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Anglewicz P, Lamba S, Kohler I, Mwera J, Zulu A, Kohler HP. Is experience of the HIV/AIDS epidemic associated with responses to COVID-19? Evidence from the Rural Malawi. PLoS One 2023; 18:e0292378. [PMID: 37878643 PMCID: PMC10599567 DOI: 10.1371/journal.pone.0292378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/19/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Starting in late 2019, the coronavirus "SARS-CoV-2", which causes the disease Covid-19, spread rapidly and extensively. Although many have speculated that prior experience with infectious diseases like HIV/AIDS, Ebola, or SARS would better prepare populations in sub-Saharan Africa for COVID-19, this has not been formally tested, primarily due to data limitations. METHODS We use longitudinal panel data from the Malawi Longitudinal Study of Families and Health (MLSFH, waves 2006, 2008, and 2020) to examine the association between exposure to the HIV/AIDS epidemic and perceptions of, and behavioral response to, the COVID-19 pandemic. We measured exposure to HIV infection through perceived prevalence of HIV/AIDS in the community, worry about HIV infection, perceived likelihood of HIV infection, and actual HIV status; and the experience of HIV/AIDS-related mortality through self-reports of knowing members of the community and extended family who died from AIDS (measured in 2006 or 2008). Our outcome measures were perceptions of COVID-19 presence in the community, perceptions of individual vulnerability to COVID-19, and prevention strategies to avoid COVID-19 collected through phone-interviews in 2020. RESULTS Based on our data analysis using multivariable regression models, we found that the experience of HIV-related mortality was positively associated with perceptions of COVID-19 prevalence in the community and preventive behaviors for COVID-19. However, perceived vulnerability to HIV-AIDS infection and actual HIV positive status 10-years prior to the COVID-19 pandemic are generally not associated with COVID-19 perceptions and behaviors. CONCLUSIONS Our results suggest that COVID-19-related behaviors are impacted more by experience of AIDS mortality instead of HIV/AIDS risk perceptions, and that individuals may be correctly viewing HIV/AIDS and COVID-19 transmission as distinct disease processes.
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Affiliation(s)
- Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sneha Lamba
- Department of Development Economics and Centre for Modern Indian Studies (CeMIS), University of Göttingen, Waldweg Göttingen, Germany
| | - Iliana Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James Mwera
- Invest in Knowledge Initiative (IKI), Zomba, Malawi
| | - Andrew Zulu
- Invest in Knowledge Initiative (IKI), Zomba, Malawi
| | - Hans-Peter Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Ade-Ojo IP, Dada MU, Adeyanju TB. Comparison of Anxiety and Depression Among HIV-Positive and HIV-Negative Pregnant Women During COVID-19 Pandemic in Ekiti State, Southwest Nigeria. Int J Gen Med 2022; 15:4123-4130. [PMID: 35465305 PMCID: PMC9020505 DOI: 10.2147/ijgm.s362225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Idowu Pius Ade-Ojo
- Department of Obstetrics & Gynecology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
- Correspondence: Idowu Pius Ade-Ojo, Department of Obstetrics & Gynecology, Ekiti State University, PMB 5363, Ado-Ekiti, Ekiti State, Nigeria, Tel +234 8033886173, Email
| | - Mobolaji Usman Dada
- Department of Psychiatry, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
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HIV Prevalence and Associated Factors Among Men in South Africa 30 Years into the Epidemic: The Fifth Nationwide Cross-Sectional Survey. AIDS Behav 2022; 26:986-995. [PMID: 34460028 DOI: 10.1007/s10461-021-03453-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
We investigated HIV prevalence and associated factors among men ≥ 15 years in South Africa using data from a 2017 nationwide cross-sectional survey. HIV prevalence was 10.5% among 6 646 participants. Prevalence increased from 4.1% in the younger men (15-24 years), 12.5% in young men (25-34 years) to 12.7% in older men (≥ 35 years). Odds of being infected with HIV were lower among younger men who had secondary level education and those who reported poor/fair self-rated health. Young and older men of other race groups had lower odds of HIV infection. Odds of infection were lower among young men who had moderate/high exposure to HIV communication programmes. Men not aware of their HIV status had higher odds of HIV infection, including older men who never married. Improved access to education, behavioral change programmes, and awareness of HIV status are necessary to reduce the risk of HIV infection among Black African men.
