HIV and Islam: is HIV prevalence lower among Muslims?

A Giant Eyelid Molluscum Contagiosum Revealing an HIV Infection: A Case Report and Literature Review

Molluscum contagiosum (MC) is a common benign cutaneous viral infection. It can affect any part of the skin with a high propensity for facial skin, especially in human immunodeficiency virus (HIV) patients with low CD4 count. We report a case of a 16-year-old female patient who presented with a giant isolated right upper eyelid MC lesion that served as the first clinical indicator of her HIV infection and acquired immunodeficiency syndrome (AIDS). A final diagnosis of MC was made based on the history, clinical findings, and histopathological examination. Moreover, due to its vital location, large size, and atypical presentation, a surgical excision by simple unroofing and curettage was performed under local anesthesia to speed recovery, prevent corneal complications, and reduce transmission. Her follow-up visits showed satisfactory clinical and cosmetic outcomes. Patients presenting with giant atypical eyelid lesions must be thoroughly investigated for immunosuppressive states, especially HIV infection. MC can have atypical presentations in HIV patients. To our knowledge, this is one of a few cases in the literature reporting a giant isolated eyelid MC lesion leading to a diagnosis of HIV infection with AIDS.

Traditional male circumcision and the risk for HIV transmission among men: a systematic review

OBJECTIVES

To synthesise evidence to determine whether, in contrast to medical male circumcision, traditional male circumcision (TMC) practices may contribute to HIV transmission and what the impacts of TMC are on the initiates, their families and societies.

DESIGN

Systematic review.

DATA SOURCE

PubMed, CINHAL, SCOPUS, ProQuest, Cochrane database and Medline were searched between 15 and 30 October 2022.

ELIGIBILITY CRITERIA

(1) Studies involving young men, young male adults, male adults and mixed male and female participants; (2) studies on TMC involving men living with HIV (married and non-married); (3) studies on TMC, HIV transmission and impact in low-income and middle-income countries; (4) qualitative, quantitative and mixed-method studies and (5) studies aimed at exploring TMC and how it contributes to HIV transmission and the impacts of HIV on circumcised men and their families.

DATA EXTRACTION

Data were extracted based on study details, study design, characteristics of participants and results.

RESULT

A total of 18 studies were included: 11 were qualitative studies, five were quantitative studies and two were mixed-method studies. All the studies included were conducted in areas where TMC was performed (17 in Africa and one in Papua New Guinea). The review's findings were categorised into themes: TMC as a cultural practice, consequences of not being traditionally circumcised on men and their families and TMC-related risk of HIV transmission.

CONCLUSION

This systematic review highlights that TMC practice and HIV risk could negatively impact men and their families. Existing evidence suggests that little attention has been paid to men and their families experiencing the impacts of TMC and HIV risk factors. The findings recommend the need for health intervention programmes such as safe circumcision and safe sexual behaviours following TMC and efforts to address psychological and social challenges in communities practising TMC.

PROSPERO REGISTRATION NUMBER

CRD42022357788.

The role of religious leaders on the use of HIV/AIDS prevention strategies among young people (15-24) in Lira district, Uganda

BACKGROUND

Young people (15-24 years) bear the highest burden of new infections and are particularly vulnerable because of their highly risky behavior such as early sexual activity. There is paucity of information on the role of religious leaders in the multi-sectoral fight against HIV/AIDS. We examined the role of religious leaders in the use of HIV prevention strategies among young people.

METHODS

A cross sectional study was conducted between March and April 2021 among 422 randomly selected young people in Lira district, Uganda. An interviewer administered a questionnaire to the young people in order to collect quantitative data. A total 20 key informants were purposively sampled and interviews were conducted with religious leaders using a key informant's interview guide. Data was collected on social demographics, HIV prevention messages, and awareness about HIV prevention strategies. Data was analyzed using Stata version 15 using proportions, means, percentages, frequencies, and logistic regression analysis at a 95% level of significance. Qualitative data was analyzed using thematic content analysis and the major themes were generated from the participants' responses.

RESULTS

About 57.1% (241/422) of the respondents were females. The prevalence of use of HIV prevention strategies among young people was 69.4%. Factors significantly associated with the use of HIV prevention included completing the primary level (aOR 4.95, p< 0.05), completing at least A level (aOR 8.85, p < <0.05), Awareness of HIV prevention strategies advocated for by religious leaders (aOR 0.02, p<0.001), religious leaders provided targeted HIV prevention messages (aOR 2.53, p<0.01), Advocacy for abstinence outside marriage and fidelity in marriage (aOR 35.6, p<0.01), Religious leaders preaching about HIV prevention (aOR 4.88, p<0.001). Qualitative data indicated that a section of religious leaders recommended abstinence/faithfulness. Condom use was the most discouraged HIV prevention strategy. However, most religious leaders agree with the fact that they have a role to play in HIV prevention, which includes sensitization, teaching and organizing sermons about HIV prevention.

CONCLUSION

The use of HIV prevention strategies advocated for by religious leaders among young people was nearly 70%. This finding indicates that religious leaders have a role to play in HIV/AIDS prevention among young people in the Lira district. This calls for the involvement of religious leaders in HIV prevention programs tailored to prevent new infections of HIV among young people.

Sexual knowledge based on Islamic values and sexual risk behaviors of HIV/STIs among Thai Muslim army conscripts: A cross-sectional study

BACKGROUND

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), are commonly associated with conflict areas. In Thailand, conflict situations have occurred from 2004 until the present in three Muslim-majority southernmost provinces, including Yala, Pattani, and Narathiwat. However, Islam provides strict guidelines on sexuality. Therefore, those who strictly practice Islam will have lower sexual risk behavior.

OBJECTIVE

This study aimed to examine the relationship between Islamic values-based sexual knowledge, sociodemographic factors, and risk for HIV/STIs among Thai Muslim army conscripts in the unrest situation area.

METHODS

A cross-sectional study was conducted between May and July 2020. Data were collected using a validated questionnaire among 421 participants. Descriptive statistics and Chi-square were used to examine the association among variables.

RESULTS

57.5% of Muslim army conscripts had poor sexual knowledge based on Islamic aspects, and the participants showed high-risk profiles for HIV/STIs (32.5%). Marital status, hometown, smoking and drinking status, and Islamic values-based sexual knowledge were significantly associated with the risk of HIV/STIs (p <0.05).

CONCLUSION

Participants with poor sexual knowledge according to Islamic values, smokers, single-status, alcoholic drinkers, and non-three southernmost provinces' hometowns had higher risks of HIV/STIs. Thus, it is suggested that nurses and public health professionals implement sexual health promotion and prevention for HIV/STIs. In addition, misperceptions of Islamic aspects toward sexual behavior should receive immediate adjustments.

Risk of HIV/STIs among Muslim army conscripts in the three deep southern provinces of Thailand

Background: The prevalence of sexually transmitted diseases is an important public health problem, especially in people who are sexually active, such as the army conscript group. However, their knowledge, attitudes, and practices may be influenced by certain cultures and beliefs. This study explored the factors associated with the risk of human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) among the Muslim army conscript in three deep southern provinces of Thailand.

