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Ijaiya MA, Anibi A, Abubakar MM, Obanubi C, Anjorin S, Uthman OA. A multilevel analysis of the determinants of HIV testing among men in Sub-Saharan Africa: Evidence from Demographic and Health Surveys across 10 African countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003159. [PMID: 38696392 PMCID: PMC11065312 DOI: 10.1371/journal.pgph.0003159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/05/2024] [Indexed: 05/04/2024]
Abstract
Sub-Saharan Africa, the epicenter of the HIV epidemic, has seen significant reductions in new infections over the last decade. Although most new infections have been reported among women, particularly adolescent girls, men are still disadvantaged in accessing HIV testing, care, and treatment services. Globally, men have relatively poorer HIV testing, care, and treatment indices when compared with women. Gender norms and the associated concept of masculinity, strength, and stereotypes have been highlighted as hindering men's acceptance of HIV counseling and testing. Therefore, men's suboptimal uptake of HIV testing services will continue limiting efforts to achieve HIV epidemic control. Thus, this study aimed to identify individual, neighborhood, and country-level determinants of sub-optimal HIV testing among men in Sub-Saharan African countries. We analyzed demographic and health datasets from surveys conducted between 2016 and 2020 in Sub-Saharan African Countries. We conducted multivariable multilevel regression analysis on 52,641 men aged 15-49 years resident in 4,587 clusters across 10 countries. The primary outcome variable was ever tested for HIV. HIV testing services uptake among men in these ten Sub-Saharan African countries was 35.1%, with a high of 65.5% in Rwanda to a low of 10.2% in Guinea. HIV testing services uptake was more likely in men with increasing age, some form of formal education, in employment, ever married, and residents in relatively wealthier households. We also found that men who possessed health insurance, had some form of weekly media exposure, and had accessed the internet were more likely to have ever received an HIV test. Unlike those noted to be less likely to have ever received an HIV test if they had discriminatory attitudes towards HIV, comprehensive HIV knowledge, recent sexual activity, and risky sexual behavior were positive predictors of HIV testing services uptake among men. Furthermore, men in communities with high rurality and illiteracy were less likely to receive an HIV test. Individual and community-level factors influence the uptake of HIV testing among Sub-Saharan African men. There was evidence of geographical clustering in HIV testing uptake among men at the community level, with about two-thirds of the variability attributable to community-level factors. Therefore, HIV testing programs will need to design interventions that ensure equal access to HIV testing services informed by neighborhood socioeconomic conditions, peculiarities, and contexts.
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Affiliation(s)
| | | | - Mustapha Muhammed Abubakar
- Directorate of Therapeutic Services, Medical Services Branch, Nigerian Air Force, Abuja, Federal Capital Territory, Nigeria
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chris Obanubi
- United States Agency for International Development, Gaborone, Botswana
| | - Seun Anjorin
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Olalekan A. Uthman
- Division of Health Sciences, Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Gittings L, Hodes R, Kom P, Mbula S, Pantelic M. 'Remember there is that thing called confidentiality': experiences of institutional discrimination in the health system among adolescent boys and young men living with HIV in the Eastern Cape province of South Africa. CULTURE, HEALTH & SEXUALITY 2024; 26:575-587. [PMID: 37480578 DOI: 10.1080/13691058.2023.2232023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Abstract
Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives (n = 36) and in-depth semi-structured interviews (n = 32) with adolescent boys living with HIV aged 13-22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners (n = 14), analysis of health facility files (n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector.