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Mojola SA, Angotti N, Schatz E, Houle B. "A NOWADAYS DISEASE": HIV/AIDS AND SOCIAL CHANGE IN A RURAL SOUTH AFRICAN COMMUNITY. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2021; 127:950-1000. [PMID: 35967824 PMCID: PMC9365075 DOI: 10.1086/718234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Why do some people adapt successfully to change while others do not? We examine this question in the context of a severe HIV/AIDS epidemic in South Africa, where adapting (or not) to social change has borne life and death consequences. Applying an age-period-cohort lens to the analysis of qualitative life history interviews among middle-aged and older adults, we consider the role of the life course and gendered sexuality in informing Africans' strategies of action, or inaction, and in differentially driving and stalling change in each cohort in response to the HIV/AIDS epidemic. Our study illuminates the unique challenges of adapting to social change that result from dynamic interactions among aging, prevailing social structures, and a cohort's socio-historical orientation to a new period.
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Affiliation(s)
- Sanyu A Mojola
- Princeton University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- American University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Enid Schatz
- University of Missouri Columbia and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Houle
- The Australian National University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Angelucci M, Bennett D. Adverse Selection in the Marriage Market: HIV Testing and Marriage in Rural Malawi. THE REVIEW OF ECONOMIC STUDIES 2021; 88:2119-2148. [PMID: 35662917 PMCID: PMC9165572 DOI: 10.1093/restud/rdaa088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Asymmetric information in the marriage market may cause adverse selection and delay marriage if partner quality is revealed over time. Sexual safety is an important but hidden partner attribute, especially in areas where HIV is endemic. A model of positive assortative matching with both observable (attractiveness) and hidden (sexual safety) attributes predicts that removing the asymmetric information about sexual safety accelerates marriage and pregnancy for safe respondents, and more so if they are also attractive. Frequent HIV testing may enable safe people to signal and screen. Consistent with these predictions, we show that a high-frequency, "opt-out" HIV testing intervention changed beliefs about partner's safety and accelerated marriage and pregnancy, increasing the probabilities of marriage and pregnancy by 26 and 27 percent for baseline-unmarried women over 28 months. Estimates are larger for safe and attractive respondents. Conversely, a single-test intervention lacks these effects, consistent with other HIV testing evaluations in the literature. Our findings suggest that an endogenous response to HIV risk may explain why the HIV/AIDS epidemic has coincided with systematic marriage and pregnancy delays.
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Affiliation(s)
| | - Daniel Bennett
- Center for Economic and Social Research and Dept. of Economics, University of Southern California
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Grubb J, Lopez D, Mohan B, Matta J. Network centrality for the identification of biomarkers in respondent-driven sampling datasets. PLoS One 2021; 16:e0256601. [PMID: 34428228 PMCID: PMC8384166 DOI: 10.1371/journal.pone.0256601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022] Open
Abstract
Networks science techniques are frequently used to provide meaningful insights into the populations underlying medical and social data. This paper examines SATHCAP, a dataset related to HIV and drug use in three US cities. In particular, we use network measures such as betweenness centrality, closeness centrality, and eigenvector centrality to find central, important nodes in a network derived from SATHCAP data. We evaluate the attributes of these important nodes and create an exceptionality score based on the number of nodes that share a particular attribute. This score, along with the underlying network itself, is used to reveal insight into the attributes of groups that can be effectively targeted to slow the spread of disease. Our research confirms a known connection between homelessness and HIV, as well as drug abuse and HIV, and shows support for the theory that individuals without easy access to transportation are more likely to be central to the spread of HIV in urban, high risk populations.
