1
|
Magadi M, Gazimbi M, Wafula C, Kaseje M. Understanding ethnic variations in HIV prevalence in Kenya: the role of cultural practices. CULTURE, HEALTH & SEXUALITY 2021; 23:822-839. [PMID: 32364024 DOI: 10.1080/13691058.2020.1734661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
Patterns of HIV prevalence in Kenya suggest that areas where various cultural practices are prevalent bear a disproportionate burden of HIV. This paper examines (i) the contextual effects of cultural practices (polygyny, male circumcision) and related sexual behaviour factors on HIV prevalence and (ii) the extent to which specific cultural practices in a community/county might explain existing ethnic variations in HIV prevalence in Kenya. The analysis applies multilevel logistic regression to data from the 2012/13 Kenya AIDS Indicator Survey. The results reveal striking ethnic variations in HIV prevalence in Kenya. The prevalence of polygyny in a community is positively associated with HIV prevalence, while a higher level of male circumcision in a county is protective for both men and women. The effects of these factors are stronger for men than women at both individual and contextual (community/county) levels. These cultural practices and associated risk factors partly explain existing ethnic differences in HIV prevalence in Kenya, but there remain significant ethnic variations that are not explained by these cultural practices or related sexual behaviour factors. These call for stronger empirical evidence to offer stronger theoretical explanations and inform effective policy and practice to address HIV epidemic in adversely affected communities in Kenya and similar settings in sub-Saharan Africa.
Collapse
Affiliation(s)
- Monica Magadi
- School of Education and Social Sciences, University of Hull, Hull, UK
| | - Martin Gazimbi
- School of Education and Social Sciences, University of Hull, Hull, UK
| | - Charles Wafula
- Research Department, Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
| | - Margaret Kaseje
- Research Department, Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
| |
Collapse
|
2
|
Gregson S, Nyamukapa C. Did sexual behaviour differences between HIV infection and treatment groups offset the preventative biological effects of ART roll-out in Zimbabwe? Population Studies 2021; 75:457-476. [PMID: 33559537 DOI: 10.1080/00324728.2021.1874043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Declines in HIV incidence have been slower than expected during the roll-out of antiretroviral treatment (ART) services in sub-Saharan African populations suffering generalized epidemics. Using data from a population-based, open cohort HIV sero-survey (2004-13), we found evidence for initial reductions in sexual activity and multiple sexual partnerships, followed by increases during the period of ART scale-up in areas of high HIV prevalence in Manicaland, east Zimbabwe. Recent population-level increases in condom use were also recorded, but largely reflected high use by the rapidly growing proportion of HIV-infected individuals on treatment. Sexual risk behaviour increased in susceptible uninfected individuals and in untreated (and therefore more infectious) HIV-infected men, which may have slowed the decline in HIV incidence in this area. Intensified primary HIV prevention programmes, together with strengthened risk screening, referral, and support services following HIV testing, could help to maximize the impact of 'test-and-treat' programmes in reducing new infections.
Collapse
Affiliation(s)
- Simon Gregson
- Imperial College London.,Biomedical Research and Training Institute
| | | |
Collapse
|
3
|
Merzouki A, Estill J, Orel E, Tal K, Keiser O. Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence. PeerJ 2021; 9:e10660. [PMID: 33520455 PMCID: PMC7812934 DOI: 10.7717/peerj.10660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction HIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries. Methods We analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries (2010–2017), which included 594,644 persons (183,310 men and 411,334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster. Results The most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median (IQR); 0.5/1000 (0.6/1000), 1.8/1000 (1.3/1000) and 5.0/1000 (4.2/1000)). Conclusions Our findings suggest that the combination of sociobehavioural factors play a key role in determining the course of the HIV epidemic, and that similar techniques can help to predict the effects of behavioural change on the HIV epidemic and to design targeted interventions to impede HIV transmission in SSA.
