Revisiting the Housing-Health Relationship for HIV-Positive Persons: Qualitative Evidence From the Lower Manya Krobo District, Ghana

'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study

The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.

Conflicting HIV/AIDS Sex Education Policies and Mixed Messaging among Educators and Students in the Lower Manya Krobo Municipality, Ghana

While school-based comprehensive sex education (CSE) is effective in HIV prevention among young people ages 10-24 years, Ghana's national sexual and reproductive health education policy promotes abstinence. Meanwhile, the Ministry of Health's HIV prevention programs provide more comprehensive school-based education. This qualitative study evaluated the HIV/AIDS education program in the Lower Manya Krobo Municipality to assess the perspectives of students and educators in 10 schools on school-based sexual and reproductive health programs, including HIV/AIDS education and conflicting HIV/AIDS sex education policies. HIV prevalence in the Lower Manya Krobo Municipality of Ghana was more than twice the national average at 5.64% in 2018, and prevalence among youth in the municipality aged 15-24 was the highest in the nation at 0.8%. Educators have mixed feelings regarding abstinence-based and CSE approaches. However, students generally endorse abstinence and describe the limitations of condom use. Ambiguity in overarching policies is identified as a factor that could influence the orientation of school-based health educators, create disharmony in sex education interventions, introduce confusing sex education messages to young people, and create a potentially narrow curriculum that limits the gamut of HIV/AIDS sex education to exclude young people's risky sexual behaviours and diverse teaching and implementation strategies. Policies and the scope of sex education should be realigned to ensure the transparent implementation of HIV/AIDS sex education programs in Ghana.

Perceived self-efficacy of students and its influence on attitudes and knowledge about HIV/AIDS in Ghana

Globally, human immunodeficiency syndrome (HIV) and its accompanying acquired immune deficiency syndrome (AIDS) have long been a public health threat due to the high death toll and the various effects on individuals and societies. Unfortunately, in developing countries such as Ghana, persons living with HIV/AIDS are victims of discrimination and rejection and are often excluded from social activities. Consequently, there is a need for mitigation strategies aimed at reducing the spread of the disease. Indeed, in human society, beliefs are fundamental to understanding people's intentions towards a given phenomenon. The purpose of this study was to assess students' perceived self-efficacy, attitude towards and knowledge about HIV/AIDS. In this study, Bandura's self-efficacy theory was used as a framework to assess the relationship between students' perceived self-efficacy, attitude towards and knowledge about HIV/AIDS. A total of 342 students of at least 15 years old were recruited from junior and senior high schools and a public university to complete two scales: the general self-efficacy and attitude and knowledge about HIV/AIDS scales. While there was a positive correlation among self-efficacy, attitude and knowledge, attitude and knowledge combined to predict self-efficacy. The limitations of the study, recommendations for future research and policy implications are discussed herein.

Living with HIV in Ghana: Disclosure of status and experiences of persons receiving antiretroviral therapy

Barriers to treatment faced by people living with HIV (PLWH) have been well explored in the literature. Despite the importance of antiretroviral therapy (ART) in the treatment of HIV and prevention of AIDS, in the Ghanaian context only about 32% of infected persons have access to treatment. This underscores a need to understand the experiences of PLWH receiving ART to provide baseline information for policymakers' efforts to increase access to treatment. This study captures the voices of PLWH who were receiving ART in Ghana. A total of 35 participants receiving treatment in a hospital setting (11 males, 24 females; mean age 38 years, age range 21-60 years) took part in semi-structured face-to-face interviews to discuss their opinions about the cause of their HIV infection and its impact on their lives. The study found that the participants were susceptible to discrimination in their communities and at health care facilities. Some participants experienced marriage breakdowns, unemployment, social isolation, and were unable to perform everyday chores and responsibilities. Concerted efforts to address the barriers to treatment faced by PLWH are needed.

The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana

Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.

Mortality due to acquired immunodeficiency syndrome and associated social factors: a spatial analysis

OBJECTIVE

To analyze the spatial pattern of AIDS mortality and social factors associated with its occurrence.

METHODS

An ecological study that considered 955 AIDS deaths of residents in Piauí, reported in the Mortality Information System (MIS) from 2007 to 2015. Non-spatial and spatial regression models were used to identify social determinants of AIDS mortality, with a significance of 5%.

