1
|
Norr KF, Banda CK, Chang C, Krishna S, Kumbani LC, Liu L, McCreary LL, Patil CL. Condom use increased after a peer group intervention implemented by community volunteers in Malawi. BMC Public Health 2024; 24:1483. [PMID: 38831266 PMCID: PMC11145788 DOI: 10.1186/s12889-024-18991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. METHODS Three communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11-13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. RESULTS This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. CONCLUSIONS In this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa. TRIAL REGISTRATION Clinical Trials.gov NCT02765659 Registered May 6, 2016.
Collapse
Affiliation(s)
- Kathleen F Norr
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA.
| | - Chimwemwe K Banda
- Malawi Liverpool Wellcome Clinical Research Program, P.O Box 30096, Chichiri, Blantyre 3, Malawi
| | - Cecilia Chang
- School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA
| | - Shruthi Krishna
- School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA
| | - Lily C Kumbani
- Kamuzu University of Health Sciences, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Li Liu
- School of Public Health, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA
| | - Crystal L Patil
- School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48109, USA
| |
Collapse
|
2
|
Norr KF, Banda CK, Chang C, Krishna S, Kumbani LC, Liu L, McCreary LL, Patil CL. Condom use increased after a peer group intervention implemented by community volunteers in Malawi. RESEARCH SQUARE 2023:rs.3.rs-3120974. [PMID: 37461672 PMCID: PMC10350185 DOI: 10.21203/rs.3.rs-3120974/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. Methods Three communities sequentially rolled out the program. Effectiveness was evaluated using repeated surveys. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 776) and condom use at last sex (N = 880). For each indicator, the sample included all sexually active persons answering that question at one or more time points. Regression analyses were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. Results This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final regression models. Other predictors of greater condom use for at least one condom use indicator included younger age group (13-19), male gender, not married/cohabiting, high involvement in religiously affiliated activities, higher safer sex self-efficacy, and greater partner communication. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. Conclusions This community engaged implementation study found that an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Leveraging community strengths and human capital resources facilitated implementation of this effective HIV prevention program in rural Malawi. Community ownership and program delivery by trained local volunteers offers an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening heathcare systems in sub. Trial registration Clinical Trials.gov NCT02765659 Registered May 6, 2016.
Collapse
Affiliation(s)
| | | | - Cecilia Chang
- School of Public Health, University of Illinois Chicago
| | | | | | - Li Liu
- School of Public Health, University of Illinois Chicago
| | | | | |
Collapse
|
3
|
Gebresilassie F, Ayele B, Hadgu T, Gebretnsae H, Negash D, Demoz Ghebremdhin K, Gebru KT, Wubayehu T, Ricceri F. Predictors of Condom Use Among Youth of the Rural Tigray, Northern Ethiopia: Community-Based Cross-Sectional Study. HIV AIDS (Auckl) 2023; 15:377-385. [PMID: 37377455 PMCID: PMC10292206 DOI: 10.2147/hiv.s412337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Background Condom is one of the most commonly used and cost-effective HIV preventive measures, particularly in low-income countries. Despite the proven effect of condoms for STI/HIV prevention, there are limited data on its utilization. Hence, this community-based study aimed to assess the level and determinant factors of condom utilization among the youth of the rural Tigray. Methods This study was part of a large community-based cross-sectional study conducted to assess the utilization of adolescent and youth-friendly health services among randomly selected 631 youth aged 15-24 years from May 23 to June 30, 2018. We used 273 youth who reported having a history of sexual activity during the study period. The data were collected using an interviewer-administered structured questionnaire. Logistic regression analysis was used to determine the independent predictors of the outcome variable and the level of significance was declared at a P-value of <0.05. Results A total of 273 participants were included in the study. The mean age (+SD) of the respondents was 19.14 (±2.74) years. Only one-third (35.2%) of the respondents used a condom during their last sexual encounter and 51 (53.1%) of them used it consistently. Being married (AOR = 0.17; 95% CI: 0.04, 0.60), respondent's partner attained primary education (AOR = 0.14; 95% CI: 0.04, 0.50), and having multiple sexual partners (AOR = 6.97; 95% CI: 2.09, 23.20) were found to be the determinants of condom utilization. Conclusion The study participants had a low level of condom utilization. Social and sexual related factors were the major predictors of condom use among the youth. Therefore, focused interventions need to be designed specifically to strengthen condom promotion campaigns.