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Affiliation(s)
- Lesley Gittings
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Rebecca Hodes
- Department of Anthropology, Archaeology and Social Development, Humanities Faculty, Pretoria University, South Africa
| | - Phakamani Kom
- Oxford Research South Africa, East London, South Africa
| | | | - Marija Pantelic
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Jude O, Nelson O, Katagwa I. Socio-economic and demographic factors associated with never having tested for HIV among sexually active men across the four administrative regions of Uganda. BMC Public Health 2021; 21:2301. [PMID: 34923979 PMCID: PMC8684685 DOI: 10.1186/s12889-021-12384-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing among men is paramount in the prevention, diagnosis, and treatment of HIV. There is limited literature in understanding the socio-economic and demographic factors associated with never having tested for HIV among sexually active men aged 15 - 54 across the four administrative regions of Uganda. The purpose of this study is to investigate the socio-economic and demographic factors associated with never having tested for HIV among sexually active men aged 15 - 54 across the four administrative regions in the country. METHODS The study used a cross-sectional research design to examine factors associated with never having tested for HIV among 4,168 sexually active men (15 - 54 years) across four administrative regions of Uganda using data from 2016 Uganda Demographic and Health Survey (UDHS). Frequency distributions, Pearson chi-square tests, and multivariable logistic regression were used to establish the association between never having tested for HIV among sexually active men (15 - 54 years) and selected independent variables across regions. RESULTS About 20% of sexually active men (15 - 54 years) never tested for HIV across regions of the country. The major correlates amidst variability of never testing for HIV among sexually active men across regions were; educational level and marital status. Age, religious status, wealth quintile, worked in the last 12 months, circumcised, and one sexual partner in the last 12 months were only correlates of never having tested for HIV among respondents in particular regions of the country. CONCLUSION Findings in the study suggest promotion of male education, and suggest further investigation into the relationship between HIV non-testing among sexually active men (15 - 54 years) and being married across regions of the country. The study also proposes appreciation of regional differences in the outcome of HIV non-testing and suggests that efforts be focused on addressing regional differences in order to attain high HIV testing among sexually active men (15 - 54 years) across regions of Uganda, and thus reduce HIV related morbidity and mortality.
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Affiliation(s)
- Otim Jude
- Kyambogo University, Kampala, Uganda
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Gittings L, Hodes R, Colvin C, Mbula S, Kom P. 'If you are found taking medicine, you will be called names and considered less of a man': young men's engagement with HIV treatment and care during ulwaluko (traditional initiation and circumcision) in the Eastern Cape Province of South Africa. SAHARA J 2021; 18:64-76. [PMID: 33847253 PMCID: PMC8049467 DOI: 10.1080/17290376.2021.1894225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This paper explores how HIV-positive abakhwetha (young male initiates) undergoing ulwaluko (traditional Xhosa initiation and circumcision) engage with HIV-related biomedical care and treatment. Health-focused life history narratives (n = 36), semi-structured interviews (n = 32) and analysis of health facility files (n = 41) with adolescent boys and young men (ages 13-24) living with HIV, and semi-structured interviews with traditional and biomedical health practitioners (n = 14) were conducted in 2017 and 2018. This research was part of the Mzantsi Wakho study, a longitudinal, mixed methods study of adolescents living with HIV (n = 1060). Findings demonstrate that ulwaluko rules of not engaging with biomedical care and treatment pose a challenge for initiates who are taking chronic medicine. Fears of inadvertent disclosure of their HIV-positive status collide with the pressure to successfully complete ulwaluko in order to be legitimised as men. In response to this dilemma, they engage a variety of strategies - including taking medicine in secret by hiding them, having a trusted person deliver them discretely, and stopping medicine-taking altogether. The three months following ulwaluko also pose a challenge in accessing biomedical treatment and care. In this time of high surveillance, amakrwala (new men) do not present at health facilities for fear of being thought to have had a botched circumcision or to have contravened 'manhood rules' and left ulwaluko before having healed properly. To get around this, those who continued taking medicine engaged caregiver pick-ups. Beyond suggesting that ulwaluko is a high-risk time for disengagement from biomedical treatment and care, this paper builds on a robust scholarship on the importance of locality and context in gender and health research. It documents the creativity, agency and resilience of initiates and their families as they subvert and re-signify health-related masculine norms.