Methods: The cross-sectional study design was conducted among 360 Muslim army conscripts. A researcher made questionnaire on knowledge of HIV/STI transmission, attitude toward condom use, and sexual behavior was distributed to the participants in a camp base. The association between the potential predictor variables and the risk of HIV/STI was analyzed using the multiple logistic regression. Statistically significant of the association considered a P value ≤ 0.05.

Results: The results suggest that most Muslim army conscripts had a poor knowledge level of HIV/STI transmission (78.7%) and that their attitude toward condom use was at a moderate level (60.0%). The predicted factors were marital status [aOR=0.078, 95% CI=0.035-0.172], substance use before having sex [aOR=8.044, 95% CI=1.288-50.230], stimulant use before having sex [aOR=3.632, 95% CI=1.080-12.211], vaginal sexual intercourse [aOR=26.228, 95% CI=8.370-82.189], and oral sexual intercourse [aOR=2.256, 95% CI=1.106-4.601].

Conclusion: A proper sexual health education program should be developed and delivered to enhance knowledge on HIV/STI transmission among Muslim army conscripts.

Funeral Processes During the COVID-19 Pandemic: Perceptions Among Islamic Religious Leaders in Indonesia

Controversies surrounding the handling of corpses have been amplified during the present COVID-19 pandemic. According to Indonesian scholars, certain perspectives driving these controversies inhibit the implementation of health protocols issued by the government. This study comprehensively explores the diverse perceptions and responses of religious leaders regarding COVID-19 funeral management. Participants comprised six scholars from major Islamic religious organizations, two community leaders, and two families representing COVID-19 patients. Furthermore, content analysis was used to analyze the data. The results showed that the religious leaders, all men aged over 50 years, supported the health directives designed to reduce high transmission risk. However, there were substantial disparities in corpse preparation processes, potentially due to organizational beliefs around burial rites. Some religious leaders aligned their protocols with their religious beliefs. Conversely, families of the deceased insisted that the approved protocol for handling corpses went against their religious and cultural values. Therefore, promotion of protocols and coordination among the government, religious leaders, and the community are needed to decrease the misperceptions and misinformation surrounding the new COVID-19 funeral protocols.

HIV Testing Among Muslim Women in the United States: Results of a National Sample Study

Purpose: More than one million Americans are living with human immunodeficiency virus (HIV), and less than half of Americans have ever accepted an HIV test. There are no national HIV testing estimates for Muslim Americans, an underserved and often stigmatized population. Considering the lack of HIV testing estimates for this population, we conducted an exploratory study on HIV testing and potential associates in American Muslim women from across the United States. Methods: We applied logistic regression models to examine the Muslim Women's Health Project data, collected in 2015 (N=218). Results: Health care engagement and intimate partner violence were significantly associated with having been tested for HIV. Respondents using contraceptives received an influenza vaccination, and received an abnormal pap test had more than two times higher odds of having been tested for HIV (odds ratio [OR]=2.56, OR=2.43, OR=2.93, respectively; p<0.05 all). Having been sexually abused was associated with more than two times higher odds of having been tested for HIV (OR=2.49; p<0.05). Conclusion: Respondents reported higher rates of HIV testing as compared with the general public, signaling HIV knowledge, engagement in preventative health care, and possibly HIV risk. Scholars and practitioners should not assume that Muslim patients are at low risk for HIV and do not engage in HIV-risk behaviors. Thus, assumptions about Muslims women's willingness to accept HIV testing should be further examined to elucidate HIV risk among this population.

A 4D Indicator System of Count, P Rate, G Rate and PG Rate for Epidemiology and Global Health

How to end the HIV/AIDS epidemic is a typical global health question since the impact of HIV/AIDS is global and it cannot be ended without collaborative global effort. In this chapter, a new measurement system is introduced to inform HIV/AIDS control cross the globe. All countries with data available on area size, total population and total number of persons living with HIV (PLWH) were included, yielding a sample of 148 countries. Four indicators, including the total count, population-based p rate, geographic area-based g rate and population and geographic area-based pg rate were used as a 4D system to describe the global HIV epidemic. The total PLWH count provided data informing resource allocation for individual countries to improve HIV/AIDS care; and the top five countries with highest PLWH count were South Africa, Nigeria, India, Kenya, and Mozambique. Information from the remaining three indicators provided a global risk profile of the HIV epidemic, supporting HIV/AIDS prevention programming strategies. Five countries with highest p rates were Swaziland, Botswana, Lesotho, South Africa, and Zimbabwe; five countries with highest g rates were Swaziland, Malawi, Lesotho, Rwanda, and Uganda; and five countries with highest pg rates were Barbados, Swaziland, Lesotho, Malta, and Mauritius. According to pg rates, two HIV hotspots (south and middle Africa and Caribbean region) and one HIV belt across Euro-Asian were identified. In addition to HIV/AIDS, the 4D measurement system can be used to describe morbidity and mortality for many diseases across the globe. We recommend the use of this measurement system in research to address significant global health and epidemiologic issues.

HIV/AIDS-related beliefs among Israeli Arab-Palestinian women

Studies show that women are more vulnerable to human immunodeficiency virus (HIV) transmission than men because of biological and sociocultural risk factors. Israeli Arab-Palestinians are the largest ethnic minority group in Israel. Unofficial data suggest that merely one percent of the tests conducted in Israel to diagnose HIV/acquired immune deficiency syndrome (AIDS) are conducted by this population and that Israeli Arab-Palestinians are typically diagnosed late. Arab communities in Israel were found to be predominately patriarchal, characterised by conservative gender roles and structures, and the policing of overt sexual behaviours, particularly those of women. In order to advance our understanding of the HIV/AIDS phenomenon in different sociocultural contexts, as well as to design effective cultural-sensitive interventions, we must first understand how HIV/AIDS is constructed in different cultural sites. Against this backdrop, this exploratory study examines HIV/AIDS-related beliefs among non-infected, Israeli Arab-Palestinian women. We conducted semi-structured interviews with 12 women. Thematic content analysis was used in order to analyse the data. Five themes emerged from the analysis, in the first, personal responsibility and blame were assigned to people with HIV/AIDS for their illness. In the second theme, HIV/AIDS was constructed as a sexually transmitted disease, associated with 'deviant' sexuality and sexual conduct in the Arab culture. In the third theme, HIV/AIDS was believed to be transmitted by multiple, mostly mistaken, modes of contact. In the fourth theme, people with HIV/AIDS were believed to be subjected to severe negative social responses. In the fifth theme, individuals with HIV/AIDS were depicted as a symbol of physical and psychological malaise. In conclusion, the findings imply that Israeli Arab-Palestinian women hold negative beliefs concerning people with HIV/AIDS and are misinformed regarding HIV transmission. This suggests a need to design culturally appropriate interventions to address stigma-related beliefs and misconceptions concerning transmission, among Israeli Arab-Palestinian women.