Collapse
Affiliation(s)
| | - Brhane Ayele
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Tsegay Hadgu
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Degnesh Negash
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | | | | | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| |
Collapse
|
4
|
Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
Collapse
|
5
|
Ahinkorah BO, Budu E, Seidu AA, Hagan JE, Agbaglo E, Hormenu T, Schack T, Yaya S. Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys. PLoS One 2020; 15:e0236552. [PMID: 32776965 PMCID: PMC7416936 DOI: 10.1371/journal.pone.0236552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa. MATERIALS AND METHODS We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05. RESULTS Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men. CONCLUSION Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.
Collapse
Affiliation(s)
- Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Hormenu
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| |
Collapse
|
6
|
Conserve DF, Whembolua GLS, Surkan PJ. Attitudes Toward Intimate Partner Violence and Associations With Condom Use Among Men in Haiti: An Analysis of the Nationally Representative Demographic Health Survey. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:989-1006. [PMID: 25542524 PMCID: PMC5101235 DOI: 10.1177/0886260514564065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although men have substantial decision-making power regarding condom use, the majority of HIV knowledge and prevention studies in the general Haitian population have been conducted among youth and women. We investigated attitudes toward intimate partner violence, knowledge of, and use of condoms among 9493 men in Haiti using data from the 2012 nationally representative Demographic and Health Survey. Only 36% of HIV-negative and 44% of HIV-positive men reported using a condom the last time they had had sex. Logistic regression revealed that believing it was justified for a man to hit or beat his wife if she refuses to have sex with him was associated with a lower odds of condom use. The odds of using a condom during last sex was higher among men who reported knowing condoms can prevent HIV and who had been tested for HIV. Given the low rate of condom use among men in Haiti, these findings suggest that interventions promoting HIV knowledge, HIV testing, and gender-violence prevention among men may also increase condom use.
Collapse
|
7
|
Jimenez MM, Andrade FCD, Raffaelli M, Iwelunmor J. Heterosexual transmission of HIV in the Dominican Republic: gendered indicators are associated with disparities in condom use. BMC Public Health 2015; 15:1161. [PMID: 26597699 PMCID: PMC4657370 DOI: 10.1186/s12889-015-2432-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/20/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gendered dynamics in heterosexual relationships compromise women's self-efficacy and increase their vulnerability to acquiring HIV. This study examines the impact of socioeconomic determinants, media exposure, and sexual expectations on sexual behaviors of men and women in the Dominican Republic (DR). METHODS We analyzed cross-sectional data from 51,018 adults in the Dominican Republic age 15 to 45 years collected by the Demographics and Health Survey (DHS) in 2007. Measures included demographic and socioeconomic indicators, social exposures, sexual expectations and sexual behaviors. Logistic regression models explored gender differences in condom use. RESULTS Study findings indicated that women were less likely to use a condom at last intercourse than men (odds ratio [OR] = 0.29; 95 % CI = 0.27, 0.31). Among men, secondary (OR = 1.43; 95 % CI = 1.16, 1.76) and higher education (OR = 1.58; 95 % CI = 1.25, 2.00), being in the richest quintile (OR = 1.25; 95 % CI = 1.07, 1.47), and living in a female-headed household (OR = 1.13; 95 % CI 1.03, 1.23) increased the likelihood of condom use. Compared to never married men, currently and formerly married men were less likely to use condoms (OR = 0.03; 95 % CI = 0.03, 0.04 and OR = 0.67; 95 % CI = 0.60, 0.75, respectively). The odds of condom use increased for young women 15-19 years old in comparison with women age 30-34 years, but decreased as they grew older. For women, being in the richer quintile (OR = 1.28; 95 % CI = 1.06, 1.54), living in a female-headed household (OR = 1.26; 1.12, 1.41), and having good access to media (OR = 1.24; 95 % CI = 1.12, 1.42) increased the likelihood of condom use. Being currently married or formerly married and living in rural areas decreased such likelihood among women. CONCLUSIONS Study findings provide evidence that, in the DHS, socioeconomic and cultural differences between men and women affects condom use. Efforts to reduce HIV transmission within heterosexual relationships in the DR call for tailored, gender-specific interventions that take into account gender differences of power and sexual behaviors.