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Affiliation(s)
- Jacob Grubb
- Computer Science Department, Southern Illinois University Edwardsville, Edwardsville, IL, United States of America
| | - Derek Lopez
- Computer Science Department, Southern Illinois University Edwardsville, Edwardsville, IL, United States of America
| | - Bhuvaneshwar Mohan
- Computer Science Department, Southern Illinois University Edwardsville, Edwardsville, IL, United States of America
| | - John Matta
- Computer Science Department, Southern Illinois University Edwardsville, Edwardsville, IL, United States of America
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John BM, Adjiwanou V. Fertility decline in sub-Saharan Africa: Does remarriage matter? Population Studies 2021; 76:213-233. [PMID: 34129806 DOI: 10.1080/00324728.2021.1933148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The interplay between remarriage and fertility is among the most poorly documented subjects in sub-Saharan Africa (SSA), despite remarriage being one of the fundamental aspects of marriage dynamics in this region. We use Demographic and Health Survey data from 34 countries in SSA to document the association between remarriage and fertility during the reproductive years and over the fertility transition. The findings show that in 29 countries, remarried women end up having fewer children than women in intact unions, despite attaining similar or higher levels of fertility at early reproductive ages. However, remarriage is found to have a positive effect on fertility in Sierra Leone. The effects of remarriage on fertility diminish as fertility declines, with smaller effects generally observed in countries that are relatively advanced in their fertility transition and larger effects found elsewhere. These findings shed light on the role that remarriage might play in country-level fertility declines.
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Affiliation(s)
- Ben Malinga John
- Max Planck Institute for Demographic Research.,University of Malawi
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Myroniuk TW, Kohler HP, Kohler IV. Marital dissolutions and changes in mental health: Evidence from rural Malawi. DEMOGRAPHIC RESEARCH 2021; 44:993-1022. [PMID: 36819791 PMCID: PMC9937544 DOI: 10.4054/demres.2021.44.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Advancing efforts to unpack the complex relationship between marital dissolutions and health outcomes increasingly requires assessing the marital histories and health of individuals who have lived long enough to experience divorce or widowhood ‒ or even multiples of each ‒ and measurable changes in health. OBJECTIVE To explore this line of inquiry, we chose a sample from rural Malawi where a high prevalence of marital dissolutions and remarrying exists, as an ideal theoretical foil to the predominant literature found in high-income countries (HICs). We examine if changes in having experienced a marital dissolution, one's total number of dissolutions, and the percentage of one's life spent outside of marriage since first becoming married are associated with changes in mental health. METHODS Our analyses focus on 1,266 respondents aged 45 years and older who participated in the 2012 Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC), linked back to cohort information from 2008 and 2010 available through the MLSFH. Fixed-effects regressions guide our inferences over the 2008, 2010, and 2012 waves of data. RESULTS For men, spending more life outside of marriage is associated with worse mental health, while more marital dissolutions are surprisingly associated with better mental health for women. CONCLUSIONS These results could suggest that larger portions of one's life spent unmarried are associated with a type of role strain for men or simply that men are burdened with taking up tasks that their spouses had previously done in order to survive. For women, many may have gotten out of 'bad' marriages that otherwise would have been detrimental to their mental health and/or those in good mental health are the ones able to remarry. CONTRIBUTIONS Our research from rural Malawi provides a type of litmus test for many HICs where marriage, remarriage, and dissolution rates are lower but quite consequential for mental health outcomes. Measuring time outside of marriage should be more strongly considered in such settings. These results also inform increasingly important research on the relationship between marital dissolutions and mental health in other African nations as noncommunicable diseases play a continually more important role in people's lives.