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Affiliation(s)
- L. Gittings
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - R. Hodes
- AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - C. Colvin
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - S. Mbula
- Mzantsi Wakho, East London, South Africa
| | - P. Kom
- Mzantsi Wakho, East London, South Africa
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HIV testing and ethnicity among adolescent girls and young women aged 15-24 years in Ghana: what really matters? J Biosoc Sci 2021; 54:812-828. [PMID: 34511162 DOI: 10.1017/s0021932021000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite the high prevalence of HIV among adolescent girls and young women (AGYW) aged 15-24 years in Ghana, HIV testing remains low among this population. The objective of this study was to examine the relationship between ethnicity and HIV testing among AGYW in Ghana. The 2014 Ghana Demographic and Health Survey data were used and analyses were restricted to 3325 female participants aged 15-24 years. Chi-squared tests and a logistic regression model were used to assess the association between ethnicity and HIV testing. Furthermore, the PEN-3 cultural model informed the conceptual framework that explained the relationship between ethnicity and HIV testing behaviour. Results from the bivariate analysis showed an association between ethnicity and HIV testing among AGYW (p<0.05). However, when controlling for other behavioural and socioeconomic determinants of HIV testing in the logistic regression, there was no association between ethnicity and HIV testing. The significant predictors of HIV testing were marital status, having multiple sexual partners, and condom use. The AGYW who were married (adjusted odds ratio [aOR] = 4.56, CI: 3.46-6.08) or previously married (aOR = 4.30, CI: 2.00-9.23) were more likely to test for HIV compared with those who were never married. Having multiple sexual partners (aOR = 0.41, CI: 0.20-0.85) and condom use (aOR = 0.56, CI: 0.38-0.84) were associated with lower odds of HIV testing. The results provide evidence that ethnicity is not associated with HIV testing among AGYW in Ghana, as the bivariate association was attenuated when other behavioural and socioeconomic determinants of HIV testing were accounted for. These findings highlight the importance of considering individual-level factors, community-level factors, and other socio-cultural factors as they really matter in the development of HIV prevention programmes for adolescent girls and young women in Ghana.
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Nardell MF, Lee YS, Rousseau E, Julies R, Klaas P, Vundhla P, Butler L, Bassett IV, Mellins CA, Bekker LG, Katz IT. "You are not alone": a qualitative study to explore barriers to ART initiation and implications for a proposed community-based youth treatment club among young adults newly diagnosed with HIV in South Africa. AIDS Care 2021; 33:952-961. [PMID: 33345593 PMCID: PMC8215080 DOI: 10.1080/09540121.2020.1861179] [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: 03/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
In South Africa, despite universal antiretroviral therapy (ART) availability, 60% of persons living with HIV (PLWH) ages 15-24 are not on treatment. This qualitative study aimed to identify barriers to ART initiation and the implications for a proposed community-based Youth Treatment Club to improve ART initiation for young PLWH in limited-resource, high HIV-prevalence communities in Cape Town, South Africa. Recruiting participants at community testing sites from 2018 to 2019, we conducted semi-structured interviews, informed by Social Action Theory (SAT), with 20 young adults, ages 18- to 24-years-old, newly diagnosed with HIV, along with 10 healthcare providers. Through systematic qualitative analysis, we found that young PLWH face barriers to treatment initiation in three SAT domains: (1) stigmatizing social norms (social regulation processes); (2) challenges coping with a new diagnosis (self-regulation processes); and (3) anticipated stigma in the clinic environment (contextual factors). Participants shared that a proposed community-based Youth Treatment Club for newly diagnosed youth would be an acceptable strategy to promote ART initiation. They emphasized that it should include supportive peers, trained facilitator support for counseling and education, and a youth-friendly environment.
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Affiliation(s)
- Maria F. Nardell
- Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yeonsoo Sara Lee
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elzette Rousseau
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Robin Julies
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Portia Klaas
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Prisca Vundhla
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | - Lisa Butler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA
| | - Ingrid V. Bassett
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Linda-Gail Bekker
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, Republic of South Africa
- Institute of Infectious Disease and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, Republic of South Africa
- Governing Council, International AIDS Society, Geneva, Switzerland
| | - Ingrid T. Katz
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
