This study assessed the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people's sexual behaviour, HIV knowledge and attitudes. Fourteen schools were selected in two neighbouring districts, Bugesera (intervention group) and Rwamagana (control group), and 1,950 students participated. Researchers found that time trends in sexual risk behaviour (being sexually active, sex in last six months, condom use at last sex) were not significantly different in students from intervention and control schools, nor was the intervention associated with increased knowledge, perceived severity or perceived susceptibility. However, stigma was reported as significantly reduced. To explain the failure of the intervention, the authors argue that young people may prefer receiving HIV information from sources other than peers. In addition, outcome indicators were not adequate. They call for integration of peer-led prevention in holistic interventions, as well as redefining peer educators' role as focal points for sensitisation and referral to experts and services. Interventions with a narrow focus on sexual risks should be avoided.
Equity and HIV/AIDS
The main aim of this study was to identify predictors of HIV testing and condom use in Mozambique. Researchers analysed nationally representative survey data collected in 2009 for two outcomes: HIV testing and condom use. Results indicated that women at a higher risk of HIV were less likely to be tested for HIV than women at a lower risk. Large wealth differentials were observed: compared to the poorest women, HIV testing was higher among the wealthiest women. Perceived quality of health services was an important predictor of HIV testing, as HIV testing was higher among women who rated health services as being of very good quality. In terms of condom use, condom use was higher among men with girlfriends or those who had casual sex. Interestingly, being tested for HIV more than two years ago was not associated with condom use, and frequent mass media exposure was neither associated with HIV testing nor with condom use. The authors argue that the focus of HIV testing should shift from married women (routinely tested during antenatal care visits) to unmarried women and women with multiple sexual partners. Although services are free, transport costs to health facilities prove a major financial barrier to HIV testing. Mechanisms should be developed to cover the cost of transport, and the cost can also be reduced by substantially increasing community-based counselling. Men should be encouraged to test for HIV periodically.
In this study, researchers aimed to identify the infant-feeding challenges that Malawian women with HIV faced when they were advised to wean their children at an early age of six months, and explore how the women adhered to their infant-feeding options while facing and managing these challenges. The study was conducted between February 2008 and April 2009 at two public health facilities in Malawi where services to prevent mother-to-child transmission of HIV were implemented. Repeated in-depth interviews were conducted with 20 HIV-positive women. Several interdependent factors including the conflicting pressures of sexual morality and the demands of nurturing and motherhood in conditions of abject poverty, impeded the participating women from following medical advice on infant feeding. If they adhered to the medical advice, the women would encounter difficulty maintaining their ascribed roles as respected wives, mothers and members of the society at large. Given that the infant-feeding dilemmas for women with HIV are complex, the integration of public health efforts with context-specific socio-cultural understanding is essential, the authors argue, pointing to the recent 2010 WHO guidelines on breastfeeding, which recommend breastfeeding for two years for HIV-positive Malawian mothers.
The objective of this study was to assess the extent to which children may be falsely diagnosed as HIV-infected, using data from an antiretroviral therapy (ART) site in Pretoria, South Africa, between April 2004 and March 2010. Researchers analysed 1,526 patient files, with a male-to-female ratio of 1.01:1 and median age at first visit of 20 months. Nearly half (47%) of the children were aged less than 18 months. Fifty-one children (3.3%) were found to be HIV-uninfected after repeated diagnostic tests. Incorrect laboratory results for children aged less than 18 months included 40 false-positive HIV DNA PCR tests (6.3%) and one false-positive HIV p24Ag test. An additional four children were inappropriately referred after being incorrectly labelled as HIV-infected and one child aged younger than 18 months was referred after an inappropriate diagnostic test for age was used. The authors acknowledge that urgency in ART initiation in HIV-infected children is life-saving, especially in infants, but HIV tests may produce false-positive results so health care workers should meticulously check a child’s HIV-positive status before committing them to lifelong ART.
The authors of this study argue that the promotion of harm reduction as part of a more united and comprehensive global effort will be essential to halving HIV infections among people who inject drugs by 2015. They call for legal reform aligned with HIV prevention and treatment, complemented by the meaningful involvement of people who use drugs in policy formulation, arguing that drugs users who inject are often the most marginalised in the global HIV response. However, establishing the prevalence of drug use among men who have sex with men (MSM) in different parts of the world remains a challenge, as homosexuality is criminalised and stigmatised in many countries. Recommendations to government include ensuring sufficient programme funding and staff training to generate new interventions aimed at injecting drug users and MSM, as well as disseminating information to users regarding the risks of drug abuse. The authors also call for decriminalisation of users, provided that drug rehabilitation interventions are adequately devised and implemented.