The cultural context of sexual and reproductive health support: an exploration of sexual and reproductive health literacy among female Asylum Seekers and Refugees in Glasgow

Purpose

Sexual and reproductive health (SRH) incorporates prevention of unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The sourcing, understanding and application of related information are important for health and this defines sexual and reproductive health literacy (SRHL). Health care utilization rates among Asylum Seekers and Refugees (ASRs) may not be high and they are unlikely to seek sufficient SRH information and care in their host countries, leaving some needs unmet. No SRHL research related to Scotland’s Asylum Seeking and Refugee Women (ASRW) exists. In this qualitative study, the purpose of this paper is to explore the SRHL-related views and experiences of adult ASRW living in Glasgow and their views on assistance required to improve their SRHL.

Design/methodology/approach

In total, 14 semi-structured interviews were audio-recorded and transcribed and qualitative thematic analysis employed.

Findings

Five themes and 13 sub-themes with four key findings highlighted: experience of unmet SRHL needs, similarities and differences in the source of SRH information, SRH views and behaviours influenced by cultural and religious factors, barriers and facilitators to accessing SRH information/care and developing SRHL.

Research limitations/implications

This was a small scale qualitative study affording limited transferability. The work addressed a highly sensitive topic among women from conservative home country cultures.

Practical implications

Routine collection of sexual and reproductive health data by the NHS should be explored for this group. NHS staff should be aware of the rights of asylum seekers, Refugees and failed asylum seekers, to NHS healthcare free at the point of delivery in Scotland (National Health Service, 2019; Scottish Government, 2018), and be well trained in the likely religious and cultural norms of these groups. Host communities should consider improving access to SRH information and care in ASRWs first languages.

Social implications

The study identified weaknesses in the opportunities for social integration afforded this group and the coordination of existing social opportunities. The stigmatization of immigrants in the UK is well understood and has repercussions for many individuals and societal organizations implicated in the promotion of this.

Originality/value

This paper addresses a very sensitive topic with women from conservative cultures. With few publications in this area, and none pertaining to Scotland, the paper makes a small but original contribution that might be considered a starting point for researchers and relevant services in Scotland.

Understanding the risk factors for HIV acquisition among refugee women in South Africa

The prevalence of HIV in South Africa is among the highest in the world. This study provides an in-depth understanding of the risks for HIV transmission among refugee women residing in Durban, KwaZulu-Natal, South Africa. Qualitative interviews were conducted among refugee women originally from Sub-Saharan African countries. They reported sexual abuse by their intimate partners who were also having extramarital affairs with the local women. Condom use was low, with the women unable to negotiate use, due to fear of violence and religious beliefs, making them vulnerable to contracting HIV. Women were unable to leave their relationship due to financial constraints and dependence on their spouses. These dire circumstances also led to transactional sex. Uptake of HIV testing was high among the women. They were, however, uncertain of their partners' HIV status. We conclude that the higher risk for HIV transmission among refugee women is associated with increased engagement in sexual risk behavior. Behavioral change is required within this population and we recommend counselling in line with the religious and cultural beliefs of the population. The acceptability of condom use requires promotion. Increasing employment opportunities will empower women and decrease the social and structural determinants of sexual risk behavior.

Demographic factors associated with HIV infection between low and high prevalence areas in Nigeria, 2015

Introduction

Sub-Saharan Africa accounts for 66% of 36.7 million individuals living with HIV in 2015 with Nigeria having the second highest prevalence in Africa. The study aimed to find the prevalence and socio-demographic factors associated with HIV infection and compare these findings between high and low prevalence areas.

Methods

We conducted a cross-sectional study among adults aged 15 to 49 years from March to April 2015. We administered a questionnaire to collect linked anonymous data on socio-demographic and socio-cultural characteristics and screened all respondents for HIV infection. We defined a high HIV prevalence area as area with prevalence consistently above 5% and an area with prevalence consistently below 2% as low prevalence area. We performed univariate, bivariate and logistic regration analysis to assess factors associated with HIV infection.

Results

We screened and interviewed all 480 respondents. Majority 344 (71.7%) were females, mean age was 30.1 years (±7.4 years), high proportion were employed 246 (51.2%). In high HIV prevalence area, aged <30 years (Adjusted Odd Ratio (AOR) = 4.2, 95% Confidence Interval (CI) = 1.1-20.4) and being employed (AOR= 3.7, 95% CI=1.0-58.8) increased the likelihood of HIV infection. In low HIV prevalence area, lack of education (AOR=7.1, 95% CI= 0.9-32) was the only predictor of HIV infection.

Conclusion

Interplay of socio-demographic factors was responsible for differences in HIV prevalence. To further decrease prevalence in low prevalence areas (below 1%), government should make universal basic education mandatory and in high prevalence areas, interventions should target the young and the employed.

Crossing sexual barriers: Predictors of sexual guilt and sexual anxiety among young Canadian and American Muslim adults

The current study tested two exploratory path models predicting sexual guilt and sexual anxiety in young Muslims adults living in Canada and the United States. Using path analysis, I examined the joint influence of background (religiosity, perceived parental sexual attitudes, and gender) and attitudinal (sexual attitudes, gender role attitudes, and sexual double standard) factors on sexual guilt and sexual anxiety. Surveys were completed by 403 Canadian and American young heterosexual Muslim adults (ages 17–35). Most participants (79.4%) were women, approximately one-third of the participants were born outside Canada or the United States, and half identified as students. Most participants identified as either South Asian (43.1%) or Arab (25.1%) and the majority had either an undergraduate (32.3%) or graduate (37.2%) degree. In the final two path models, religiosity both directly and indirectly predicted sexual guilt and anxiety while sexual attitudes, belief in the sexual double standard, and gender role attitudes partially mediated this relationship. Gender role attitudes were strongly related to participants’ support for the sexual double standard, while gender was not a predictor of sexual guilt or anxiety. Perceived parental attitudes had no predictive value, possibly being redundant with religiosity. The path models revealed complex and interesting relationships between the variables which have various implications for young Muslim adults as well as the practitioners who work with them.

Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Background

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provided comprehensive estimates of health loss globally. Decision makers in Kenya can use GBD subnational data to target health interventions and address county-level variation in the burden of disease.

Methods

We used GBD 2016 estimates of life expectancy at birth, healthy life expectancy, all-cause and cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years, and risk factors to analyse health by age and sex at the national and county levels in Kenya from 1990 to 2016.

Findings

The national all-cause mortality rate decreased from 850·3 (95% uncertainty interval [UI] 829·8–871·1) deaths per 100 000 in 1990 to 579·0 (562·1–596·0) deaths per 100 000 in 2016. Under-5 mortality declined from 95·4 (95% UI 90·1–101·3) deaths per 1000 livebirths in 1990 to 43·4 (36·9–51·2) deaths per 1000 livebirths in 2016, and maternal mortality fell from 315·7 (242·9–399·4) deaths per 100 000 in 1990 to 257·6 (195·1–335·3) deaths per 100 000 in 2016, with steeper declines after 2006 and heterogeneously across counties. Life expectancy at birth increased by 5·4 (95% UI 3·7–7·2) years, with higher gains in females than males in all but ten counties. Unsafe water, sanitation, and handwashing, unsafe sex, and malnutrition were the leading national risk factors in 2016.