Collapse
Affiliation(s)
- Aziza Merzouki
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Erol Orel
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Thior I, Rowley E, Mavhu W, Kruse-Levy N, Messner L, Falconer-Stout ZJ, Mugurungi O, Ncube G, Leclerc-Madlala S. Urban-rural disparity in sociodemographic characteristics and sexual behaviors of HIV-positive adolescent girls and young women and their perspectives on their male sexual partners: A cross-sectional study in Zimbabwe. PLoS One 2020; 15:e0230823. [PMID: 32324764 PMCID: PMC7179911 DOI: 10.1371/journal.pone.0230823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/09/2020] [Indexed: 11/19/2022] Open
Abstract
We conducted a cross sectional survey in Zimbabwe to describe urban-rural disparity in socio-demographic characteristics and sexual behaviors of HIV-positive adolescent girls and young women (AGYW) and their male sexual partners. Between September and November 2016, we interviewed 360 sexually active HIV positive AGYW, aged 15––24 years attending ART and PMTCT clinics in urban and rural health facilities in Harare and Mazowe district respectively. HIV positive AGYW in rural areas as compared to those in urban areas were older, less educated, more frequently married or cohabiting, had lower number of male sexual partners in their lifetime and in the last 12 months preceding the survey. They were mostly heterosexually infected, more likely to disclose their status to a family member and to be more adherent to ART (OR = 2.5–95% CI = 1.1–5.5). Most recent male sexual partners of HIV positive AGYW in urban areas as compared to those from rural areas were mainly current or former boyfriends, single, more educated, less likely to have a child with them and to engage in couple voluntary counseling and testing (CVCT). They were more likely to patronize dancing and drinking venues and involved in transactional sex (OR = 2.2–95% CI: 1.2–4). They were also more likely to be circumcised (OR = 2.3–95% CI: 1.3–4.1) and to use condom more consistently in the last 12 months preceding the survey. Our study findings called for the strengthening of HIV prevention interventions in urban areas among HIV positive AGYW who had more than one partner in their lifetime or are patronizing dancing and drinking venues. In Zimbabwe, promotion of CVCT, index testing, male circumcision and condom use should be sustained to engage male sexual partners of both urban and rural HIV positive AGYW in HIV prevention.
Collapse
Affiliation(s)
- Ibou Thior
- PATH, Washington, D.C, United States of America
- * E-mail:
| | | | - Webster Mavhu
- Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe
| | | | - Lyn Messner
- EnCompass LLC, Rockville, Maryland, United States of America
| | | | - Owen Mugurungi
- AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Getrude Ncube
- AIDS and TB, Ministry of Health and Child Care, Harare, Zimbabwe
| | | |
Collapse
|
5
|
Abstract
BACKGROUND HIV took off rapidly in Zimbabwe during the 1980s. Yet, between 1998 and 2003, as the economy faltered, HIV prevalence declined abruptly and without clear explanation. METHODS We reviewed epidemiological, behavioural, and economic data over three decades to understand changes in economic conditions, migrant labour and sex work that may account for observed fluctuations in Zimbabwe's HIV epidemic. Potential biases related to changing epidemic paradigms and data sources were examined. RESULTS Early studies describe rural poverty, male migrant labour and sex work as conditions facilitating HIV/sexually transmitted infection (STI) transmission. By the mid-1990s, as Zimbabwe's epidemic became more generalized, research focus shifted to general population household surveys. Yet, less than half as many men than women were found at home during surveys in the 1990s, increasing to 80% during the years of economic decline. Other studies suggest that male demand for sex work fell abruptly as migrant workers were laid off, picking up again when the economy rebounded after 2009. Numbers of clients reported by sex workers, and their STI rates, followed similar patterns reaching a nadir in the early 2000s. Studies from 2009 describe a return to more active sex work, linked to increasing client demand, as well as a revitalized programme reaching sex workers. CONCLUSION The importance of the downturn in migrant labour and resultant changes in sex work may be underestimated as drivers of Zimbabwe's rapid HIV incidence and prevalence declines. Household surveys underrepresent populations at the highest risk of HIV/STI acquisition and transmission, and these biases vary with changing economic conditions.
Collapse
|
6
|
Kenyon CR, Delva W. It's the network, stupid: a population's sexual network connectivity determines its STI prevalence. F1000Res 2018; 7:1880. [PMID: 30815252 PMCID: PMC6376253 DOI: 10.12688/f1000research.17148.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 10/06/2023] Open
Abstract
There is little consensus as to why sexually transmitted infections (STIs), including HIV and bacterial vaginosis (BV) are more prevalent in some populations than others. Using a broad definition of sexual network connectivity that includes both structural and conductivity-related factors, we argue that the available evidence suggests that high prevalence of traditional STIs, HIV and BV can be parsimoniously explained by these populations having more connected sexual networks. Positive feedback, whereby BV and various STIs enhance the spread of other STIs, then further accentuates the spread of BV, HIV and other STIs. We review evidence that support this hypothesis and end by suggesting study designs that could further evaluate the hypothesis, as well as implications of this hypothesis for the prevention and management of STIs.