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Affiliation(s)
- Tyler W Myroniuk
- University of Missouri, Department of Public Health, 825 Lewis Hall, 65211 Columbia, MO, USA
| | - Hans-Peter Kohler
- Population Aging Research Center (PARC) and Department of Sociology, University of Pennsylvania., USA
| | - Iliana V Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, USA
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Exavery A, Charles J, Kuhlik E, Barankena A, Mubyazi GM, Kikoyo L, Jere E. Relationship Between Food Insufficiency and HIV Infection Among Caregivers of Orphans and Vulnerable Children in Tanzania. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:271-282. [PMID: 32801926 PMCID: PMC7399471 DOI: 10.2147/hiv.s255549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
Background Although Tanzania experiences a general decline in HIV prevalence, some populations such as caregivers of orphans may be at a higher risk than the general population, suggesting that infection pathways still need further exploration. This study examines how food insufficiency relates to HIV infection among caregivers of orphans and vulnerable children (OVC) in Tanzania. Data and Methods Data are from a community-based, USAID-funded Kizazi Kipya project that aims at increasing the uptake of HIV services, as well as other health and social services by OVC and their caregivers in Tanzania. Caregivers who were enrolled in the project from January to July 2017 in seven regions of Tanzania, and had reported their HIV status to the project, were included in the analysis. While HIV status was the outcome, the main independent variable was food insufficiency which was assessed using the Household Hunger Scale (HHS). Using Stata (version 14.0; StataCorp LP, College Station, TX, USA), data analysis involved multilevel mixed-effects logistic regression.. Results Of the 47,617 caregivers analyzed (73.7% females), 61.8% and 4.6% were experiencing moderate and severe hunger, respectively. The overall HIV prevalence among the caregivers was 28.3%. Nevertheless, the prevalence was as high as 34.2% among caregivers in severe hunger households. Multivariate analysis revealed an increasing likelihood of being HIV positive as hunger increased (moderate hunger: OR=1.10, 95%CI: 1.03–1.18; severe hunger: OR=1.51, 95%CI: 1.32–1.74). These observations were adjusted for marital status, age, sex, education, place of residence, family size, disability status, and health insurance. Conclusion Food insufficiency is associated with a higher likelihood of HIV infection among OVC caregivers in Tanzania, suggesting that improving access to adequate food has a potential to reduce HIV risks among them. Furthermore, food insufficiency could be considered an important criterion for targeting HIV testing and treatment services to expand coverage.
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Schatz E, Knight L, Belli RF, Mojola SA. Assessing the feasibility of a life history calendar to measure HIV risk and health in older South Africans. PLoS One 2020; 15:e0226024. [PMID: 31940307 PMCID: PMC6961824 DOI: 10.1371/journal.pone.0226024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/19/2019] [Indexed: 11/18/2022] Open
Abstract
Life history calendars capture patterns of behavior over time, uncovering transitions and trajectories. Despite the growing numbers of older persons living with HIV in southern Africa, little is known about how HIV testing and risk unfold in this population. Operationalizing a life course approach with the use of an innovative Testing and Risk History Calendar [TRHC], we collected pilot data on older South Africans' risk and HIV testing. We found older persons were able to provide (1) reference points to facilitate recall over a 10-year period, (2) specifics about HIV tests during that decade, and (3) details that contextualize the testing data, such as living arrangements, relationships, and health status. Interviewer debriefing sessions after each interview captured information on context and links across domains. On a larger scale, the TRHC has potential to reveal pathways between sexual behavior, HIV testing and risk perception, and health at older ages.