Interpretation

Health outcomes have improved in Kenya since 2006. The burden of communicable diseases decreased but continues to predominate the total disease burden in 2016, whereas the non-communicable disease burden increased. Health gains varied strikingly across counties, indicating targeted approaches for health policy are necessary.

Funding

Bill & Melinda Gates Foundation.

Spiritual interventions for preventing HIV/AIDS in Iran

Developing health programs based on the beliefs and values of communities has a great impact. Given the priority and importance of AIDS and its transmission through high-risk sexual behaviors, we sought to design a religious/spiritual intervention for preventing AIDS. Relevant statements were extracted from the literature and spiritual/religion documents, and the study questions were reviewed by a modified Delphi consensus panel. The statements were arranged in four areas of recipients, main components, providers, and settings for spiritual interventions. Using the existing capacities for Islamic spiritual interventions to prevent and control AIDS requires the development of executive factors along with underlying factors, such as infrastructure and facilities for the provision of interventions. The results of this study can lay the groundwork for supplementary studies.

A comprehensive analysis of trends and determinants of HIV/AIDS knowledge among the Bangladeshi women based on Bangladesh Demographic and Health Surveys, 2007-2014

Background

South-Asian countries are considered to be a potential breeding ground for HIV epidemic. Although the prevalence of this incurable disease is low in Bangladesh, women still have been identified as more vulnerable group. The aim of this study is to assess the knowledge about HIV/AIDS: its trends and associated factors among the women in Bangladesh.

Methods

We analysed the nationally representative repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) data: 2007, 2011, and 2014. These data were clustered in nature due to the sampling design and the generalized mixed effects model is appropriate to examine the association between the outcome and the explanatory variables by adjusting for the cluster effect.

Results

Overall, women’s knowledge about HIV/AIDS has been decreasing over the years. Education plays the leading role and secondary-higher educated women are 6.6 times more likely to have HIV/AIDS knowledge. The likelihood of knowledge is higher among the women who had media exposure (OR: 1.6) and knowledge on family planning (OR: 2.3). A rural-urban gap is noticed in women’s knowledge about HIV/AIDS and significant improvement has been observed among the rural and media exposed women. Results reveal that age, region, religion, socio-economic status, education, contraceptive use have significant (p<0.01) effects on women’s knowledge about HIV/AIDS.

Conclusion

This study recommends to emphasis more on women’s education, media exposure, and family planning knowledge in strengthening women’s knowledge about HIV/AIDS. In addition, residence specific programs regarding HIV/AIDS awareness also need to be prioritized.

The Islamification of antiretroviral therapy: Reconciling HIV treatment and religion in northern Nigeria

Access and adherence to antiretroviral therapy (ART) are essential to HIV treatment success and epidemic control. This article is about how HIV-positive Muslims and providers balance ART with religious tenets and obligations. I conducted 17 months of multi-site ethnographic research between 2007 and 2010, including participant-observation in an urban HIV clinic in Kano, Nigeria and a support group for people living with HIV, as well as in-depth interviews with 30 HIV-positive men and 30 key informants with caregiving, clinical, or policy roles related to HIV/AIDS. Patients migrated from Islamic prophetic medicine to ART when it became more widely available in the mid-2000s through the U.S. PEPFAR program. At the same time, a conceptual shift occurred away from considering HIV immediately curable through spiritual and herbal-based Islamic prophetic medicine toward considering HIV as a chronic infection that requires adherence to daily pill regimens. Hope for a complete cure and encouragement from some Islamic prophetic healers resulted in some patients forgoing ART. Patients and providers adapted biomedical treatment guidelines to minimize disruption to religious practices also considered essential to Muslims' wellbeing, irrespective of HIV status. Providers discouraged patients on second-line ART from fasting because such patients had fewer treatment options and, often, poorer health. However, patients' medication adherence was affected by the desire to fulfill fasting obligations and to avoid questions from family and friends unaware of their HIV-positive status. This study is one of few ethnographic accounts of HIV treatment in a Muslim-majority society and contributes to understanding the significance of religion for HIV treatment in northern Nigeria. It has implications for public health programming and clinical approaches to HIV treatment in medically pluralistic Muslim societies.

Islamic Influence on HIV Risk and Protection Among Central Asian Male Migrant Workers in Kazakhstan

HIV incidence is increasing in Central Asia, where migrant workers experience risks for acquiring sexually transmitted HIV. As a social and structural factor that may influence perceptions and behavior, we examine how Islam shapes HIV risk and protection. Phenomenological qualitative interviews examine religion and contexts of HIV risk among 48 male Central Asian migrant workers residing in Almaty, Kazakhstan. Men described nonvaginal sex, alcohol use, premarital sex, and extramarital sex as forbidden or frowned upon. Religious networks were unlikely to discuss HIV risks, and some men viewed religious affiliation or practices as protective. Marital practices including neke (religious marriage), polygyny, and bride kidnapping may be linked to risk. Findings suggest adhering to Islamic ideals may be protective for some men, but for others, assumptions of protection may enhance risk. HIV prevention strategies among Central Asian migrants may be strengthened by attention to religious and cultural understandings of risk and protection.

Ethnic groups' knowledge, attitude and practices and Rift Valley fever exposure in Isiolo County of Kenya

Rift Valley fever (RVF) is an emerging mosquito-borne viral hemorrhagic fever in Africa and the Arabian Peninsula, affecting humans and livestock. For spread of infectious diseases, including RVF, knowledge, attitude and practices play an important role, and the understanding of the influence of behavior is crucial to improve prevention and control efforts. The objective of the study was to assess RVF exposure, in a multiethnic region in Kenya known to experience RVF outbreaks, from the behavior perspective. We investigated how communities in Isiolo County, Kenya were affected, in relation to their knowledge, attitude and practices, by the RVF outbreak of 2006/2007. A cross-sectional study was conducted involving 698 households selected randomly from three different ethnic communities. Data were collected using a structured questionnaire regarding knowledge, attitudes and practices that could affect the spread of RVF. In addition, information was collected from the communities regarding the number of humans and livestock affected during the RVF outbreak. This study found that better knowledge about a specific disease does not always translate to better practices to avoid exposure to the disease. However, the high knowledge, attitude and practice score measured as a single index of the Maasai community may explain why they were less affected, compared to other investigated communities (Borana and Turkana), by RVF during the 2006/2007 outbreak. We conclude that RVF exposure in Isiolo County, Kenya during the outbreak was likely determined by the behavioral differences of different resident community groups. We then recommend that strategies to combat RVF should take into consideration behavioral differences among communities.

Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward

Although the HIV pandemic is witnessing a decline in the number of new infections in most regions of the world, the Middle East and North Africa (MENA) has a rapidly growing HIV problem. While generating HIV data has been consistently increasing since 2005, MENA’s contribution to the global HIV literature is just over 1% and the existing evidence often falls behind the academic standards. Several factors could be at play that contribute to the limited quantity and quality of HIV data in MENA. This editorial tries to explore and explain the barriers to collecting high-quality HIV data and generating precise estimates in MENA. These barriers include a number of logistic and socio-political challenges faced by researchers, public health officials, and policy-makers. Looking at successful regional HIV programs, we explore examples were policies have shifted and lessons could be learned in developing appropriate responses to HIV across the region.