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Seidu AA. Using Anderson's Model of Health Service Utilization to Assess the Use of HIV Testing Services by Sexually Active Men in Ghana. Front Public Health 2020; 8:512. [PMID: 33042949 PMCID: PMC7522213 DOI: 10.3389/fpubh.2020.00512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Globally, HIV testing and counseling is considered a key cost-effective component of HIV prevention and treatment. This study sought to use Anderson's model of health service utilization to assess the uptake of HIV testing services by sexually active men in Ghana. Materials and Methods: Data were from the 2014 Ghana Demographic and Health Survey. Both bivariate and multivariate analysis were conducted. The multivariate analysis results are presented as Adjusted Odds ratios (AORs) with 95% confidence intervals (CI). Statistical significance was declared at p < 0.05. Results: A total of 3,052 sexually active men aged 15-59 were included in the analysis. Of these, 25.4% tested for their HIV status. Men aged 30-39 (AOR = 2.715, CI = 1.458, 5.054), those with higher level of education (AOR = 3.566,CI = 2.309, 5.509), married (AOR = 1.50, CI = 1.167, 1.931), and men in Upper East (AOR = 2.625, CI = 1.608, 4.285) had higher odds of HIV testing uptake than their counter parts aged 15-19, those with no formal education unmarried and those in Western Region, respectively. However, men with no religion (AOR = 0.606, CI = 0.376, 0.975) and those who belong to the Mole-Dagbani ethnic group (AOR = 0.633, CI = 0.429, 0.934) had lower odds of HIV testing uptake compared to those who are Christians, and Akans, respectively. Men who have subscribed to health insurance (AOR = 1.896, 95% CI = 1.361, 2.643), those in the rich wealth quintile (AOR = 1.896, CI = 1.361, 2.643), those who read newspaper (AOR = 1.552, CI = 1.198, 2.012), listened to radio (AOR = 1.530, CI = 1.087, 2.153) at least once a week, and men who experienced discharge from their penis (AOR = 1.056, CI = 1.200, 1.515) had higher odds of HIV testing uptake. Conclusion: Uptake of HIV testing among Ghanaian men is relatively low. There is the need for a concerted effort by various stakeholders to strengthen current efforts to target younger and unmarried men, men with low level of education, those who do not profess any religious affiliation and men belonging to Mole-Dagbani ethnic group.
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Affiliation(s)
- 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, QLD, Australia
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Mengwai K, Madiba S, Modjadji P. Low Disclosure Rates to Sexual Partners and Unsafe Sexual Practices of Youth Recently Diagnosed with HIV; Implications for HIV Prevention Interventions in South Africa. Healthcare (Basel) 2020; 8:healthcare8030253. [PMID: 32756349 PMCID: PMC7551467 DOI: 10.3390/healthcare8030253] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023] Open
Abstract
The study investigated the motivation to disclose or the decision to withhold one’s HIV serostatus to one’s partners and assessed the implications of non-disclosure on young peoples’ sexual behaviour and access to treatment. This was a cross-sectional survey conducted with 253 youth aged 18–25 years receiving antiretroviral therapy in a health district in North West Province, South Africa. The majority were female (75%), the mean time since the HIV diagnosis was 22 months, 40% did not know their partner’s HIV status, 32% had more than two sexual partners, and 63% had not used a condom during the last sexual act. The prevalence of disclosure was 40%, 36% delayed disclosure for over a year, and most disclosed to protect the partner from HIV transmission, to receive support, and to be honest and truthful. The prevalence of non-disclosure was high, as 60% withheld disclosure due to fear of abandonment, stigma and discrimination, accusations of unfaithfulness, and partner violence. Over half (55%) had no intentions to disclose at all. The lower disclosure rates imply that HIV transmission continues to persist among sexual partners in these settings. The findings suggest that high levels of perceived stigma impact on disclosure and HIV treatment, which increases the risk of on-going HIV transmission among youth receiving long-term antiretroviral therapy (ART) in South Africa.
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Conserve DF, Issango J, Kilale AM, Njau B, Nhigula P, Memiah P, Mbita G, Choko AT, Hamilton A, King G. Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan. BMC Health Serv Res 2019; 19:317. [PMID: 31109335 PMCID: PMC6528365 DOI: 10.1186/s12913-019-4120-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to the 2016-2017 Tanzania HIV Impact Survey, 55% of men diagnosed with HIV during the survey self-reported that they were unaware of their HIV status. As a response, the Government of Tanzania launched a Test and Treat campaign in June 2018 with a focus on reaching men and developed the 2018-2020 Male Catch-Up plan. This article reports (1) the enablers and barriers of HIV testing services (HTS) uptake among men (2) and describes the strategies that were proposed as part of the Male Catch-Up Plan to address some of these barriers. METHOD Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam to explore HTS enablers and barriers. To develop the Male Catch-Up Plan strategies, a desk review of published studies, and analyses of national implementers of HIV/AIDS interventions were conducted. An additional 123 interviews were also carried out with key implementers of HIV/AIDS interventions, healthcare workers, secondary school boys and members of the community in Iringa and Tanga. RESULTS Enablers of HTS included the desire to check one's health, high HIV risk perception, wanting to protect oneself if tested negative, and being encouraged by their sexual partners. Barriers of HTS were fear of a positive test result, and low HIV risk perception. Proposed strategies from the Male Catch-Up Plan to address these barriers included non-biomedical and biomedical approaches. Non-biomedical strategies are social and cultural approaches to promote an enabling environment to encourage health seeking behavior, safe behavior, and providing peer education programs and social marketing to promote condoms. Biomedical approaches consisted of expanding targeted HIV testing, HIV self-testing, and integrating HIV services with other health services. CONCLUSION A number of barriers contribute to the low uptake of HTS among men in Tanzania. National strategies have been developed to address these HTS barriers and guide the national Test and Treat campaign focusing on increasing HTS uptake among men.