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Affiliation(s)
- Enid Schatz
- Department of Public Health, University of Missouri, Columbia, Missouri, United States of America
- MRC/Wits Rural Health and Health Transitions Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Knight
- School of Public Health, University of the Western Cape, Belville, South Africa
| | - Robert F. Belli
- Department of Psychology, University of Nebraska, Lincoln, Nebraska, United States of America
| | - Sanyu A. Mojola
- Department of Sociology, Princeton University, Princeton, New Jersey, United States of America
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America
- Office of Population Research, Princeton University, Princeton, New Jersey, United States of America
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HIV prevalence in South Africa through gender and racial lenses: results from the 2012 population-based national household survey. Int J Equity Health 2019; 18:167. [PMID: 31666077 PMCID: PMC6821038 DOI: 10.1186/s12939-019-1055-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background In South Africa, persistence of the HIV epidemic and associated gender and racial disparities is a major concern after more than 20 years of democratic dispensation and efforts to create a more healthy and equal society. This paper profiles HIV prevalence and related factors among Black African men and women compared to other race groups in South Africa using the 2012 population-based national household HIV survey. Methods This secondary data analysis was based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Bivariate and multiple logistic regression analysis were used to assess the relationship between HIV prevalence and associated factors by gender and racial profile. Results Overall HIV prevalence was significantly higher (p < 0.001) among both Black African males (16.6%; 95% CI: 15.0–18.4) and females (24.1%; 95% CI: 22.4–26.0) compared to their counterparts from other races. Among Black African males, increased risk of HIV was significantly associated with age group 25–49 years and those 50 years and older compared with young males 15–25 years. Among all males, reported condom use at last sex was significantly associated with increased risk of HIV. High socio-economic status (SES) and perceived risk of HIV were associated with a decreased risk of HIV. Among female condom use at last sex and ever testing for HIV was associated with increased prevalence of HIV only among Black African females. Lower prevalence of HIV was associated with marriage, tertiary education, high SES, having a partner five years younger, perceived risk of HIV, and awareness of HIV status among Black African females. Conclusion Gender and racial disparities rooted in structural and contextual inequalities remain important factors for the maintenance of the generalized HIV epidemic in the country. HIV prevention interventions need to cut across all strata of society but also target risk factors salient for specific groups. Alleviating vulnerability to HIV along gender and racial lines should also be viewed as part of a broader public health strategy.
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12
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Molotsky A. Income Shocks and Partnership Formation: Evidence from Malawi. Stud Fam Plann 2019; 50:219-242. [PMID: 31318060 DOI: 10.1111/sifp.12099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Abstract
The ever-increasing prevalence of negative shocks experienced by poor, vulnerable households often induces extreme measures as ways to recover from the negative effects on income. Child marriage is one of the coping mechanisms households may use. This study examines whether young people in households that experience a negative shock are more likely to marry than those not experiencing a shock, and whether this effect differs by lineage system. I show that marrying off daughters is, in fact, a coping mechanism used by patrilineal households after experiencing a shock and that these effects are potentially strongest for young women who are already out of school. Conversely, I find no significant effect for young men. Additionally, I find suggestive evidence of an increased likelihood of young women engaging in transactional sexual relationships after a shock as an individual-level coping mechanism. Understanding the mechanisms leading to the increased incidence of these phenomena provides valuable information that can help combat such practices.
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Mojola SA, Wamoyi J. Contextual drivers of HIV risk among young African women. J Int AIDS Soc 2019; 22 Suppl 4:e25302. [PMID: 31328409 PMCID: PMC6643074 DOI: 10.1002/jia2.25302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 05/10/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Significant progress has been made in the African HIV pandemic; however, the pace of incidence decline has slowed or stalled in many East and Southern African countries, especially among young women. This stall is worrying because many countries have burgeoning youth populations. There is an important window of opportunity to halt the epidemic as well as the potential for millions more infections if primary prevention efforts are not strengthened. DISCUSSION Many hyper-endemic settings have been exposed to numerous interventions; however, HIV incidence among young women has remained high. In this paper, we characterize the intervention context and examine how it can be strategically utilized to maximize HIV prevention interventions among young women. We begin by examining how contextual dynamics drive HIV risk. We illustrate how epidemiological contexts, gendered normative and economic contexts, and environmental contexts work synergistically to make young women especially vulnerable to HIV infection. We then examine how these contexts can undermine HIV prevention interventions. Finally, we discuss the importance of fully mapping out the intervention context to enhance the effectiveness of HIV prevention interventions. CONCLUSIONS Understanding an intervention context, and how its features work together to amplify young women's risk in hyper-endemic settings can contribute to sustained momentum in reducing HIV incidence among young women and help to limit the reach of the HIV pandemic into new generations of Africans.