Spirituality/Religiosity: A Cultural and Psychological Resource among Sub-Saharan African Migrant Women with HIV/AIDS in Belgium

Spirituality/religion serves important roles in coping, survival and maintaining overall wellbeing within African cultures and communities, especially when diagnosed with a chronic disease like HIV/AIDS that can have a profound effect on physical and mental health. However, spirituality/religion can be problematic to some patients and cause caregiving difficulties. The objective of this paper was to examine the role of spirituality/religion as a source of strength, resilience and wellbeing among sub-Saharan African (SSA) migrant women with HIV/AIDS. A qualitative study of SSA migrant women was conducted between April 2013 and December 2014. Participants were recruited through purposive sampling and snowball techniques from AIDS Reference Centres and AIDS workshops in Belgium, if they were 18 years and older, French or English speaking, and diagnosed HIV positive more than 3 months beforehand. We conducted semi-structured interviews with patients and did observations during consultations and support groups attendances. Thematic analysis was used to analyse the data. 44 women were interviewed, of whom 42 were Christians and 2 Muslims. None reported religious/spiritual alienation, though at some point in time many had felt the need to question their relationship with God by asking "why me?" A majority reported being more spiritual/religious since being diagnosed HIV positive. Participants believed that prayer, meditation, regular church services and religious activities were the main spiritual/religious resources for achieving connectedness with God. They strongly believed in the power of God in their HIV/AIDS treatment and wellbeing. Spiritual/religious resources including prayer, meditation, church services, religious activities and believing in the power of God helped them cope with HIV/AIDS. These findings highlight the importance of spirituality in physical and mental health and wellbeing among SSA women with HIV/AIDS that should be taken into consideration in providing a caring and healthy environment.

Hopefulness Fosters Affective and Cognitive Constructs for Actions to Cope and Enhance Quality of Life among People Living with HIV in Dar Es Salaam, Tanzania

The aims of this study were to describe how people living with HIV (PLWH) perceive hope and illustrate implications for HIV care and treatment. This is a qualitative study done to explore perceptions and meanings of hope among PLWH attending care and treatment clinics in Dar es Salaam, Tanzania. In all, 10 focus group discussions and 9 in-depth interviews were conducted. People living with HIV described the following 3 dimensions of hope: cognitive, positive emotions, and normalization. Being cognizant of the effectiveness of antiretroviral treatment (ART) often led to positive emotions, such as feeling comforted or strengthened, which in turn was related to positive actions toward normalizing life. Improved treatment outcomes facilitated hope, while persistent health problems, such as ART side effects, were sources of negative emotions contributing to loss of hope among PLWH. Hope motivated positive health-seeking behaviors, including adherence to ART, and this may guide interventions to help PLWH cope and live positively with HIV.

Trends and predictors of knowledge about HIV/AIDS and its prevention and transmission methods among women in Tajikistan

BACKGROUND

Prior research on HIV infections in Tajikistan and other Central Asian countries has focused primarily on injection drug users. Given the recent rise of heterosexual transmission, especially among women, there is a need to assess women's knowledge about HIV/AIDS and its methods of prevention and transmission across two time periods to examine cross-time changes and identify areas that need improvements.

METHODS

Logistic regression and simulation of predicted probability analyses were based on data from Tajik women ranging in age from 15 to 49 who participated in the Multiple Indicator Cluster Survey (MICS) study in 2000 and 2005.

RESULTS

We found that an over 2-fold increase in general knowledge about HIV/AIDS was accompanied by a substantial decrease in the ability to identify correct methods of prevention and to reject myths regarding its transmission.

CONCLUSION

These alarming findings should prompt policy makers and program implementers to shift the focus of programs from raising general awareness to educating women about how HIV/AIDS is transmitted. Furthermore, rigorous efforts should be made to provide the most disadvantaged groups, including women of younger ages, with lower education, and from poor households with accurate information and adequate access to limited resources.

Gender relations, sexual behaviour, and risk of contracting sexually transmitted infections among women in union in Uganda

BACKGROUND

Sexually transmitted infections (STIs) are a major reproductive and public health concern, especially in the era of HIV/AIDS. This study examined the relationship between sexual empowerment and STI status of women in union (married or cohabiting) in Uganda, controlling for sexual behaviour, partner factors, and women's background characteristics.

METHODS

The study, based on data from the 2011 Uganda Demographic and Health Survey (UDHS), analysed 1307 weighted cases of women age 15-49 in union and selected for the domestic violence module. Chi-squared tests and multivariate logistic regressions were used to examine the predicators of STI status. The main explanatory variables included sexual empowerment, involvement in decision making on own health, experience of any sexual violence, condom use during last sex with most recent partner, number of lifetime partners and partner control behaviours. Sexual empowerment was measured with three indicators: a woman's reported ability to refuse sex, ability to ask her partner to use a condom, and opinion regarding whether a woman is justified to refuse sex with her husband if he is unfaithful.

RESULTS

Results show that 28 % of women in union reported STIs in the last 12 months. Sexual violence and number of lifetime partners were the strongest predictors of reporting STIs. Women's sexual empowerment was a significant predictor of their STI status, but, surprisingly, the odds of reporting STIs were greater among women who were sexually empowered. Reporting of STIs was negatively associated with a woman's participation in decision-making with respect to her own health, and was positively associated with experience of sexual violence, partner's controlling behaviour, and having more than one life partner.

CONCLUSIONS

Our findings suggest that, with respect to STIs, sexual empowerment as measured in the study does not protect women who have sexually violent and controlling partners. Interventions promoting sexual health must effectively address negative masculine attitudes and roles that perpetuate unhealthy sexual behaviours and gender relations within marriage. It is also important to promote marital fidelity and better communication within union and to encourage women to take charge of their health jointly with their partners.

Control of corruption, democratic accountability, and effectiveness of HIV/AIDS official development assistance

Background

Despite continued global efforts, HIV/AIDS outcomes in developing countries have not made much progress. Poor governance in recipient countries is often seen as one of the reasons for ineffectiveness of aid efforts to achieve stated objectives and desired outcomes.

Objective

This study examines the impact of two important dimensions of governance – control of corruption and democratic accountability – on the effectiveness of HIV/AIDS official development assistance.

Design

An empirical analysis using dynamic panel Generalized Method of Moments estimation was conducted on 2001–2010 datasets.

Results

Control of corruption and democratic accountability revealed an independent effect and interaction with the amount of HIV/AIDS aid on incidence of HIV/AIDS, respectively, while none of the two governance variables had a significant effect on HIV/AIDS prevalence. Specifically, in countries with accountability level below −2.269, aid has a detrimental effect on incidence of HIV/AIDS.

Conclusion

The study findings suggest that aid programs need to be preceded or at least accompanied by serious efforts to improve governance in recipient countries and that democratic accountability ought to receive more critical attention.