The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence area in rural Kenya, in which researchers examined the role of women's perceptions of HIV-related stigma during pregnancy in their subsequent utilisation of maternity services. From 2007–2009, 1,777 pregnant women with unknown HIV status completed an interviewer-administered questionnaire assessing their perceptions of HIV-related stigma before being offered HIV testing during their first antenatal care visit. After the visit, a sub-sample of women was selected for follow-up of whom 411 (69%) were located and completed another questionnaire postpartum. Additional qualitative in-depth interviews were conducted with community health workers, childbearing women and family members. Qualitative data revealed that health facility birth is commonly viewed as most appropriate for women with pregnancy complications, such as HIV. Thus, women delivering at health facilities face the risk of being labeled as HIV-positive in the community. Quantitative data revealed that women with higher perceptions of HIV-related stigma (specifically those who held negative attitudes about persons living with HIV) at baseline were subsequently less likely to deliver in a health facility with a skilled attendant, even after adjusting for other known predictors of health facility delivery. These findings point to the urgent need for interventions to reduce HIV-related stigma, not only for improving quality of life among persons living with HIV, but also for better health outcomes among all childbearing women and their families.
Women comprise nearly half of the HIV-infected population worldwide, but these 15.5 million women tend to be under-represented in clinical trials of anti-HIV drug therapies, according to this study. The authors used the US Food and Drug Administration (FDA) database created from 40 clinical studies to assess gender differences in the efficacy of antiretroviral treatments. They found that women represented only about 20% of the subjects in randomised clinical trials submitted to the FDA between 2000 and 2008. When they compared the effectiveness of anti-HIV drug regimens reported for women versus men overall and among various subgroups, they found no statistically or clinical significant differences between women and men in outcomes with regard to viral load after 48 weeks. However, they did report significant gender differences favouring males based on subgroup analyses. They argue that this is a critical area of research in terms of developing new HIV therapies, as mounting evidence indicates that metabolism of certain drugs varies in men vs. women, and side effects that interfere with adherence to these medications may also be manifested differently.
Stigma is increasingly regarded as a key driver of the HIV and AIDS epidemic and has a major impact on public health interventions. The objective of this ‘creativity initiative’ was to provide activities in an HIV clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic-based stigma felt by clients. The study took the form of a cross-sectional survey carried out in October-November 2005 and March-April 2007 at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. Comparisons were made between patients who took part in activities and those who did not. Results suggest that clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the creativity intervention, HIV-related stigma was reduced in this clinic setting.
In this paper, the author investigates uptake of prevention of mother-to-child transmission of HIV (PMTCT) services, infant feeding recommendations and specific drug regimens necessary to achieve the virtual elimination of paediatric HIV in Zimbabwe. She used a computer model to simulate a cohort of HIV-infected pregnant or breastfeeding women, and evaluated three PMTCT regiments: single-dose nevirapine; ‘Option A’ from the 2010 World Health Organisation guidelines (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral (ARV) therapy for women with advanced disease); and WHO ‘Option B’ (limited combination ARV drug regimens without advanced disease during pregnancy and breastfeeding; lifelong ARV therapy with advanced disease). Results indicated that the latest WHO PMTCT guidelines (Options A and B) plus better access to PMTCT programmes, better retention of women in care, and better adherence to drugs are needed to eliminate paediatric HIV in Zimbabwe.
Punitive laws and human rights abuses are costing lives, wasting money and stifling the global AIDS response, according to a report by the Global Commission on HIV and the Law, an independent body of global leaders and experts. The Commission report, "HIV and the Law: Risks, Rights and Health," finds evidence that governments in every region of the world have wasted the potential of legal systems in the fight against HIV. The report also concludes that laws based on evidence and human rights strengthen the global AIDS response - these laws exist and must be brought to scale urgently."Bad laws should not be allowed to stand in the way of effective HIV responses," said Helen Clark, United Nations Development Programme Administrator. "In the 2011 Political Declaration on HIV and AIDS, Member States committed to reviewing laws and policies which impede effective HIV responses."