Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa

AIM: This paper is a report of a study to determine the aetiological distribution of sexually transmitted infections and prevalence of human immunodeficiency virus infection in selected primary health care clinic attendees. BACKGROUND: South Africa has a high prevalence of human immunodeficiency virus and other sexually transmitted infections. Sexually transmitted infections are managed syndromically in the public sector as part of the essential nurse-driven primary care services provided at no cost to the client. METHOD: This cross-sectional study was conducted in a rural community in South Africa between September and November 2002. A total of 277 consenting women were recruited. Vulvo-vaginal swabs were collected for screening for Neisseriae gonorrheae, Chlamydia trachomatis and Trichomonas vaginalis using DNA amplification methods and Gram stain with Nugent's score for the diagnosis of bacterial vaginosis. Seroprevalence of syphilis and human immunodeficiency virus infection were determined. FINDINGS: The overall prevalence of human immunodeficiency virus in the study was 43.7% (95% confidence interval 37.6-50.0) with the prevalence in family planning clinic attendees 45.5% (95% confidence interval 38.9-52.3) and antenatal clinic attendees 33.3% (95% confidence interval 19.6-50.3). The prevalence of sexually transmitted infections amongst both the antenatal clinic and family planning attendees accounted for at least 70% of cases. Fifty per cent of women had one recognized sexually transmitted infection with 17.9% of the family planning and 14.5% of the antenatal clinic attendees having infections from two recognized pathogens. All infections were asymptomatic. CONCLUSION: Nurse-driven antenatal and family planning services provide a useful opportunity for integrating reproductive health services, human immunodeficiency virus voluntary counselling and testing and treatment of sexually transmitted infections.     

Research Article: Development of a theory‐based sexual and reproductive health promotion and HIV prevention program for Chinese early adolescents

The purpose of this study was to develop a theory‐based program for Chinese early adolescents in order to promote their sexual and reproductive health and to prevent HIV infection. The program was designed based on the Information–Motivation–Behavioral skills model and a needs assessment among the stakeholders. A technical collaborative action research approach was applied. The study's participants were 102 early adolescents in a public middle school in mainland China, with the involvement of other key stakeholders, including 15 teachers and 12 parents. The results revealed a statistically significant improvement in the scores of sexual and reproductive health promotion and HIV prevention information, motivation, and behavioral skills after the program's implementation. Meanwhile, qualitative data from the early adolescents' reflection indicated that the content was useful and comprehensive, the trainers were friendly and knowledgeable, and participatory learning with an “edutainment” style was especially impressive. Additionally, the early adolescents expressed that they could apply the knowledge and skills in their daily life, which would benefit themselves and their family and peers. The Information–Motivation–Behavioral skills model could be explored in a non‐Western context and the program was shown to be acceptable for use in a Chinese middle school setting.     

Culture-specific factors contributing to HIV risk among Jamaican adolescents.

The purpose of this article is to describe the results from an elicitation research study addressing the multisystem-level factors that contribute to HIV risk among Jamaican adolescents. Focus group and survey data were determined from parents, adolescents, and teachers in Kingston, Jamaica, from 2004 and 2005. Guided by an ecological extension of the Theory of Planned Behavior, focus groups and survey questionnaires identified cultural factors at the individual, family, and societal levels that significantly influence Jamaican adolescents' behavioral, normative, and control beliefs related to sexual behaviors that contribute to risk for HIV and other sexually transmitted infections. Although some factors were similar to those reported among adolescents living in the United States, others were culture-specific influences and beliefs that were unique to Jamaica. Results from the current study could contribute to the development of theory-based, culture-specific HIV risk-reduction interventions for use with Jamaican adolescents.     

Diagnostic classification,viral sexually transmitted infections and discourses of femininity: limits of normalisation to erase stigma

Clinicians in the field of women’s sexual health typically classify the two most common viral sexually transmitted infections (STIs), the human papilloma virus and the herpes simplex virus, as relatively innocuous infections. Teaching interventions include ‘normalising’ adult sexual activity and the epidemiological ordinariness of infection. Normalising is intended to disarm the potential stigma of the diagnosis. In this study, in‐depth email interviews were conducted with 26 women with a viral STI diagnosis and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Normalising is contextualised as an example of the workings of western philosophical thought whereby dualistic classifications privilege certain terms and subordinate other terms. In this instance, the relative medical normalcy of viral STIs is given primacy compared to the social abnormality experienced by women. Although these viral STIs infect women and men, this research concentrates on women’s learning about viral STIs. For women, beliefs about femininity, sexuality, health, morality and responsibility influence effects of a viral STI diagnosis. These discourses are clinically significant because beliefs that specifically link to ideas about how to be a woman are overlooked when clinicians devise educational interventions.     