Association between sexually transmitted disease and church membership. A retrospective cohort study of two Danish religious minorities

OBJECTIVES

Studies comprising Danish Seventh-day Adventists (SDAs) and Danish Baptists found that members have a lower risk of chronic diseases including cancer. Explanations have pointed to differences in lifestyle, but detailed aetiology has only been sparsely examined. Our objective was to investigate the incidence of sexually transmitted diseases (STDs) among Danish SDAs and Baptists as a proxy for cancers related to sexual behaviour.

METHODS

We followed the Danish Cohort of Religious Societies from 1977 to 2009, and linked it with national registers of all inpatient and outpatient care contacts using the National Patient Register. We compared the incidence of syphilis, gonorrhoea and chlamydia among members of the cohort with the general population.

RESULTS

The cohort comprised 3119 SDA females, 1856 SDA males, 2056 Baptist females and 1467 Baptist males. For the entire cohort, we expected a total of 32.4 events of STD, and observed only 9. Female SDAs and Baptists aged 20-39 years had significant lower incidence of chlamydia (both p<0.001). Male SDAs and Baptists aged 20-39 years also had significant lower incidence of chlamydia (p<0.01 and p<0.05, respectively). No SDA members were diagnosed with gonorrhoea, when 3.4 events were expected, which, according to Hanley's 'rule of three', is a significant difference. No SDA or Baptist was diagnosed with syphilis.

CONCLUSIONS

The cohort shows significant lower incidence of STD, most likely including human papillomavirus, which may partly explain the lower incidence of cancers of the cervix, rectum, anus, head and neck.

The when and how of male circumcision and the risk of HIV: a retrospective cross-sectional analysis of two HIV surveys from Guinea-Bissau

Introduction

Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV is crucial and can increase insight into the HIV epidemic in Africa.

Methods

We used data from two retrospective HIV surveys conducted in Guinea-Bissau from 1993 to 1996 (1996 cohort) and from 2004 to 2007 (2006 cohort). Multivariate logistical models were used to investigate the relationships between HIV risk and circumcision status, timing, method of circumcision, and socio-demographic factors.

Results

MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years) circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised. However, the difference between pre-pubertal (≤12 years) and post-pubertal (≥13 years) circumcision was not significant in the multivariate analysis. Seventy-six percent (678/888) of circumcised males in the 2006 cohort were circumcised traditionally, and 7.7% of those males were HIV-infected compared to 1.9% of males circumcised medically, with AOR of 2.7 (95% CI 0.91-8.12).

Conclusion

MC is highly prevalent in Guinea-Bissau, but ethnic variations in method and timing may affect its protection against HIV. Our findings suggest that sexual risk behaviour and traditional circumcision may increases HIV risk. The relationship between circumcision age, sexual behaviour and HIV status remains unclear and warrants further research.

Sexual Health Care, Sexual Behaviors and Functioning, and Female Genital Cutting: Perspectives From Somali Women Living in the United States

We investigated the sexual values, attitudes, and behaviors of 30 Somali female refugees living in a large metropolitan area of Minnesota by collecting exploratory sexual health information based on the components of the sexual health model-components posited to be essential aspects of healthy human sexuality. A Somali-born bilingual interviewer conducted the semistructured interviews in English or Somali; 22 participants chose to be interviewed in Somali. Interviews were translated, transcribed, and analyzed using descriptive statistics and thematic analyses. Our study findings highlighted a sexually conservative culture that values sexual intimacy, female and male sexual pleasure, and privacy in marriage; vaginal sexual intercourse as the only sanctioned sexual behavior; and the importance of Islamic religion in guiding sexual practices. Findings related to human immunodeficiency virus (HIV) revealed HIV testing at immigration, mixed attitudes toward condom use, and moderate knowledge about HIV transmission modes. Female genital cutting (FGC) was a pervasive factor affecting sexual functioning in Somali women, with attitudes about the controversial practice in transition. We recommend that health professionals take the initiative to discuss sexual health care and safer sex, sexual behaviors/functioning, and likely challenges to sexual health with Somali women--as they may be unlikely to broach these subjects without permission and considerable encouragement.

Chinese Immigrant Religious Institutions' Variability in Views on Preventing Sexual Transmission of HIV

OBJECTIVES

We examined Chinese immigrant religious institutions' views on teaching about preventing sexual transmission of HIV and the consistency of their views with public health best practices in HIV prevention.

METHODS

We used 2009 to 2011 survey data from 712 members of 20 New York City-based Chinese immigrant religious institutions to analyze their views on (1) teaching adolescents about condoms, (2) discussing homosexuality nonjudgmentally, and (3) promoting abstinence until marriage.

RESULTS

Religion type was a significant predictor of views in the 3 domains, with Evangelical Protestants in least agreement with public health best practices, Buddhists in most agreement, and mainline Protestants between them. Greater HIV knowledge was significantly associated with agreement with best practices in all 3 domains. The frequency of prayer, meditation, or chanting and the level of acculturation were significant predictors of views on teaching adolescents about condoms and promoting abstinence until marriage.

CONCLUSIONS

The best practice messages about HIV prevention that Chinese immigrant religious institutions find acceptable vary according to religion type and several other key factors, including HIV knowledge; frequency of prayer, meditation, or chanting; and level of acculturation.

Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.

Dilemmas and tensions facing a faith-based organisation promoting HIVprevention among young people in South Africa

Faith-based organisations (FBOs) are receiving growing attention for their roles in addressing HIV and AIDS in southern Africa. These roles, however, are not without philosophical challenges. Yet, to date, most references to the successes or limitations of FBOs have remained the domain of theoretical and, often, ideological debate. In this context, discussions about the roles of faith and FBOs in responding to HIV and AIDS often evoke extreme positions-either advocating for or critiquing their involvement. In place of this there is a need for empirical evidence and analyses that shed light on both the challenges and opportunities of faith-based HIV-prevention programming. This article presents a critical sociological analysis of the complexities confronting one FBO in its effort to deliver an abstinence-focused HIV-prevention programme to school-going adolescents in a poor peri-urban area of South Africa. As one aspect of a larger mixed-methods evaluation, this analysis is based on 11 focus group discussions, variously held with parents, teachers, learners and programme facilitators, in an effort to determine how and why the participants perceived the programme to work. We present and analyse four sources of tension appearing within the data which relate to the programme's faith-based orientation: a) enthusiasm for sexual abstinence despite awareness of the structural constraints; b) a dichotomous framing of behaviours (i.e. good versus bad); c) mixed messages about condoms; and d) administering faith-based programming within secular public schools. Through this analysis we aim to identify opportunities and challenges for faith-based HIV-prevention efforts more broadly. We argue that any assessment of faith-based HIV-prevention programming ought to respect and reflect its complexity as well as the complexity of the context within which it operates.

Risk factors for HIV infection among circumcised men in Uganda: a case-control study

INTRODUCTION

Male circumcision (MC) reduces the risk of HIV infection. However, the risk reduction effect of MC can be modified by type of circumcision (medical, traditional and religious) and sexual risk behaviours post-circumcision. Understanding the risk behaviours associated with HIV infection among circumcised men (regardless of form of circumcision) is critical to the design of comprehensive risk reduction interventions. This study assessed risk factors for HIV infection among men circumcised through various circumcision approaches.

