Prevalence of, and factors associated with, HIV/AIDS-related stigma and discriminatory attitudes in Botswana

Botswana has the highest prevalence of HIV in the world. The epidemic of HIV/AIDS is often accompanied by stigma and discrimination that create the circumstances for spreading HIV. To facilitate the design of effective programmes to fight the high prevalence of HIV/AIDS-related stigma and discriminatory attitudes, this study examined survey data on the prevalence of, and factors associated with, such attitudes in Botswana. While most respondents showed discriminatory attitudes towards a teacher or a shopkeeper with HIV/AIDS, only 11% of 4,147 respondents reported unwillingness to care for a family member with HIV/AIDS. The more tolerant attitudes towards a family member with HIV/AIDS appeared to be promoted by the fact that family members have been and continue to care for their sick members through a government project called Community Home-based Care aimed at relieving public hospitals of HIV/AIDS patients. Since the burden of caring for sick relatives rests on the shoulders of women, they portrayed more tolerant attitudes towards HIV/AIDS patients. Young people and those who believed a person could get HIV infection by sharing a meal with an HIV/AIDS patient had discriminatory attitudes towards people with HIV/AIDS. The national information, education and communication programme needs to be strengthened to reach more people for HIV/AIDS education. Finally, programmes that aim to promote more tolerant attitudes towards people with HIV/AIDS may be more effective if the human rights of those with HIV/AIDS are promoted and respected.     

Health implications of early childbearing on pregnancy outcome in Botswana: insights from the institutional records

Early childbearing can have deleterious effects on pregnancy outcome. This study in Botswana found that both birth injuries and congenital abnormalities were common among infants born to teenage mothers compared to infants of women aged 20-34 years. This statistically significant relationship disappeared, however, when controls were introduced. Based on the results of this study, it appears that in order to improve pregnancy outcomes, frequent and early prenatal visits and improvements in the socioeconomic environment are needed. Thus, postponement of childbearing beyond teenage years alone would not necessarily improve pregnancy outcomes in Botswana.     

Impact of male circumcision on HIV risk compensation through the impediment of condom use in Botswana

Background

Male circumcision has been recommended as a method of reducing the risk of transmitting HIV. However, widespread uptake of male circumcision may lead to HIV risk compensation by impeding condom use.

Objective

To investigate the impact of male circumcision on condom use.

Methods

The study used cross-sectional data from the Botswana AIDS Impact Survey III on 1,257 men aged 15 years or older who were sexually active. Data were analyzed using Pearson''s chi-square statistic and binary logistic regression.

Results

The study found that 15% of circumcised men did not use condoms compared to 12% of uncircumcised men, and circumcision was not significantly associated with condom use. Non-use of condoms was significantly affected by religious beliefs, low level of education, marriage, drunkenness, and misconceptions regarding antiretroviral therapy (ART).

Conclusions

We conclude that male circumcision does not impede condom use. Condom use is impeded by low level of education, marriage, drunkenness, and misconceptions regarding ART. We recommend the emphasis of consistent condom use targeting people with low education, those in marriage, users of alcohol, and people receiving ART.     

Evaluation of economic costs of a measles outbreak and outbreak response activities in Keffa Zone,Ethiopia

Objective

To estimate the economic impact of a measles outbreak and response activities that occurred in Keffa Zone, Ethiopia with 5257 reported cases during October 1, 2011–April 8, 2012, using the health sector and household perspectives.

Methods

We collected cost input data through interviews and record reviews with government and partner agency staff and through a survey of 100 measles cases-patients and their caretakers. We used cost input data to estimate the financial and opportunity costs of the following outbreak and response activities: investigation, treatment, case management, active surveillance, immunization campaigns, and immunization system strengthening.

Findings

The economic cost of the outbreak and response was 758,869 United States dollars (US$), including the opportunity cost of US$327,545 (US$62.31/case) and financial cost of US$431,324 (US$82.05/case). Health sector costs, including the immunization campaign (US$72.29/case), accounted for 80% of the economic cost. Household economic cost was US$29.18/case, equal to 6% of the household median annual income. 92% of financial costs were covered by partner agencies.

Conclusion

The economic cost of the measles outbreak was substantial when compared to household income and health sector expenditures. Improvement in two-dose measles vaccination coverage above 95% would both reduce measles incidence and save considerable outbreak-associated costs to both the health sector and households.     

The impact of HIV antiretroviral treatment perception on risky sexual behaviour in Botswana: a short report

The aim of this article is to investigate the impact of ART perception on risky sexual behaviours in Botswana. Using binary logistic regression analysis controlling for individual characteristics, the results tend to support the hypothesis that ART misconceptions do not necessarily increase risky sexual behaviours. In particular, the study findings suggest the belief that ARVs cure HIV and AIDS and that people on ARVs should not always use condoms do not necessarily lead to increased risky sexual behaviours, particularly among women. Gender differentials exist in the perceived sexual risk resulting from the use of ART. Risky sexual behaviours increase for women who, wrongly, believed that ARVs cure HIV and AIDS and people on ARVs should not always use condoms. Although there is evidence to suggest ART perceptions do not necessarily lead to increased risky sexual behaviours, HIV and AIDS prevention programmes are needed to strengthen their information, education and communication intervention component that can address misconceptions about ART treatment and provide correct information that is gender-appropriate.     

Factors associated with non-use of maternal health services in Botswana

The study investigated individual and household factors associated with non-use of maternal health services in Botswana. Nationally-representative data, drawn from the 1996 Botswana Family Health Survey, were used. A weighted sample of 19,031 women, aged 15-49 years, who had at least one pregnancy history in the five years prior to the survey was considered for analysis. Both simple cross-tabulations and logistic regression were used for analyzing the data. Consistently, the teenagers were less likely to seek prenatal care, to have their babies delivered by a qualified person, and to seek postnatal check-up. Using results from logistic regression analysis, it can be observed that low-parity women were less likely to use maternal services. Another consistent finding is that women with low educational level, those residing in rural areas, and those with low socioeconomic status were less likely to use maternal services. More focussed investigation is needed, but understanding the differentials of the use of maternal services allows policy-makers to identify problem areas that need attention.