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Jumanne Issango
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Bernard Njau
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Nhigula
- Darla Moore School of Business, University of South Carolina, Columbia, USA
| | | | | | - Augustine T. Choko
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Akeen Hamilton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Gary King
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, PA USA
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Conserve DF, Muessig KE, Maboko LL, Shirima S, Kilonzo MN, Maman S, Kajula L. Mate Yako Afya Yako: Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men. PLoS One 2018; 13:e0202521. [PMID: 30148846 PMCID: PMC6110473 DOI: 10.1371/journal.pone.0202521] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 08/03/2018] [Indexed: 11/22/2022] Open
Abstract
The purpose of this formative research, guided by the Integrated Behavioral Model, was to assess men's attitudes and personal agency towards HIV self-testing (HIVST) and confirmatory HIV testing in order to inform the development of the Tanzania STEP (Self-Testing Education and Promotion) Project, a peer-based HIV self-testing intervention for young men in Tanzania. Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam, Tanzania who socialize in networks locally referred to as "camps". Men reported privacy, confidentiality, and saving time as the primary reasons for their self-testing interest. Most participants had high perceived control and self-efficacy to self-test and seek confirmatory HIV testing. Nevertheless, men reported concerns related to their ability to perform the test and the potential lack of post-test counseling. Specific recommendations for the intervention included providing HIVST education and pre-test counseling, and using mobile health (mHealth) strategies for participants to reach a healthcare professional for further assistance. The findings suggest that while HIVST is highly acceptable among men in Tanzania, future interventions will need to address the challenges that men may face with HIVST before promoting it as an alternative or supplement to facility-based HIV testing.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Sylvia Shirima
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Mrema N. Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Conserve DF, Alemu D, Yamanis T, Maman S, Kajula L. "He Told Me to Check My Health": A Qualitative Exploration of Social Network Influence on Men's HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania. Am J Mens Health 2018; 12:1185-1196. [PMID: 29808781 PMCID: PMC6142152 DOI: 10.1177/1557988318777674] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers.
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Affiliation(s)
- Donaldson F Conserve
- 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Dawit Alemu
- 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Thespina Yamanis
- 2 School of International Service, American University, Washington, DC, USA
| | - Suzanne Maman
- 3 Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lusajo Kajula
- 4 Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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12
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Conserve DF, Iwelunmor J, Whembolua GL, Sofolahan-Oladeinde Y, Teti M, Surkan PJ. Factors Associated With HIV Testing Among Men in Haiti: Results From the 2012 Demographic and Health Survey. Am J Mens Health 2017; 11:1322-1330. [PMID: 26961936 PMCID: PMC5102815 DOI: 10.1177/1557988316635247] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
HIV testing serves as the gateway to HIV prevention and treatment. However, research examining men's HIV testing behaviors in the Caribbean remains limited. The Andersen Behavioral Model of Health Services Utilization was used to examine factors associated with HIV testing among 7,354 men who participated in the 2012 Demographic and Health Survey conducted in Haiti. Few men (35%) reported having ever been tested for HIV. Logistic regression analyses revealed that HIV testing increased with education and wealth. Marital status was associated with HIV testing, with married men more likely to have been tested (adjusted odds ratio: 2.57, 95% CI [2.07, 3.19]) than unmarried men. Positive attitudes toward people living with HIV, indicated by willing to care for a relative who has HIV/AIDS, was also correlated with higher odds of having been tested (adjusted odds ratio: 1.28, 95% CI [1.08, 1.51]). Men who reported condom use during last sex were more likely to have been tested (odds ratio: 1.58, 95% CI [1.33, 1.88). The findings indicate that HIV testing rates remain low among men in Haiti and more efforts are needed to increase HIV testing among men who are not married, have low level of education, and engage in unprotected sex.