RESULTS

The predictors of AIDS mortality were illiteracy rate in males (p = 0.020), proportion of households with water supply (p = 0.015), percentage of people in households with inadequate walls (p = 0.022), percentage of people in households vulnerable to poverty and in whom no one has completed primary education (p = 0.000) and percentage of people in households vulnerable to poverty and dependent on the elderly (p = 0.009).

CONCLUSION

Social indicators related to education, job and income generation and housing were associated with AIDS mortality.

A gendered analysis of living with HIV/AIDS in the Eastern Region of Ghana

BACKGROUND

A gender gap exists in knowledge regarding persons living with HIV/AIDS in Ghana. Women living with HIV/AIDS (WLHIV) greatly outnumber males living with HIV/AIDS (MLHIV) in Ghana and Sub-Saharan Africa generally. This necessitates more gender-nuanced evidence-based information on HIV/AIDS to guide individuals, healthcare workers, and other stakeholders in Ghana particularly. This paper undertook a gender-focused analysis of the experiences of WLHIV and MLHIV in a municipal area in Ghana which has been most impacted by HIV/AIDS.

METHODS

In-depth interviews of 38 HIV-positive persons recruited using combined purposive and random sampling for one month, were tape recorded and analyzed using thematic content analysis. Participants were out-patients who were receiving routine care for co-morbidities at two specially equipped HIV/AIDS Voluntary Counseling and Testing Centers in the Lower Manya Krobo Municipality (LMKM), Eastern Region, Ghana.

RESULTS

Our data yielded three major themes: characteristics of participants, health status and health seeking behavior, and challenges encountered living with HIV/AIDS. Except for feeling of sadness due to their HIV/AIDS-positive status, there were significant differences in the experiences of MLHIV, compared to WLHIV. WLHIV were more likely to be housing insecure, unemployed due mostly to stigmatization/self-stigmatization, less likely to have revealed their HIV-positive status to multiple family members, and had more profound challenges regarding their healthcare. Most MLHIV expected, demanded, and had support from their wives; WLHIV were mostly single-never married, divorced or widowed (mostly due to HIV/AIDS). The vast majority of WLHIV complained of near-abject poverty, including for most of them, lack of food for taking their anti-retroviral medicines and/or taking it on time.

CONCLUSIONS

The experiences of the MLHIV and WLHIV with living and coping with the virus mostly differed. These experiences were unequivocally shaped by differential socio-cultural tenets and gendered nuances; WLHIV had more negative experiences. Public education on the extra burden of HIV/AIDS on WLHIV, more social support, and affirmative action in policy decisions in favor of WLHIV in the study district are needed to seek public sympathy and improve health outcomes and livelihoods of WLHIV particularly. Further studies using multiple sites to explore these differences are warranted.

INFLUENCE OF THE SOCIAL DETERMINANTS ON THE INCIDENCE OF AIDS IN PIAUÍ: AN ECOLOGICAL STUDY

ABSTRACT Objective: to identify the social factors that determine the incidence of aids in the Piauí territory. Method: an ecological study that uses geoprocessing techniques in which 2,908 aids cases of individuals residing in Piauí were considered, notified to the Notifiable Disease Information System (Sistema de Informações de Agravos de Notificação, SINAN), from 2007 to 2015. Gross and Bayesian incidence rates were calculated using the population of the central year (2011), multiplied by 100,000 inhabitants, with Bayesian statistics used to identify spatial clusters. The non-spatial Ordinary Least Squares Estimation (OLS) and spatial Geographically Weighted Regression (GWR) regression models were used to identify the social determinants of the incidence of aids in the state, with 5% of significance. Results: the highest rates of the disease are concentrated in cities near the capital Teresina, with a Bayesian incidence of over 11.27 cases/100,000 inhabitants. The predictor variables of the incidence of ADIS in Piauí cities were the following: the percentage of individuals in houses with inadequate walls (p=0.0139), the mean number of residents per household (p=0.0309), and the percentage of individuals in households vulnerable to poverty and in which no one has completed elementary school (p=0.0051). Conclusion: according to GWR, the social factors that influence the incidence of aids in the cities of Piauí are the percentage of individuals in houses with inadequate walls, the mean number of residents per household, and the percentage of individuals in houses vulnerable to poverty and in which no one has completed elementary school. Given the above, interventions on the health social determinants of a structural nature should be established as effective methods for the prevention of HIV/ aids.