Primary and preferred sources for HIV/AIDS and sexual risk behavior information among adolescents in Swaziland, Southern Africa

The HIV/AIDS epidemic in Sub-Saharan Africa poses a massive diffusion and persuasion challenge for health professionals. Individuals working with adolescents to prevent the spread of HIV/AIDS must gain an understanding of adolescent's preference in obtaining information about HIV/AIDS and sexual behaviors. This study describes the primary and preferred sources of information regarding HIV/AIDS and sexual risk behavior in relation to several socio-demographic variables (n=941) in Swaziland, Southern Africa. Although print/broadcast media was the primary source for HIV/AIDS and sexual risk behavior information for the students, most participants preferred information from the healthcare workers. This study suggests a greater role for healthcare providers in providing HIV/AIDS and sexual risk information.     

HIV/AIDS knowledge, attitudes and beliefs among Nepalese adolescents

AIM: This paper reports an exploration of Nepalese adolescents' knowledge, attitudes and beliefs of HIV/AIDS. BACKGROUND: Nepal is confronted with an increasing incidence of HIV/AIDS among adolescents and young adults. A priority of nurses and other health professionals in Nepal is the prevention of the spread of HIV infection. The first step in prevention is assessing the HIV/AIDS knowledge, attitudes and beliefs of adolescents. METHODS: A cross-sectional correlational design was carried out in 2003 in a private school in Kathmandu, Nepal. A total of 150 adolescents participated in the study. Two instruments were used: a demographic questionnaire and the Youth Survey, which included questions on knowledge, attitudes and beliefs. FINDINGS: The majority of the adolescents had a moderate level of overall HIV/AIDS knowledge, but lacked knowledge in the areas of mode of transmission and prevention of HIV/AIDS. Approximately 79% thought that AIDS was a big problem and 67% were afraid of getting AIDS. However, only 16.7% reported that they were likely to get AIDS, and 18.7% did not perceive living in Kathmandu as a risk for HIV/AIDS. CONCLUSION: The findings of this study will help policymakers and healthcare professionals develop a culturally sensitive and needs specific educational programme for urban Nepalese adolescents. The findings may also have lessons for public health and school nurses working in similar contexts. Nurses, and more specifically public health nurses in Nepal, need to play an active role in the development and implementation of educational programs on HIV/AIDS. Research needs to be done in rural as well as urban areas of Nepal on adolescents' HIV/AIDS knowledge, attitudes and beliefs.     

Practice brief: adolescents and HIV clinical trials: ethics, culture, and context.

One quarter of HIV infections globally occur among young people 15 to 24 years of age, and more than half of all new infections are in people younger than 25 years. Clearly, there is a need to identify and implement effective HIV prevention strategies among at-risk teens. Some of the most effective options for slowing the epidemic are biomedical, and several promising methods are in development, including microbicides, vaccines, and preexposure prophylaxis (PREP, or the daily use of antiretrovirals to prevent the acquisition of HIV). There is widespread reluctance to enroll minors in such biomedical prevention trials because of concerns about vulnerability related to physical maturity, experiential maturity, and diminished autonomy as well as legal and social challenges that vary across and within nations. However, excluding minors from trials misses an important opportunity to evaluate the effectiveness, acceptability, and safety of innovative interventions under the best conditions for identifying and resolving potential problems. The challenges of including minors in HIV prevention trials are highlighted through the example of one rural South African community that has been particularly devastated by the HIV epidemic.     

Point of care diagnostics for sexually transmitted infections: perspectives and advances

Accurate and inexpensive point-of-care (POC) tests are urgently needed to control sexually transmitted infection epidemics, so that patients can receive immediate diagnoses and treatment. Current POC assays for Chlamydia trachomatis and Neisseria gonorrhoeae perform inadequately and require better assays. Diagnostics for Trichomonas vaginalis rely on wet preparation, with some notable advances. Serological POC assays for syphilis can impact resource-poor settings, with many assays available, but only one available in the U.S. HIV POC diagnostics demonstrate the best performance, with excellent assays available. There is a rapid assay for HSV lesion detection; but no POC serological assays are available. Despite the inadequacy of POC assays for treatable bacterial infections, application of technological advances offers the promise of advancing POC diagnostics for all sexually transmitted infections.     

Comparison of free and anonymous testing for HIV and sexually transmitted infections between the University Hospital and Health Center