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13
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Conserve DF, Teti M, Shin G, Iwelunmor J, Handler L, Maman S. A Systematic Review and Narrative Synthesis of Interventions for Parental Human Immunodeficiency Virus Disclosure. Front Public Health 2017; 5:187. [PMID: 28824896 PMCID: PMC5545755 DOI: 10.3389/fpubh.2017.00187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/10/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Disclosure of parental human immunodeficiency virus (HIV) infection to their children remains a difficult process for parents living with HIV (PLWH). In order to identify the best strategies to facilitate parental HIV disclosure, it is necessary to examine the efficacy of existing interventions designed to help PLWH parents with the disclosure process to their children. OBJECTIVES To systematically review the efficacy of interventions designed to assist PLWH disclose their HIV status to their children. METHODS We conducted a systematic review and narrative synthesis of interventions designed to assist PLWH disclose their HIV status to their children. MEDLINE/PubMed, PsycINFO, Embase, Global Health, and Web of Science were searched. RESULTS Studies were eligible for inclusion if they evaluated an intervention for parental HIV disclosure. Five studies published between 2001 and 2015 met the inclusion criteria. The interventions were conducted in South Africa, China, and the United States. Three of the studies used two-arm randomized controlled trials, in which the intervention group was given enhanced care while the control group received standard care. Four of the five studies included a theoretically informed intervention and three were limited to mothers. Results showed that four of the interventions increased parental HIV disclosure. CONCLUSION The findings suggest that parental HIV disclosure interventions are successful in assisting parents with the disclosure process and can be adapted in different cultural context. Future parental HIV disclosure interventions should include fathers in order to assist men with parental HIV disclosure.
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Affiliation(s)
- Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Michelle Teti
- Department of Health Sciences, University of Missouri, Columbia, MO, United States
| | - Grace Shin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Lara Handler
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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14
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Gittings L. 'When you visit a man you should prepare yourself': male community care worker approaches to working with men living with HIV in Cape Town, South Africa. CULTURE, HEALTH & SEXUALITY 2016; 18:936-950. [PMID: 26967538 DOI: 10.1080/13691058.2016.1150513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Caring is typically constructed as a feminised practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regards to gendered constructions of caring. Using semi-structured interviews and observational home visits, this study explored the techniques that community care workers employ when working with male clients. The empirical analysis draws on the perspectives of eight care workers and three of their male clients from the Cape Town area. Interviews reveal how care workers and clients perform and negotiate masculinities as they navigate hegemonic masculine norms that require men to act tough, suppress emotions and deny weakness and sickness. Both parties bump up against ideals of what it means to be a man as they strive to provide care and receive support. Community care workers avoid rupturing client performances of hegemonic masculinities which inhibit confession and support. To do this, they use techniques of indirectly broaching sensitive subjects, acting in a friendly way and being clear about the intention of their work.
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Affiliation(s)
- Lesley Gittings
- a AIDS and Society Research Unit (ASRU), Centre for Social Science Research , The University of Cape Town , Cape Town , South Africa
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15
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Mclean EM, Chihana M, Mzembe T, Koole O, Kachiwanda L, Glynn JR, Zaba B, Nyirenda M, Crampin AC. Reliability of reporting of HIV status and antiretroviral therapy usage during verbal autopsies: a large prospective study in rural Malawi. Glob Health Action 2016; 9:31084. [PMID: 27293122 PMCID: PMC4904066 DOI: 10.3402/gha.v9.31084] [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] [Received: 01/22/2016] [Revised: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Verbal autopsies (VAs) are interviews with a relative or friend of the deceased; VAs are a technique used in surveillance sites in many countries with incomplete death certification. The goal of this study was to assess the accuracy and validity of data on HIV status and antiretroviral therapy (ART) usage reported in VAs and their influence on physician attribution of cause of death. Design This was a prospective cohort study. Methods The Karonga Health and Demographic Surveillance Site monitors demographic events in a population in a rural area of northern Malawi; a VA is attempted on all deaths reported. VAs are reviewed by clinicians, who, with additional HIV test information collected pre-mortem, assign a cause of death. We linked HIV/ART information reported by respondents during adult VAs to database information on HIV testing and ART use and analysed agreement using chi-square and kappa statistics. We used multivariable logistic regression to analyse factors associated with agreement. Results From 2003 to 2014, out of a total of 1,952 VAs, 80% of respondents reported the HIV status of the deceased. In 2013–2014, this figure was 99%. Of those with an HIV status known to the study, there was 89% agreement on HIV status between the VA and pre-mortem data, higher for HIV-negative people (92%) than HIV-positive people (83%). There was 84% agreement on whether the deceased had started ART, and 72% of ART initiation dates matched within 1 year. Conclusions In this population, HIV/ART information was often disclosed during a VA and matched well with other data sources. Reported HIV/ART status appears to be a reliable source of information to help classification of cause of death.