METHODS

This was a case-control study which enrolled 155 cases (HIV-infected) and 155 controls (HIV-uninfected), all of whom were men aged 18-35 years presenting at the AIDS Information Center for HIV testing and care. The outcome variable was HIV sero-status. Using SPSS version 17, multivariable logistic regression was performed to identify factors independently associated with HIV infection.

RESULTS

Overall, 83.9% among cases and 56.8% among controls were traditionally circumcised; 7.7% of cases and 21.3% of controls were religiously circumcised while 8.4% of cases and 21.9% of controls were medically circumcised. A higher proportion of cases than controls reported resuming sexual intercourse before complete wound healing (36.9% vs. 14.1%; p<0.01). Risk factors for HIV infection prior to circumcision were:being in a polygamous marriage (AOR: 6.6, CI: 2.3-18.8) and belonging to the Bagisu ethnic group (AOR: 6.1, CI: 2.6-14.0). After circumcision, HIV infection was associated with: being circumcised at >18 years (AOR: 5.0, CI: 2.4-10.2); resuming sexual intercourse before wound healing (AOR: 3.4, CI: 1.6-7.3); inconsistent use of condoms (AOR: 2.7, CI: 1.5-5.1); and having sexual intercourse under the influence of peers (AOR: 2.9, CI: 1.5-5.5). Men who had religious circumcision were less likely to have HIV infection (AOR: 0.4, 95% CI: 0.2-0.9) than the traditionally circumcised but there was no statistically significant difference between those who were traditionally circumcised and those who were medically circumcised (AOR: 0.40, 95% CI: 0.1-1.1).

CONCLUSIONS

Being circumcised at adulthood, resumption of sexual intercourse before wound healing, inconsistent condom use and having sex under the influence of peers were significant risk factors for HIV infection. Risk reduction messages should address these risk factors, especially among traditionally circumcised men.

No association between gender inequality and peak HIV prevalence in developing countries - an ecological study

The prevalence of both gender inequality and HIV prevalence vary considerably both within all developing countries and within those in sub-Saharan Africa. We test the hypothesis that the extent of gender inequality is associated with national peak HIV prevalence. Linear regression was used to test the association between national peak HIV prevalence and three markers of gender equality - the gender-related development index (GDI), the gender empowerment measure (GEM), and the gender inequality index (GII). No evidence was found of a positive relationship between gender inequality and HIV prevalence, either in the analyses of all developing countries or those limited to Africa. In the bivariate analyses limited to Africa, there was a positive association between the two measures of gender "equality" and peak HIV prevalence (GDI: coefficient 28, 95% confidence interval (CI) 9.1-46.8; GEM: coefficient 54.8, 95% CI 20.5-89.1). There was also a negative association between the marker of gender "inequality" and peak HIV prevalence (GII: coefficient -66.9, 95% CI -112.8 to -21.0). These associations all disappeared on multivariate analyses. We could not find any evidence to support the hypothesis that variations in the extent of gender inequality explain variations in HIV prevalence in developing countries.

The influence of religion on sexual HIV risk

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

Gender inequality and HIV transmission: a global analysis

Introduction

The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15–24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young – often poor – women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women.

Methods

HIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII). Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU) as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI) per capita at purchasing power parity (PPP), and region as independent variables.

Results and discussion

There is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to the abatement of generalized epidemics.

Conclusions

Gender inequality is an important factor in the maintenance – and possibly in the establishment of – generalized HIV epidemics. We should view improvements in gender inequality as part of a broader public health strategy.

HIV-Care Outcome in Saudi Arabia; a Longitudinal Cohort

Background

Clinical characteristics of HIV-1 infection in people inhabiting Western, Sub-Saharan African, and South-East Asian countries are well recognized. However, very little information is available with regard to HIV-1 infection and treatment outcome in MENA countries including the Gulf Cooperation Council (GCC) states.

Methods

Clinical, demographic and epidemiologic characteristics of 602 HIV-1 infected patients followed in the adult Infectious Diseases Clinic of King Faisal Specialist Hospital and Research Centre, in Riyadh, Kingdom of Saudi Arabia a tertiary referral center were longitudinally collected from 1989 to 2010.

Results

Of the 602 HIV-1 infected patients in this observation period, 70% were male. The major mode of HIV-1 transmission was heterosexual contact (55%). At diagnosis, opportunistic infections were found in 49% of patients, most commonly being pneumocysitis. AIDS associated neoplasia was also noted in 6% of patients. A hundred and forty-seven patients (24%) died from the cohort by the end of the observation period. The mortality rate peaked in 1992 at 90 deaths per 1000 person-year, whereas the mortality rate gradually decreased to <1% from 1993-2010. In 2010, 71% of the patients were receiving highly active retroviral therapy.

Conclusions

These data describe the clinical characteristic of HIV-1-infected patients at a major tertiary referral hospital in KSA over a 20-year period. Initiation of antiretroviral therapy resulted in a significant reduction in both morbidity and mortality. Future studies are needed in the design and implementation of targeted treatment and prevention strategies for HIV-1 infection in KSA.

Correlates of condom use among males in North Sudan

Objectives In sub-Saharan Africa countries, HIV infections are transmitted primary through heterosexual contact. Correct and consistent condom use has been promoted as a method to prevent sexually transmissible infections, including HIV. The aim of this study was to assess and determine the factors influencing condom use in Khartoum, Sudan.

MATERIALS AND METHODS

Out of the 45 voluntary counselling and testing centres in Khartoum region, 10 centres were selected. A random sample of 804 respondents aged 20-40 years was selected. Stepwise multiple logistic regression analysis was used to investigate the predictors of condom use.

RESULTS

About 12% of respondents reported using condoms consistently, 41.5% used them sporadically and 46.3% were nonusers. Most of the participants had problems with condom use (81.9%) and friends were the main source of condoms (72%). Knowledge about AIDS transmission, knowing someone who is infected with or had died of AIDS, experiencing condom problems, type of sexual partners, purchase embarrassment and education were the main predictors of condom use.

CONCLUSIONS

Condom use among the Sudanese is low. Strategies to promote condom use should focus on price support for condoms by the government, expanded private sector condom distribution and the integration of sex education in school curriculums or via frequent discussion on television.

Factors affecting the HIV/AIDS epidemic: an ecological analysis of global data

BACKGROUND

All over the world the prevalence of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) has became a stumbling stone in progress of human civilization and is a huge concern for people worldwide.

OBJECTIVES

To determine the social and health factors which contribute to increase the size of HIV epidemic globally.

METHODS

The country level indicators of HIV prevalence rates, are contraceptive prevalence rate, physicians density, proportion of Muslim populations, adolescent fertility rate, and mean year of schooling were compiled of 187 countries from the United Nations (UN) agencies. To extract the major factors from those indicators of the later five categories, backward multiple regression analysis was used as the statistical tool.