We gathered data regarding age, sex, and positivity rates for human immunodeficiency virus (HIV), syphilis, gonococcus, and chlamydia from individuals who underwent free and anonymous sexually transmitted infection (STI) testing conducted at the Jikei University School of Medicine Hospital (our hospital). These data were compared to results of subjects who underwent similar testing at the Minato Health Center and several private facilities of urologists and gynecologists belonging to the Minato Ward Medical Association. The positivity rate of chlamydia was found to be high in female subjects, particularly at the Minato Health Center, with 15 of 194 subjects (7.73 %) testing positive. In our hospital, we only detected 3 of 133 subjects (2.26 %) who were gonococcus positive. On the other hand, at the doctor’s facilities, 10 of 188 male subjects (5.32 %) were syphilis positive, and 8 of 185 male subjects (4.32 %) were chlamydia positive, thus showing high positivity rates for both infections. At our hospital, 1 of 231 subjects was positive for gonococcus and 4 of 230 subjects (1.74 %) were positive for chlamydia, thus showing lower positivity rates for both infections. HIV-positive subjects were, however, only confirmed at our hospital, with 2 of 243 subjects (0.82 %) being positive. We were able to diagnose infected patients using free and anonymous STI testing at hospitals, and the same as at doctors’ facilities. This result suggests that the hospitals that have many opportunities to diagnose HIV patients may become potential candidates for the development of new consultation facilities, establishment of testing facilities, and enhancement of consultation processes that include STI prevention.     

HIV, stigma and health: integration of theoretical concepts and the lived experiences of individuals

AIM: To explore individual concepts of health and the role of stigma in human immunodeficiency virus (HIV) and HIV disease. The balance of power and knowledge are examined from both macro and micro perspectives, including both concepts of health and health and illness behaviour. METHOD: A literature review which supports the integration of theoretical concepts and research findings demonstrating the lived experiences of individuals. CONCLUSION: Stigma is a social construct which has significant impact on the life experiences of individuals both infected with and affected by HIV. The stigma experienced is unique to each individual and changes dynamically throughout the course of the HIV illness trajectory. Each of the four identified phases poses unique stigmatic qualities.     

A four-year observation of HIV and sexually transmitted infections among men who have sex with men before and during pre-exposure prophylaxis in Tokyo

BackgroundPre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) has been recommended worldwide. We evaluated the safety and efficacy of daily PrEP with TDF/FTC in Tokyo.MethodsThis single-center, single-arm study was performed with 124 men who have sex with men (MSM) between January 2017 and March 2021. MSM who entered into an MSM cohort from January 2017 through March 2018 and had a pre-PrEP observational period of 1 year were eligible and recruited to the study between April 2018 and March 2019 and followed for 2 years. The primary outcome was the incidence of HIV infection (per 100 person-years). Secondary outcomes were the incidence of sexually transmitted infections and adverse events, and the rate of retention and adherence to PrEP.ResultsThere were 309 MSM registered in the cohort (mean age, 36.6 years); 124 fulfilled the criteria and were included in the study. The remaining patients were continuously followed. There was a significant decrease in incidental HIV infection among PrEP users (0 infections, 235.5 person-years) compared to non-PrEP users (11 infections [3.4%/year], 318.9 person-years; p = 0.01). The average adherence rate was consistently greater than 95%, and the retention rate at two years was approximately 80%.ConclusionsThe present study showed a high prophylactic effect against HIV infection, retention, and adherence to PrEP. PrEP is feasible and highly recommended in Japan.Trial registrationUMIN Clinical Trials Registry (UMIN000031040, www.umin.ac.jp), Japan Registry of Clinical Trials (jRCTs031180134).     

Research brief: sexual communication and knowledge among Mexican parents and their adolescent children.

This study describes the sexual knowledge and communication of Mexican parents and adolescents. Preintervention data were analyzed from 829 high school students (ages 14-17) and one of the parents of each. Differences were found between parents and adolescents in sexual knowledge (M = 16.16 vs. M = 14.92; t = 7.20, p < .001); specifically, parents had higher knowledge related to sexually transmitted diseases, HIV/AIDS, and condom use. Parents perceived more general communication (t [787] = 6.33, p < .001), and less discomfort talking about sex (t [785] = 4.69, p < .001) than adolescents. Parents with higher education levels scored higher in HIV knowledge and general communication. Fathers had higher total sexual knowledge, whereas mothers perceived higher sexual communication than fathers. There were no differences in knowledge and communication by parental socioeconomic level. Results suggest health care providers need to assist parents in developing specific knowledge and skills to support their adolescents' sexual decision-making.     

Childhood abuse history and risk behaviors among teen parents in a culturally rooted, couple-focused HIV prevention program.

Pregnant and parenting adolescents living in inner cities are at risk for acquiring HIV through unprotected sexual activity. In addition to individual risk behaviors, a lack of socioeconomic and other environmental resources create risk environments that make certain communities vulnerable to both adolescent pregnancy and HIV/AIDS. Research indicates that adolescent parents, many who have histories of childhood trauma, may use their experience of young parenthood and the concomitant feelings of parental protectiveness as a source of renewed hope for their future. The purpose of this report is to explore the relationship between history of childhood abuse and high risk behaviors in adolescent Latino mothers and fathers enrolled in a randomized clinical trial of a culturally rooted, couple-focused HIV prevention program. In addition, this report describes the HIV prevention program that was designed specifically for young Latino parents wherein maternal and paternal protectiveness are viewed as intrinsic and developing critical factors that promote resiliency and motivate behavioral change.