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Affiliation(s)
- Estelle M Mclean
- Karonga Prevention Study, Chilumba, Karonga, Malawi.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;
| | | | | | - Olivier Koole
- Karonga Prevention Study, Chilumba, Karonga, Malawi.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Judith R Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Basia Zaba
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Moffat Nyirenda
- Karonga Prevention Study, Chilumba, Karonga, Malawi.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amelia C Crampin
- Karonga Prevention Study, Chilumba, Karonga, Malawi.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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16
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Doherty IA, Myers B, Zule WA, Minnis AM, Kline TL, Parry CD, El-Bassel N, Wechsberg WM. Seek, Test and Disclose: knowledge of HIV testing and serostatus among high-risk couples in a South African township. Sex Transm Infect 2015; 92:5-11. [PMID: 26175479 DOI: 10.1136/sextrans-2014-051882] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 06/20/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV testing and disclosure of results to partners is an important strategy in HIV prevention but is under-researched within heterosexual partnerships. To address this gap, we describe patterns of HIV testing, discrepancies between beliefs and biologically confirmed HIV status of each partner, and characteristics of mutually correct knowledge of HIV status among heterosexual couples in a high-prevalence community. METHODS The study recruited 290 high-risk heterosexual couples in stable relationships from a township in Cape Town, South Africa. Male patrons of shebeens (drinking establishments) were approached to participate with their main partner in an intervention designed to reduce substance use, violence and unsafe sex. All participants were tested for HIV at baseline and asked about their partner's past HIV testing and current status. Using the couple as the unit of analysis, we conducted logistic regression to identify partnership and individual characteristics associated with having mutually correct knowledge of partner's HIV status. RESULTS Half (52%) of women and 41% of men correctly knew whether their partner had ever been tested for HIV. 38% of women, 28% of men and in 17% of couples, both members reported mutually correct knowledge of their partner's HIV status. Correlates of correct knowledge included married/cohabitating (aOR 2.69, 95% CI 1.35 to 5.40), both partners HIV-negative (aOR 3.32 (1.38 to 8.00)), women's acceptance of traditional gender roles (aOR 1.17 (1.01 to 1.40)) and men's relationship satisfaction (aOR 2.22 (1.01 to 4.44)). CONCLUSIONS Findings highlight the need to improve HIV testing uptake among men and to improve HIV disclosure among women in heterosexual partnerships. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registration NCT01121692.
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Affiliation(s)
- Irene A Doherty
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - William A Zule
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Alexandra M Minnis
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Tracy L Kline
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Charles D Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Nabila El-Bassel
- Columbia University, School of Social Work, New York, New York, USA
| | - Wendee M Wechsberg
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA Department of Psychology in the Public Interest, North Carolina State University, Raleigh, North Carolina, USA
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17
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Abstract
Many of the over 3 million HIV-positive children will only be told of their status as adolescents. Knowing one's status may increase treatment adherence, reduce onward HIV transmission, increase trust in caregivers and maximise available support. Yet deciding whether, what, how and when to tell HIV-positive children about their condition is challenging for caregivers. We systematically review HIV disclosure theories before presenting a process model of caregiver paediatric HIV disclosure decision-making. The model, consisting of both a pre-intention and a post-intention stage, integrates individual and contextual determinants. It aims to be situationally specific, broadly applicable and consistent with the empirical literature. Research and practice implications are discussed.
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Affiliation(s)
- Michael Evangeli
- a Department of Psychology , Royal Holloway University of London , Egham Hill, Egham, Surrey, TW20 0EX , UK
| | - Ashraf Kagee
- b Department of Psychology , Stellenbosch University , Stellenbosch, Private Bag X1, Matieland, 7602 , South Africa
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