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Affiliation(s)
- Sanyu A Mojola
- Department of Sociology and Woodrow Wilson School of Public and International AffairsPrinceton UniversityPrincetonNJUSA
| | - Joyce Wamoyi
- Department of Sexual and Reproductive HealthNational Medical Research InstituteMwanzaTanzania
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Houle B, Mojola SA, Angotti N, Schatz E, Gómez-Olivé FX, Clark SJ, Williams J, Kabudula C, Tollman S, Menken J. Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons. AIDS Care 2018; 30:1435-1443. [PMID: 29701073 PMCID: PMC6150786 DOI: 10.1080/09540121.2018.1468008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is limited information about sexual behavior among older Africans, which is problematic given high HIV rates among older adults. We use a population-based survey among people aged 15-80+ to examine the prevalence of sexual risk and protective behaviors in the context of a severe HIV epidemic. We focus on variation across the life course, gender and HIV serostatus to compare the similarities and differences of young, middle aged, and older adults. Younger adults continue to be at risk of HIV, with potential partners being more likely to have been diagnosed with an STI and more likely to have HIV, partner change is high, and condom use is low. Middle aged and older adults engage in sexual behavior that makes them vulnerable at older ages, including extramarital sex, low condom use, and cross-generational sex with people in age groups with the highest rates of HIV. We find insignificant differences between HIV positive and negative adults' reports of recent sexual activity. This study provides new information on sexual behavior and HIV risk across the life course in rural South Africa to inform HIV prevention and treatment programing.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
| | - Sanyu A. Mojola
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- Department of Sociology, University of Colorado Boulder, Boulder, Colorado, United States
| | - Nicole Angotti
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- Department of Sociology and Center on Health, Risk and Society, American University, Washington, D.C., United States
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- Department of Health Sciences, University of Missouri, Columbia, Missouri, United States
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Samuel J. Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
- INDEPTH Network, Accra, Ghana
- Department of Sociology, The Ohio State University, Columbus, Ohio, United States
- ALPHA Network, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jill Williams
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Public Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jane Menken
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado, United States
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Agadjanian V, Hayford SR. Men's Migration, Women's Autonomy, and Union Dissolution in Rural Mozambique. JOURNAL OF FAMILY ISSUES 2018; 39:1236-1257. [PMID: 31395999 PMCID: PMC6687330 DOI: 10.1177/0192513x17698184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Victor Agadjanian
- Corresponding author, Professor, Department of Sociology, UCLA, Los Angeles, CA 90095; phone: 310-2674943;
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Yang Y, Thapa R, Lewis FM. "I Am a Good Example": Suggestions From HIV-Infected Cambodians for Preventing HIV Infection in Marital Relationships. J Assoc Nurses AIDS Care 2018; 29:592-603. [PMID: 29500097 DOI: 10.1016/j.jana.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022]
Abstract
Developing effective and influential messages for HIV prevention in marriage has been difficult. We explored couple-based HIV prevention measures that would be socially and culturally suitable for Cambodia. Thirty in-depth qualitative interviews were conducted with people living with HIV in the local Khmer language. Using thematic analysis, codes and themes were generated to get to the meanings of participant data. Male and female suggestions were analyzed together, and four themes emerged: (a) Safer practices, (b) Trustworthy relationships, (c) Sexual variety, and (d) Exemplar. Premarital HIV testing, grooming oneself, sexual variety within a married relationship, monogamy, and sex education for teenagers were significant suggestions derived from participant input about protecting spouses from HIV infection. The explained strategies illustrated the importance of gender-based prevention programs in Cambodia and provided insight about needed and possible interventions to prevent HIV transmission within marriage.