Collapse
Affiliation(s)
- Chris R. Kenyon
- Institute of Tropical Medicine, Antwerp, Antwerp, 2000, Belgium
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Wim Delva
- Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa
| |
Collapse
|
7
|
Kenyon CR, Delva W. It's the network, stupid: a population's sexual network connectivity determines its STI prevalence. F1000Res 2018; 7:1880. [PMID: 30815252 PMCID: PMC6376253 DOI: 10.12688/f1000research.17148.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 11/20/2022] Open
Abstract
There is little consensus as to why sexually transmitted infections (STIs), including HIV and bacterial vaginosis (BV) are more prevalent in some populations than others. Using a broad definition of sexual network connectivity that includes both structural and conductivity-related factors, we argue that the available evidence suggests that high prevalence of traditional STIs, HIV and BV can be parsimoniously explained by these populations having more connected sexual networks. Positive feedback, whereby BV and various STIs enhance the spread of other STIs, then further accentuates the spread of BV, HIV and other STIs. We review evidence that support this hypothesis and end by suggesting study designs that could further evaluate the hypothesis, as well as implications of this hypothesis for the prevention and management of STIs.
Collapse
Affiliation(s)
- Chris R. Kenyon
- Institute of Tropical Medicine, Antwerp, Antwerp, 2000, Belgium
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Wim Delva
- Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa
| |
Collapse
|
8
|
Qasim A, Turcotte M, de Souza RJ, Samaan MC, Champredon D, Dushoff J, Speakman JR, Meyre D. On the origin of obesity: identifying the biological, environmental and cultural drivers of genetic risk among human populations. Obes Rev 2018; 19:121-149. [PMID: 29144594 DOI: 10.1111/obr.12625] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022]
Abstract
Genetic predisposition to obesity presents a paradox: how do genetic variants with a detrimental impact on human health persist through evolutionary time? Numerous hypotheses, such as the thrifty genotype hypothesis, attempt to explain this phenomenon yet fail to provide a justification for the modern obesity epidemic. In this critical review, we appraise existing theories explaining the evolutionary origins of obesity and explore novel biological and sociocultural agents of evolutionary change to help explain the modern-day distribution of obesity-predisposing variants. Genetic drift, acting as a form of 'blind justice,' may randomly affect allele frequencies across generations while gene pleiotropy and adaptations to diverse environments may explain the rise and subsequent selection of obesity risk alleles. As an adaptive response, epigenetic regulation of gene expression may impact the manifestation of genetic predisposition to obesity. Finally, exposure to malnutrition and disease epidemics in the wake of oppressive social systems, culturally mediated notions of attractiveness and desirability, and diverse mating systems may play a role in shaping the human genome. As an important first step towards the identification of important drivers of obesity gene evolution, this review may inform empirical research focused on testing evolutionary theories by way of population genetics and mathematical modelling.
Collapse
Affiliation(s)
- A Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - M Turcotte
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - R J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - M C Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, ON, Canada
| | - D Champredon
- Department of Biology, McMaster University, Hamilton, ON, Canada.,Agent-Based Modelling Laboratory, York University, Toronto, ON, Canada
| | - J Dushoff
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - J R Speakman
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK.,State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - D Meyre
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
9
|
Gregson S, Mugurungi O, Eaton J, Takaruza A, Rhead R, Maswera R, Mutsvangwa J, Mayini J, Skovdal M, Schaefer R, Hallett T, Sherr L, Munyati S, Mason P, Campbell C, Garnett GP, Nyamukapa CA. Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort. BMJ Open 2017; 7:e015898. [PMID: 28988165 PMCID: PMC5639985 DOI: 10.1136/bmjopen-2017-015898] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART). PARTICIPANTS General population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15-44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years). FINDINGS TO DATE HIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART. FUTURE PLANS We plan to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome.
