Beyond Sugar Daddies: Intergenerational Sex and AIDS in Urban Zimbabwe

In a survey of 1,313 men reporting on 2,465 partnerships recruited at beer halls in Harare, Zimbabwe, 2.5% met a definition of “sugar daddy”: men with a non-marital partner at least 10 years younger and under 20 years old, and exchanged cash or goods for sex. Men engaging in intergenerational sex with a teenage woman had similar HIV prevalence, incomes, and condom use as men in other partnerships. Most men (62.3%) had partners 5 or more years younger, with wider age gaps in longer-term relationships. Condom use was less common within married and steady partnerships compared to casual and more common with younger women. The most common form of intergenerational sex, with the widest age gap and lowest condom use, occurs within marriages and steady partnerships. Such “conventional” intergenerational sex may play the pivotal role in sustaining a generalized epidemic across generations and present the most difficult challenge to prevention.     

Prevalence and factors associated with knowledge of and willingness for male circumcision in rural Zimbabwe

Objective To explore male circumcision (MC) prevalence, knowledge, attitudes and intentions among rural Zimbabweans. Methods Representative survey of 18–44 year olds in two provinces, as part of an evaluation of the Zimbabwe National Behaviour Change Programme. We conducted univariate, bivariate and multivariate analyses. Linear regression was employed to predict knowledge of MC (composite index) and logistic regression to predict knowledge that MC prevents HIV, willingness (oneself or one’s partner) to undergo MC, and willingness to have son circumcised. Results Two thousand seven hundred and forty‐six individuals participated in the survey (87% of eligibles). About two‐thirds were women (64%). Twenty per cent of men reported being circumcised, while 17% of women reported having a circumcised partner. Knowledge of MC and its health benefits was low. Attitudes towards MC were relatively positive. If it could prevent HIV, 52% of men reported that they would undergo MC and 58% of women indicated that they would like their partners to be circumcised. Seventy‐five per cent of men who reported being HIV positive were willing to undergo MC, against 52% of those who reported HIV negative status. Reported acceptability of neonatal circumcision was high with 58% of men and 60% of women reporting that they would have their sons circumcised if it protected them against HIV. Fear of adverse effects was highlighted as a barrier to MC acceptability. Conclusion More knowledge about MC’s health benefits positively affects people’s attitudes towards MC. The relatively high MC acceptability suggests an enabling environment for the scale‐up programme.     

Promoting interdisciplinary care of patients and families: a classroom project

Interdisciplinary educational experiences provide opportunities for nursing students to gain knowledge regarding the contributions of other healthcare providers in ensuring quality patient care. The project, part of a family health course, brought together students from 5 disciplines to heighten awareness of the necessity of, and the call for, interdisciplinary education. The authors discuss the project and its structure to provide ideas to other educators who may want to integrate an innovative interdisciplinary experience into their course.     

Lateral differences in the default mode network in healthy controls and patients with schizophrenia

We investigate lateral differences in the intrinsic fluctuations comprising the default mode network (DMN) for healthy controls (HCs) and patients with schizophrenia (SZ), both during rest and during an auditory oddball (AOD) task. Our motivation for this study comes from multiple prior hypotheses of disturbed hemispheric asymmetry in SZ and more recently observed lateral abnormalities in the DMN for SZ during AOD. We hypothesized that significant lateral differences would be found in HCs during both rest and AOD, and SZ would show differences from HCs due to hemispheric dysfunction. Our study examined 28 HCs and 28 outpatients with schizophrenia. The scans were conducted on a Siemens Allegra 3T dedicated head scanner. There were numerous crossgroup lateral fluctuations that were found in both AOD and rest. During the resting state, within-group results showed the largest functional asymmetries in the inferior parietal lobule for HCs, whereas functional asymmetries were seen in posterior cingulate gyrus for SZ. Comparing asymmetries between groups, in resting state and/or performing AOD, areas showing significant differences between group (HC > SZ) included inferior parietal lobule and posterior cingulate. Our results support the hypothesis that schizophrenia is characterized by abnormal hemispheric asymmetry. Secondly, the number of similarities in crossgroup AOD and rest data suggests that neurological disruptions in SZ that may cause evoked symptoms are also detectable in SZ during resting conditions. Furthermore, the results suggest a reduction in activity in language-related areas for SZ compared to HCs during rest.     

Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania

Prevention of mother-to-child transmission of HIV (PMTCT) is a foundational component of a comprehensive HIV treatment program. In addition to preventing vertical transmission to children, PMTCT is an important catch-point for universal test-and-treat strategies that can reduce community viral load and slow the epidemic. However, systematic reviews suggest that care engagement in PMTCT programs is sub-optimal. This study enrolled a cohort of 200 women initiating PMTCT in Kilimanjaro, Tanzania, and followed them to assess HIV care engagement and associated factors. Six months after delivery, 42/200 (21%) of participants were identified as having poor care engagement, defined as HIV RNA >200?copies/mL or, if viral load was unavailable, being lost-to-follow-up in the clinical records or self-reporting being out of care. In a multivariable risk factor analysis, younger women were more likely to have poor postpartum care engagement; with each year of age, women were 7% less likely to have poor care engagement (aRR: 0.93; 95% CI: 0.89, 0.98). Additionally, women who had told at least one person about their HIV status were 47% less likely to have poor care engagement (aRR: .53; 95% CI: 0.29, 0.97). Among women who entered antenatal care with an established HIV diagnosis, those who were pregnant for the first time had increased risk of poor care engagement (aRR 4.16; 95% CI 1.53, 11.28). The findings suggest that care engagement remains a concern in PMTCT programs, and must be addressed to realize the goals of PMTCT. Comprehensive counseling on HIV disclosure, along with community-based stigma reduction programs to provide a supportive environment for people living with HIV, are crucial to address barriers to care engagement and support long-term treatment. Women presenting to antenatal care with an established HIV status require support for care engagement during the crucial period surrounding childbirth, particularly those pregnant for the first time.