Stepping Stones, a 50-hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. This article details the results of a randomised trial to measure the impact of the programme on HIV and herpes rates in rural South Africa. The trial also measured unwanted pregnancy, reported sexual practices, depression, and substance misuse. The article shows how there was no evidence that Stepping Stones lowered the incidence of HIV. However, it significantly improved a number of reported risk behaviours in men, with a lower proportion of men acting violently towards their intimate partners and less transactional sex and drinking problems. In women, desired behaviour changes were not reported.
Equity and HIV/AIDS
A self-administered survey was distributed to a convenience sample of church-goers in both urban and rural areas, which included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about anti-retrovirals (ARVs). Results indicated that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God or that people living with HIV/AIDS (PLWHA) have not followed the Word of God. Most participants said that they would disclose their HIV status to their pastor or congregation if they became infected. Although most respondents believed that prayer could cure HIV, almost all said that they would begin ARV treatment if they became HIV-infected. So, the decision to start treatment was hinged primarily on education level and knowledge about ARVs, rather than on religious beliefs.
HIV serostatus disclosure to community members has been shown to have potential public and personal health benefits. This study examined the impact of bonding and bridging social capital (i.e. close and distant ties) on public disclosure. Data was collected from a public sector ART programme in the Free State province in the form of semi-structured, face-to-face interviews with 268 patients. The study identified bonding social capital as a leverage to maximise potential benefits and minimise potential risks so as to shift the balance toward consistent public disclosure. Furthermore, the importance of bridging social capital initiatives is demonstrated, especially for the most vulnerable patients, namely those who cannot capitalise their bonding social capital by disclosing their HIV serostatus to family and friends at the start of treatment.
Fifteen percent of South African school children between the ages of 12 and 17 years would knowingly spread HIV, the South African Broadcasting Corporation has reported. This was revealed in a study of more than 15 000 school children by an international group of epidemiologists based in Canada. The organisation's Nobantu Marokane said that most of the learners who said they would spread the virus had been abused. 'These learners were not tested so they did not know if they were HIV positive. In most cases, these learners have been exposed to some kind of abuse.'
Complementary breastfeeding represents an important source of risk of HIV infection for infants born to HIV positive mothers. The World Health Organisation recommends that infants born to HIV positive mothers receive either replacement feeding or exclusive breastfeeding (EBF) followed by early weaning. Beyond the clinical and epidemiological debate, it remains unclear how acceptable and feasible the two options are for rural populations in sub-Saharan Africa. This qualitative study aims to fill this gap in knowledge by exploring both the socio-cultural construction and the practice of breastfeeding in the Nouna Health District, rural Burkina Faso. Information was collected through 32 individual interviews and 3 focus group discussions with women of all ages, and 6 interviews with local guérisseurs. The findings highlight that breastfeeding is perceived as central to motherhood, but that women practice complementary, rather than exclusive, breastfeeding. Women are reported to recognise both the nutritional value of breast milk and its potential to act as a source of disease transmission. Given the socio-cultural importance attributed to breastfeeding and the prevailing poverty, the authors suggest that it may be more acceptable and more feasible to promote EBF followed by early weaning than replacement feeding. A set of operational strategies are proposed to favour the prevention of mother to child transmission of HIV in the respect of the local socio-cultural setting.
The female condom is reported to have resurfaced in Uganda's prevention programme almost one and a half years after the government halted distribution of the prophylactic due to poor uptake by women. The Ministry of Health carried out a situation analysis to gauge the acceptability of the female condom by women across the country before it was reintroduced. It found that women wanted a method that would give them control in protecting themselves from sexually transmitted infections and unwanted pregnancy. However, women in western Uganda felt it went against their culture. The Ministry is reported to have plans to embark on a sensitisation campaign to ensure the prophylactic is accepted in all parts of the country and to distribute one hundred thousand female condoms to target groups that have showed interest in them, mainly in the eastern and central parts of the country.
This report compared prevalence rates in Blantyre and Lilongwe, Malawi’s two major cities. It found that the rates in Blantyre were higher than those in Lilongwe, but these differences could not easily be explained, even though other sources of data, namely 2004 DHS data and 2005 and 2006 screening data from ANC clinics, confirmed the findings. Although incidence studies among the general population have not been conducted, there is some evidence from available data that the difference is caused by a real difference in HIV incidence. In-migration may have diluted prevalence, but data is inadequate to assess this issue. Lack of male circumcision was ruled out as a contributing factor. Possible contributing factors include a younger age of sexual debut and a longer gap between first sex and first marriage, as well as sex with a non-cohabitating partner, which was more common in Blantyre. Marital stability was found to be protective for women.
Candidate microbicide PRO 2000 cuts HIV transmission by 30%, falling just short of the one-third required to be deemed a success. But scientists say this trial offers proof that the concept of a vaginal gel to block HIV is possible. The gel was tested on over 770 women in a huge three-year study involving over 3 000 women in southern Africa and the USA. Only 36 women using PRO 2000 became HIV positive in comparison with around 50 women in the other three groups, who were given either a gel called BufferGel, a water-based placebo gel or no gel at all. This translates into a success rate of 30% for PRO 2000 and a success rate of zero for the other microbicide candidate, BufferGel. Researchers are waiting for the results of another study involving PRO 2000, which will be released in December, and this may push up the success rate of PRO 2000.
Total HIV and AIDS expenditure in 2005 in Zimbabwe was around 20.9 trillion Zimbabwe dollars, an equivalent of US$209.4 million, which represents about US$150.50 per adult living with HIV, according to an assessment of HIV and AIDS spending. The largest contributors to this expenditure were donors at 49% of the total HIV and AIDS expenditures. This is similar to that found in studies undertaken in other countries prior to the surge of external targeted funds for HIV and AIDS, such as in Kenya, Malawi, Rwanda and Zambia. From this analysis, it can be concluded that most of the funds from Ministry of Health and Child Welfare, local NGOs, UN agencies and international NGOs were used for the provision of prevention and public health programmes for HIV and AIDS, whereas spending by people living with HIV went directly to health facilities for treatment and care of opportunistic infections. The Ministry of Health and Child Welfare and PLWHA through direct out-of-pocket payments were those principally responsible for paying for treatment and care of opportunistic infections. Donors, international NGOs and Local NGOs, on the other hand, were mainly responsible for the payment of provision and administration of prevention and public health programmes for HIV and AIDS and for Anteretroviral treatment in 2005.
The objective of this paper was to assess the awareness, attitude and perceptions on HIV AND AIDS vaccine trials among students at the University of Dar es Salaam, Tanzania. This was a descriptive cross-sectional study. A total of 384 students were recruited in the study. Out of these, 41.7% reported that HIV vaccine can not prevent the spread of HIV. One hundred-and-four (26.8%) were of the opinion that an HIV vaccine can cause infection to the person vaccinated. The perceptions and attitudes of University of Dar es Salaam students towards HIV vaccine trials were generally positive. However misconceptions were common. The community should be educated more on HIV vaccine trials, and more socio-behavioral studies need to be done among different social groups on HIV vaccine trials.