Collapse
Affiliation(s)
- Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Jeffrey Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rebecca Rhead
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | | | - Justin Mayini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Robin Schaefer
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Timothy Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Geoffrey P Garnett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Constance Anesu Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|
10
|
Shaw SA, McCrimmon T, Mergenova G, Sultangaliyeva A, El-Bassel N. Islamic Influence on HIV Risk and Protection Among Central Asian Male Migrant Workers in Kazakhstan. QUALITATIVE HEALTH RESEARCH 2017; 27:1553-1561. [PMID: 28728529 DOI: 10.1177/1049732317697101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Stacey A Shaw
- 1 Brigham Young University School of Social Work, Provo, Utah, USA
| | - Tara McCrimmon
- 2 Columbia University School of Social Work, New York, New York, USA
| | | | | | - Nabila El-Bassel
- 2 Columbia University School of Social Work, New York, New York, USA
| |
Collapse
|
11
|
Yerges AL, Stevens PE, Mkandawire-Valhmu L, Bauer W, Ng'ombe Mwenyekonde T, Weinhardt LS, Galvao LW. Women's narratives of living in polygamous marriages: Rural Malawian experience distilled and preserved in poetic constructions. Health Care Women Int 2017; 38:873-891. [PMID: 28481143 DOI: 10.1080/07399332.2017.1326494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Polygamy in sub-Saharan Africa has been linked to poverty, infant mortality, and HIV; however, it is unknown how interpersonal dynamics within polygamous households may influence population health outcomes. Findings from this postcolonial feminist study derive from interview data in a larger mixed-methods study in rural Malawi. We used thematic narrative analysis to probe 25 women's stories and applied an arts-based research technique, poetic construction, to present the results. Participants' evocative expressions, distilled and preserved in poetic form, illustrate themes of perseverance, grief, agency, and reflection. We discuss how gender relations, childrearing, tradition, economics, and health intersect in polygamous households.
Collapse
Affiliation(s)
- April L Yerges
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | - Patricia E Stevens
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | | | - Wendy Bauer
- a College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | | | - Lance S Weinhardt
- c Zilber School of Public Health , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| | - Loren W Galvao
- d Center for Global Health Equity, College of Nursing , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin , USA
| |
Collapse
|
12
|
Ngilangwa DP, Ochako R, Mboya BA, Noronha RH, Mgomella GS. Prevalence and predictors of HIV sero-discordance among cohabiting couples tested in northern Tanzania. Pan Afr Med J 2015; 22:275. [PMID: 26958138 PMCID: PMC4765341 DOI: 10.11604/pamj.2015.22.275.5961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 10/20/2015] [Indexed: 01/09/2023] Open
Abstract
Introduction In sub-Saharan Africa where HIV/AIDS epidemic is predominantly generalized, majority of HIV infections occur among heterosexual couples. The majority of people do not know their sero-status. Thus, utilisation of Couples’ HIV Counselling and Testing (CHCT) services remain to be critical in preventing new infections. The objective was to establish prevalence and predictors of HIV sero-discordance among cohabiting couples presenting for CHCT services in northern Tanzania. Methods A cross-sectional study inteveviewed 1,333 couples aged 18-49 years tested from 2005 to 2007 in Kilimanjaro and Arusha regions. A CHCT checklist was used to collect data from couples. Data were analyzed using STATA 10. Results Generally, 220(16%) out of 1,333 couples were HIV sero-discordant. In sero-discordance unions, women were likely to be HIV positive than men (71% versus 29% respectively p<0.001). HIV sero-discordant relationship was associated with age (35-45 years) for both men and women (Adjusted Odds Ratio (AOR): 2.3, 95% Confidence Interval (CI): 1.7-3.2) and (AOR: 2.6, 95% CI 1.9-3.7) respectively. Women with older men partners were less likely to be in HIV sero-discordance relationships (AOR: 0.5 95% CI 0.3-09). Arusha couples were likely to be HIV sero-discordant than those of Kilimanjaro (AOR: 2.3 95% CI 1.7-3.2). Couples living far away from CHCT centres were less likely to be sero-discordant than those live nearby (AOR: 0.4 95% CI 0.2-0.9). Conclusion HIV sero-discordance prevalence is high among our participants. Thus, we recommend CHCT utilization should widely be promoted as entry point in treatment as prevention strategy in order to protect uninfected partners in HIV sero-discordance relationships.