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Abstract
A growing body of literature has examined the impact of different types of family structures on children's schooling in sub-Saharan Africa. These studies have investigated how living arrangements, gender of the household head, parental death, and paternal migration are related to schooling. Although many sub-Saharan African countries have high divorce rates, very few studies have explored the impact of parental divorce on children's schooling. The present study uses three waves of data from the Malawi Longitudinal Study of Families and Health (MLSFH) to investigate the effect of parental divorce on children's schooling and the possible mechanisms driving this relationship. Unlike prior studies, this study uses child-level fixed-effects models to control for selection into divorce. Results show that parental divorce is associated with lower grade attainment and a larger schooling gap, defined as the number of years a child is behind in school (among children currently attending school). Although no association exists between parental divorce and current school attendance, girls affected by divorce are significantly less likely to be attending school. Differences in economic resources, maternal coresidence, or maternal psychological well-being do not explain the relationship between parental divorce and children's schooling.
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Affiliation(s)
- Sophia Chae
- Guttmacher Institute, 125 Maiden Lane, New York, NY, 10038, USA.
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Smith-Greenaway E, Clark S. Variation in the link between parental divorce and children's health disadvantage in low and high divorce settings. SSM Popul Health 2017; 3:473-486. [PMID: 28890915 PMCID: PMC5589346 DOI: 10.1016/j.ssmph.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Like in other world regions, children with divorced parents in sub-Saharan Africa experience significant heath disadvantages relative to their peers with married parents. Preliminary evidence suggests this disadvantage may not be uniform across the subcontinent's diverse settings. Research from other world regions shows that the childhood health consequences of divorce vary across different contexts. Specifically, we hypothesize that the childhood disadvantages associated with divorce are more severe in regions of sub-Saharan Africa where divorce is rare, and less so where divorce is a more common family experience. Using Demographic and Health Survey data from 290 subnational regions within 31 sub-Saharan African countries, multilevel models document the previously shown link between having a divorced mother and child morbidity and mortality. The study results further demonstrate that the childhood health disadvantage is accentuated in subnational African regions where fewer women are divorced and muted in areas where more women are divorced. The findings demonstrate that the broader context can powerfully moderate childhood health inequalities traditionally thought of as operating at the family or individual level.
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Myroniuk TW. Marital Dissolutions and the Health of Older Individuals in a Rural African Context. J Gerontol B Psychol Sci Soc Sci 2017; 72:656-664. [PMID: 27382043 PMCID: PMC5927165 DOI: 10.1093/geronb/gbw077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Research from high-income countries has often found a negative relationship between marital dissolutions and health. This paper assesses that relationship among older sub-Saharan Africans, on a now-aging continent. Such individuals are likely to be at risk of a dissolution, or have already experienced one, due to high rates of marriage. METHODS Data from over 1,200 rural Malawians, age 45+, are employed from the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health. Cross-sectional and lagged dependent variable regressions examine the relationship between marital dissolutions and 4 measures of self-reported health: retrospective health, relative health (compared with others in one's village), and age-standardized SF-12 mental and physical health scales. RESULTS Worse relative, mental, and physical health are associated with being currently divorced/widowed compared with being married. However, worse retrospective health is linked to becoming divorced/widowed between 2008 and 2010. Those divorced/widowed prior to 2008, and who remained so through 2010, are in worse relative and physical health. DISCUSSION The findings question the relative hardship of marital dissolutions for those who have managed to survive into old age, and call for the collection of more detailed longitudinal data on older Africans on this topic.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Sociology and Anthropology, George Mason University, Fairfax, Virginia
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20
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Yang Y, Thai S. Sociocultural Influences on the Transmission of HIV From Husbands to Wives in Cambodia: The Male Point of View. Am J Mens Health 2017; 11:845-854. [PMID: 28128012 PMCID: PMC5675348 DOI: 10.1177/1557988317690079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of the study was to explore, within cultural and societal contexts, the factors of spousal HIV transmission as described by the experiences of HIV-positive Cambodian men. Using qualitative research methods, the researchers collected data from in-depth interviews with 15 HIV-positive Cambodian men of seroconcordant couples recruited from an HIV/AIDS clinic in Phnom Penh. Using a model of HIV transmission from husbands to wives, the questions were designed to elicit the men’s perspectives on the topics of promiscuity, masculinity, condom use in marriage, the image of the ideal Cambodian woman, and attitudes toward sex and marriage. Directed content analysis was used to analyze the interview data. The main results were as follows: (a) men involved with sex workers perceived this as a natural behavior and a necessary part of being an approved member in a male peer group, (b) married men never used condoms during sex with their wives prior to their HIV diagnosis, (c) men perceived a good wife as one who is diligent and loyal to her husband, and (4) men’s attitudes toward sex and marriage (e.g., sex perceived as a part of life pleasure) differed from those of their wives. Promoting honest spousal communication about sexuality, maintaining men’s marital fidelity, and increasing women’s comfort in the use of sexual techniques are suggested as strategies for reducing HIV transmission within marriage in Cambodia. Future interventions should focus on reshaping men’s behaviors and changing cultural norms to protect them and their spouses from HIV infection.