Collapse
Affiliation(s)
- Michelle M Jimenez
- Department of Medicine, Pontificia Universidad Catolica Madre y Maestra, Santiago, Dominican Republic.
| | - Flavia C D Andrade
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Illinois, USA.
| | - Marcela Raffaelli
- Department of Human and Community Development, University of Illinois at Urbana-Champaign, Illinois, USA.
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Illinois, USA.
| |
Collapse
|
8
|
Adedimeji AA, Hoover DR, Shi Q, Gard T, Mutimura E, Sinayobye JD, Cohen MH, Anastos K. Sexual Behavior and Risk Practices of HIV Positive and HIV Negative Rwandan Women. AIDS Behav 2015; 19:1366-78. [PMID: 25488169 PMCID: PMC4461563 DOI: 10.1007/s10461-014-0964-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75 % of participants were HIV positive and ~50 % reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents' age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors.
Collapse
Affiliation(s)
- Adebola A Adedimeji
- Centre for Public Health Sciences, Albert Einstein College of Medicine, Mazer 515, 1300 Morris Park Avenue, Bronx, NY, 10461, USA,
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Closson EF, Mimiaga MJ, Sherman SG, Tangmunkongvorakul A, Friedman RK, Limbada M, Moore AT, Srithanaviboonchai K, Alves CA, Roberts S, Oldenburg CE, Elharrar V, Mayer KH, Safren SA. Intimacy versus isolation: a qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia. PLoS One 2015; 10:e0120957. [PMID: 25793283 PMCID: PMC4368566 DOI: 10.1371/journal.pone.0120957] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 02/07/2015] [Indexed: 12/21/2022] Open
Abstract
The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010–2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.
Collapse
Affiliation(s)
- Elizabeth F. Closson
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Susan G. Sherman
- Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | | | - Ruth K. Friedman
- Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Mohammed Limbada
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ayana T. Moore
- FHI360, Durham, North Carolina, United States of America
| | - Kriengkrai Srithanaviboonchai
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Carla A. Alves
- Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Sarah Roberts
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Catherine E. Oldenburg
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Elharrar
- National Institute of Allergy and Infectious Disease, Bethesda, Maryland, United States of America
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard School of Public Health, Boston, Massachusetts, United States of America
- Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | | |
Collapse
|
10
|
Medley A, Baggaley R, Bachanas P, Cohen M, Shaffer N, Lo YR. Maximizing the impact of HIV prevention efforts: interventions for couples. AIDS Care 2013; 25:1569-80. [PMID: 23656251 PMCID: PMC4664148 DOI: 10.1080/09540121.2013.793269] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite efforts to increase access to HIV testing and counseling services, population coverage remains low. As a result, many people in sub-Saharan Africa do not know their own HIV status or the status of their sex partner(s). Recent evidence, however, indicates that as many as half of HIV-positive individuals in ongoing sexual relationships have an HIV-negative partner and that a significant proportion of new HIV infections in generalized epidemics occur within serodiscordant couples. Integrating couples HIV testing and counseling (CHTC) into routine clinic- and community-based services can significantly increase the number of couples where the status of both partners is known. Offering couples a set of evidence-based interventions once their HIV status has been determined can significantly reduce HIV incidence within couples and if implemented with sufficient scale and coverage, potentially reduce population-level HIV incidence as well. This article describes these interventions and their potential benefits.
Collapse
Affiliation(s)
- Amy Medley
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Baggaley
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Pamela Bachanas
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Myron Cohen
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | - Nathan Shaffer
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Ying-Ru Lo
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| |
Collapse
|