Collapse
Affiliation(s)
- David Paul Ngilangwa
- Amref Health Africa, P.O Box 2773 Dar es Salaam, Tanzania; Kilimanjaro Reproductive Health Program, Moshi, Tanzania
| | | | | | | | - George Suleman Mgomella
- Kilimanjaro Reproductive Health Program, Moshi, Tanzania; Department of Medicine, Strangeways Research Laboratory, University of Cambridge, Worts' Causeway, Cambridge CB1 8RN, UK
| |
Collapse
|
13
|
Mugweni E, Pearson S, Omar M. Concurrent sexual partnerships among married Zimbabweans - implications for HIV prevention. Int J Womens Health 2015; 7:819-32. [PMID: 26491372 PMCID: PMC4599069 DOI: 10.2147/ijwh.s88884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Concurrent sexual partnerships play a key role in sustaining the HIV epidemic in Zimbabwe. Married couples are at an increased risk of contracting HIV from sexual networks produced by concurrent sexual partnerships. Addressing these partnerships is an international HIV prevention priority. METHODS Our qualitative study presents the socioeconomic factors that contribute to the occurrence of concurrent sexual partnerships among married people in Zimbabwe. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008 to understand the organizations of concurrent sexual partnerships. Data were analyzed using framework analysis. RESULTS Our study indicates that relationship dissatisfaction played a key role in the engagement of concurrent sexual partnerships. Depending on the source of the dissatisfaction, there were four possible types of concurrent sexual relationships that were formed: sex worker, casual partner, regular girlfriend or informal polygyny which was referred to as "small house". These relationships had different levels of intimacy, which had a bearing on practicing safer sex. Participants described three characteristics of hegemonic masculinity that contributed to the sources of dissatisfaction leading to concurrent sexual activity. Similarly, various aspects of emphasized femininity were described as creating opportunities for the occurrence of concurrent sexual relationships. Economic status was also listed as a factor that contributed to the occurrence of concurrent sexual partnerships. CONCLUSION Marital dissatisfaction was indicated as a contributing factor to the occurrence of concurrent sexual relationships. There were several reports of satisfying marital relationships in which affairs did not occur. Lessons from these marriages can be made part of future HIV prevention interventions targeted at preventing concurrent sexual partnerships by married couples.
Collapse
Affiliation(s)
- Esther Mugweni
- UCL Department of Infection and Population Health, University College London, London, UK
| | - Stephen Pearson
- The Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Mayeh Omar
- The Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| |
Collapse
|
14
|
Concurrent partnerships in Cape Town, South Africa: race and sex differences in prevalence and duration of overlap. J Int AIDS Soc 2015; 18:19372. [PMID: 25697328 PMCID: PMC4334769 DOI: 10.7448/ias.18.1.19372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/19/2014] [Accepted: 01/13/2015] [Indexed: 01/02/2023] Open
Abstract
Introduction Concurrent partnerships (CPs) have been suggested as a risk factor for transmitting HIV, but their impact on the epidemic depends upon how prevalent they are in populations, the average number of CPs an individual has and the length of time they overlap. However, estimates of prevalence of CPs in Southern Africa vary widely, and the duration of overlap in these relationships is poorly documented. We aim to characterize concurrency in a more accurate and complete manner, using data from three disadvantaged communities of Cape Town, South Africa. Methods We conducted a sexual behaviour survey (n=878) from June 2011 to February 2012 in Cape Town, using Audio Computer-Assisted Self-Interviewing to collect sexual relationship histories on partners in the past year. Using the beginning and end dates for the partnerships, we calculated the point prevalence, the cumulative prevalence and the incidence rate of CPs, as well as the duration of overlap for relationships begun in the previous year. Linear and binomial regression models were used to quantify race (black vs. coloured) and sex differences in the duration of overlap and relative risk of having CPs in the past year. Results The overall point prevalence of CPs six months before the survey was 8.4%: 13.4% for black men, 1.9% for coloured men, 7.8% black women and 5.6% for coloured women. The median duration of overlap in CPs was 7.5 weeks. Women had less risk of CPs in the previous year than men (RR 0.43; 95% CI: 0.32–0.57) and black participants were more at risk than coloured participants (RR 1.86; 95% CI: 1.17–2.97). Conclusions Our results indicate that in this population the prevalence of CPs is relatively high and is characterized by overlaps of long duration, implying there may be opportunities for HIV to be transmitted to concurrent partners.
Collapse
|
15
|
Ward H, Gregson S, Watts C, Garnett GP. Translational epidemiology: developing and applying theoretical frameworks to improve the control of HIV and other sexually transmitted infections. J Infect Dis 2015; 210 Suppl 2:S547-8. [PMID: 25381373 PMCID: PMC4231646 DOI: 10.1093/infdis/jiu559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Helen Ward
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London
| | - Charlotte Watts
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Geoffrey P Garnett
- Integrated Delivery Department, Bill and Melinda Gates Foundation, Seattle, Washington
| |
Collapse
|