, making this the first study linking socio-demographic information to HIV status at the national level. The study sample is limited to 3 413 men aged 15–54 years who gave valid information on their circumcision and HIV statuses. Nearly 5% of the men were HIV-positive, and 86% had been circumcised. HIV prevalence was significantly higher among the uncircumcised men (12%) than among the circumcised men (3%). This indication of the protective effect of male circumcision on HIV infection remained statistically significant (OR 0.15; 95%CI: 0.09–0.23) even after controlling for the effects of socio-demographic variables, age at first sexual intercourse, and use of paid sex. Based on these results, we recommend that HIV-prevention advocates and activists, scholars, bio-medical communities and political leaders find ways to include this oldest surgical procedure in their HIV/AIDS discourses and programmes in sub-Saharan Africa.     

The economic impact of HIV/AIDS morbidity and mortality on households in Addis Ababa, Ethiopia

The present study investigates whether the household-level economic impact of an adult AIDS death is different from that of death from another cause. The data come from cross-sectional post-mortem interviews (verbal autopsies) with relatives or primary caregivers of deceased adults randomly selected from deaths recorded in an ongoing burial surveillance in Addis Ababa. Our analyses consist of three parts. First, we assess the sociodemographic risk factors for AIDS mortality. Subsequently, we reverse the causal order of this relationship and carry out an analysis of the effect of AIDS mortality on the subjective experience of change in the household's financial situation following the death of a household member. Finally, we quantify the direct and indirect costs of illness and death on the household. Results indicate that households experiencing an HIV/AIDS death are poorer than those experiencing a non-HIV/AIDS death. In addition, poorer households experience a greater decline in socioeconomic status following death of a household member. AIDS mortality has more detrimental effects on the household economic status than deaths due to other causes. While the difference between AIDS and non-AIDS mortality in terms of direct costs is minimal, the indirect cost of an AIDS death per household exceeds that of non-AIDS death by 58%. In conclusion, poor households are more likely to experience an AIDS death and in turn are more vulnerable to the socioeconomic impact of death. Therefore, it is justifiable to target HIV-impact mitigation programs on poorer households.     

Knowledge,attitudes and perceptions of HIV/AIDS among traditional birth attendants and herbal practitioners in Lagos State,Nigeria

Recognising the widespread role of traditional birth attendants (TBAs) and herbal practitioners (HPs) in health care at community level in Nigeria, we set out to assess their knowledge, attitudes and practices in relation to HIV infection and prevention. Questionnaires were administered to a convenience sample of 189 participants in 20 local government areas of Lagos State. We found that knowledge of modes of transmission of HIV was less than adequate and included lack of knowledge of the existence of HIV/AIDS amongst some practitioners, claims for the ability to treat HIV/AIDS, failure to name major avenues of transmission and confusion of HIV/AIDS with other conditions. The use of measures to prevent infection of clients and themselves showed that normal standards of infection control are not adhered to. Considering that as many as 60% of children born in Nigeria are delivered by traditional birth attendants and that use of the services of herbal practitioners extends across the entire society in both rural and urban settings, this is seen as reason for concern. It is suggested that better incorporation of TBAs/HPs into the well-developed primary health care system offers not only a way of overcoming the risks of infection posed by traditional health practices but also offers an opportunity to extend the reach of voluntary counselling and testing and prevention of mother-to-child infection programmes. The research has shown the need for appropriate training of TBAs, to enable them to recognise the risk of HIV infection in their own practices and to encourage them to adopt universal precautions against spreading infection. We also recommend that they be more extensively integrated as primary health care workers in VCT and PMTCT programmes in Nigeria. We further suggest that referrals made between the traditional practitioners and professional health care providers can be an effective and successful element of HIV/AIDS prevention and control programmes.     

The quality of HIV/AIDS case-detection and case-reporting systems in Mozambique

Despite the underlying importance of surveillance systems for the management of HIV/AIDS prevention and control programmes, there has been limited analysis of the quality of HIV/AIDS case-detection and case-reporting systems, beginning with peripheral facilities through to those at national levels. In Mozambique, HIV cases are generally correctly detected despite some unreliable use of test kits beyond their expiry date, uneven distribution of test kits among facilities, frequent disregard for bio-safety measures and irregular external quality assessment. Furthermore, HIV/AIDS case-reporting is compromised by poor data quality, including under-reporting and discrepancies across different reporting channels and organisational levels, as well as a lack of standardised data forms, data items collected and report formats. Our analysis of HIV/AIDS surveillance systems in Mozambique leads to the following key recommendations: (1) a strengthening and standardisation of both the case-detection and case-reporting systems at all levels; (2) the regular training of staff at peripheral facilities, to allow for better testing and improved local data analysis, validation and interpretation; (3) the redesign of reporting systems for blood banks, including integration of the AIDS case-reporting subsystems into one; and (4) the use of baseline data as a foundation for more comprehensive analysis across the country, in response to UNAIDS advice regarding second-generation HIV surveillance.     