RESULTS

The national HIV prevalence rate was significantly correlated with almost all the predictors. Backward multiple linear regression analysis identified the proportion of Muslims, physicians density, and adolescent fertility rate are as the three most prominent factors linked with the national HIV epidemic.

CONCLUSION

The findings support the hypotheses that a higher adolescent fertility rate in the population is the adverse effect of premarital and extramarital sex that leads to longer period of sexual activity which increases the risk of HIV infection. On the hand, and cultural restrictions of Muslims and sufficient physicians will decelerate the spread of HIV infections in the society.

Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis

BACKGROUND

Bacterial vaginosis (BV) and Trichomonas vaginalis (TV) have been estimated to affect one-quarter to one-third of sexually active women worldwide, and are often found concurrently. Few studies have examined this relationship longitudinally to better understand the direction and temporality of this association.

METHODS

Between 2005 and 2006, a cohort of 853 young, sexually active women was followed in Mysore, India; participants were interviewed and tested for BV and TV at baseline, and at 3- and 6-month visit. Generalized estimating equations were used to estimate how changes in vaginal flora between consecutive visits-as defined by Nugent diagnostic criteria for BV-were related to the risk of TV infection at the latter visit, adjusted for sociodemographic and behavioral covariates. Treatment was offered to women with TV and/or symptomatic BV.

RESULTS

After adjustment for covariates, participants with abnormal vaginal flora at 2 consecutive visits had 9 times higher risk of TV (95% CI: 4.1, 20.0) at the latter visit, relative to those with persistently normal flora. An increased risk of TV was also observed for participants whose flora status changed from normal to abnormal (adjusted risk ratio: 7.11, 95% CI: 2.8, 18.2) and from abnormal to normal (adjusted risk ratio: 4.50, 95% CI: 1.7, 11.8).

CONCLUSIONS

Women experiencing abnormal flora during a 3-month span appear to have significantly increased risk of acquiring TV infection. Women of reproductive age in low-resource settings found to have abnormal vaginal flora should be assessed for TV.

Understanding culture and HIV/AIDS in sub-Saharan Africa

Early in the study of HIV/AIDS, culture was invoked to explain differences in the disease patterns between sub-Saharan Africa and Western countries. Unfortunately, in an attempt to explain the statistics, many of the presumed risk factors were impugned in the absence of evidence. Many cultural practices were stripped of their meanings, societal context and historical positioning and transformed into cofactors of disease. Other supposedly beneficial cultural traits were used to explain the absence of disease in certain populations, implicitly blaming victims in other groups. Despite years of study, assumptions about culture as a cofactor in the spread of HIV/AIDS have persisted, despite a lack of empirical evidence. In recent years, more and more ideas about cultural causality have been called into question, and often disproved by studies. Thus, in light of new evidence, a review of purported cultural causes of disease, enhanced by an understanding of the differences between individual and population risks, is both warranted and long overdue. The preponderance of evidence suggests that culture as a singular determinant in the African epidemic of HIV/AIDS falls flat when disabused of its biased and ethnocentric assumptions.

Myths and misconceptions about HIV transmission in Ghana: what are the drivers?

Biomedical and social cognitive models driving HIV preventive activities in sub-Saharan Africa are mostly premised on factual and accurate knowledge of the disease. While knowledge about HIV exists in most parts of Africa, there is widespread belief in myths that often contradict and undermine preventive efforts. Using the 2008 Demographic and Health Survey and applying logit models, we examined what influences belief in myths and misconceptions surrounding HIV transmission among Ghanaian men and women. Results indicate that respondents with high knowledge of how HIV may be transmitted had lower odds of endorsing myths about the disease. Compared to the less educated and poorer Ghanaians, educated and wealthier Ghanaians were less likely to endorse myths about HIV. Also, compared to the Akan people, respondents identifying with other ethnic groups were significantly less likely to endorse myths. The findings suggest that policy makers provide accurate information about how the disease is spread to counter myths surrounding HIV transmission.

Polygyny, partnership concurrency, and HIV transmission in Sub-Saharan Africa

We study the relationship between polygyny and HIV infection using nationally representative survey data with linked serostatus information from 20 African countries. Our results indicate that junior wives in polygynous unions are more likely to be HIV positive than spouses of monogamous men, but also that HIV prevalence is lower in populations with more polygyny. With these results in mind, we investigate four explanations for the contrasting individual- and ecological-level associations. These relate to (1) the adverse selection of HIV-positive women into polygynous unions, (2) the sexual network structure characteristic of polygyny, (3) the relatively low coital frequency in conjugal dyads of polygynous marriages (coital dilution), and (4) the restricted access to sexual partners for younger men in populations where polygynous men presumably monopolize the women in their community (monopolizing polygynists). We find evidence for some of these mechanisms, and together they support the proposition that polygynous marriage systems impede the spread of HIV. We relate these results to the debate about partnership concurrency as a primary behavioral driver for the fast propagation of HIV in some parts of sub-Saharan Africa.

Trauma exposure, PTSD, and HIV sexual risk behaviors among labor migrants from Tajikistan

Little is known about the role of trauma and PTSD symptoms in the context of migration-associated HIV risk behaviors. A survey of Tajik married male seasonal labor migrants in Moscow was completed by 200 workers from 4 bazaars and 200 workers from 18 construction sites as part of a mixed method (quantitative and qualitative) study. The mean PC-PTSD score was 1.2 with one-quarter of migrants scoring at or above the cutoff of 3 indicating likely PTSD diagnosis. PC-PTSD score was directly correlated with both direct and indirect trauma exposure, but PC-PTSD score did not predict either HIV sexual risk behaviors or HIV protective behaviors. HIV sexual risk behavior was associated with higher indirect trauma exposure. PC-PTSD score was associated with some indicators of increased caution (e.g., more talking with partners about HIV and condoms; more use of condom when drinking). Qualitative findings were used to illustrate the differences between direct and indirect traumas in terms of HIV sexual risk. The study findings call for future efforts to address labor migrant's mental health needs and to integrate trauma dimensions into HIV prevention.

Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey

Background

Voluntary HIV counselling and testing (VCT) is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing.

Methods

The study utilized data from the Ethiopian Demographic Health Survey (EDHS) 2005, which is a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 6,778 men aged 15–59 years were selected from all the eleven administrative regions in Ethiopia. Logistic regression was used to analyze potential factors associated with VCT utilization.

Results

Overall, 21.9% of urban men and 2.6% of rural men had ever tested for HIV through VCT and most of them had learned their HIV test result. Having no stigmatizing attitudes toward people living with HIV/AIDS was found to be strongly and positively associated with VCT utilization in both urban and rural strata. In rural areas HIV test rates were higher among younger men (aged ≤44 years) and those of higher socio-economic position (SEP). Among urban men, risky sexual behaviour was positively associated with VCT utilization whereas being Muslim was found to be inversely associated with utilization of VCT. Area of residence as well as SEP strongly affected men’s level of stigmatizing attitudes toward people living with HIV/AIDS.

Conclusions

VCT utilization among men in Ethiopia was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma. Targeting rural men with low SEP should be given first priority when designing, expanding, and implementing VCT services in the country.