The impact of the HIV epidemic on the composite wellbeing of educators in South Africa: a qualitative study

In South Africa, support is available for educators who are HIV-positive, and there are numerous initiatives to curb further HIV infections. What is lacking though is an understanding of how the HIV epidemic impacts on educators who are affected personally or professionally. For this reason a qualitative study was undertaken with 25 affected educators from the Gauteng and Free State provinces. Semi-structured interviews were conducted to determine how the epidemic is impacting the health of educators who are affected but not HIV infected. The results suggest that affected educators are in need of interventions that target health promotion, since those who participated reported poor physical, emotional, social, spiritual and professional health. The results also suggest that some educators do cope with the overall impact of the epidemic, implying that resilient functioning among affected educators should be promoted.     

Knowledge and perception of HIV/AIDS among pregnant women attending antenatal clinics in Ogun State,Nigeria

Mother-to-child transmission of HIV (MTCT) is responsible for more than 90% of the cases of HIV infection in infants and children in sub-Saharan Africa. Accurate data on the knowledge and perceptions of HIV/AIDS among women attending antenatal clinics in Nigeria are scarce. A cross-sectional survey of 804 women attending antenatal clinics in Ogun State, South-West Nigeria was done using interviewer-administered questionnaires. Approximately 90% of the women respondents had heard of HIV/AIDS, but only about 27% knew HIV could be transmitted from mother to child; of those, almost 94% believed in the reality of HIV disease; in contrast, the majority (64%) believed they were not at risk of HIV infection, and a slightly greater proportion (70%) did not understand the benefits of voluntary HIV counselling and testing (VCT). Nonetheless, almost 90% of respondents were willing to know their status following health education about VCT. Those that were older, attending public hospitals, and with a higher level of education had more knowledge and better perceptions about HIV. The results suggest an urgent need for public health education on HIV/AIDS and the benefits of VCT to control MTCT, particularly targeting young women and those with little or no education.     

云南农村少数民族地区艾滋病对家庭影响的研究

目的通过调查农村少数民族地区艾滋病病毒(HIV)感染者家庭和非HIV感染者家庭的家庭规模、经济状况和医疗负担等,了解艾滋病在云南省少数民族地区对家庭造成的社会经济影响。方法采用对照的方法,首先整群随机抽取HIV/艾滋病(AIDS)病人家庭,然后按2∶1的比例选取吸毒非感染者家庭和一般家庭。结果调查发现,HIV感染者家庭目前家庭规模显著小于一般家庭(P<0.01);HIV感染者家庭年均收入较低,而年均支出没有统计学意义;HIV感染者家庭的医疗负担要显著高于对照组家庭。结论艾滋病对家庭造成的最直接的影响在于削弱劳动力、减少家庭收入、增加医疗负担,进而破坏家庭规模和结构,导致家庭社会功能的丧失和经济贫困。     

Prevalence of HIV infection among premarital couples in southeast Nigeria

The Catholic Church in Nigeria offers premarital HIV screening to couples, yet instances of voluntary screening are rare in southeast Nigeria. This study examines the contribution of such tests to HIV detection, and evaluates the prevalence of HIV infection in southeast Nigeria among couples who are planning to marry. Out of 858 individuals (or 429 couples) tested for HIV, 52 individuals were found to be HIV-positive (overall prevalence 6.1%), and females were marginally more affected than males. In both sexes, prevalence was higher in younger age groups. Prevalence among adolescent females was 10.7%. Although no male adolescents were screened, prevalence for the group aged 20 to 29 years was 6.3% for females and 10.8% for males. The prevalence estimate was slightly higher for rural dwellers (6.2%) than for urban residents (5.9%), but this was not statistically significant. We propose that screening apparently healthy individuals, such as couples intending to marry, and who are otherwise not members of a group considered at high risk for HIV infection, can serve an important role in HIV detection in the general population.