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Affiliation(s)
- Youngran Yang
- 1 Chonbuk National University, Jeonju, Republic of Korea
| | - Sopheak Thai
- 2 Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
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Sia D, Onadja Y, Hajizadeh M, Heymann SJ, Brewer TF, Nandi A. What explains gender inequalities in HIV/AIDS prevalence in sub-Saharan Africa? Evidence from the demographic and health surveys. BMC Public Health 2016; 16:1136. [PMID: 27809824 PMCID: PMC5095963 DOI: 10.1186/s12889-016-3783-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Women are disproportionally affected by human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa (SSA). The determinants of gender inequality in HIV/AIDS may vary across countries and require country-specific interventions to address them. This study aimed to identify the socio-demographic and behavioral characteristics underlying gender inequalities in HIV/AIDS in 21 SSA countries. METHODS We applied an extension of the Blinder-Oaxaca decomposition approach to data from Demographic and Health Surveys and AIDS Indicator Surveys to quantify the differences in HIV/AIDS prevalence between women and men attributable to socio-demographic factors, sexual behaviours, and awareness of HIV/AIDS. We decomposed gender inequalities into two components: the percentage attributable to different levels of the risk factors between women and men (the "composition effect") and the percentage attributable to risk factors having differential effects on HIV/AIDS prevalence in women and men (the "response effect"). RESULTS Descriptive analyses showed that the difference between women and men in HIV/AIDS prevalence varied from a low of 0.68 % (P = 0.008) in Liberia to a high of 11.5 % (P < 0.001) in Swaziland. The decomposition analysis showed that 84 % (P < 0.001) and 92 % (P < 0.001) of the higher prevalence of HIV/AIDS among women in Uganda and Ghana, respectively, was explained by the different distributions of HIV/AIDS risk factors, particularly age at first sex between women and men. In the majority of countries, however, observed gender inequalities in HIV/AIDS were chiefly explained by differences in the responses to risk factors; the differential effects of age, marital status and occupation on prevalence of HIV/AIDS for women and men were among the significant contributors to this component. In Cameroon, Guinea, Malawi and Swaziland, a combination of the composition and response effects explained gender inequalities in HIV/AIDS prevalence. CONCLUSIONS The factors that explain gender inequality in HIV/AIDS in SSA vary by country, suggesting that country-specific interventions are needed. Unmeasured factors also contributed substantially to the difference in HIV/AIDS prevalence between women and men, highlighting the need for further study.
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Affiliation(s)
- Drissa Sia
- Département des sciences infirmières, Campus de Saint-Jérôme, Université du Québec en Outaouais, 5, rue Saint-Joseph, bureau J-3226, Saint Jérôme, Québec, J7Z 0B7, Canada.
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Ouaga I Pr Joseph Ki-Zerbo, 03 BP 7118 Ouagadougou 03, Ouagadougou, Burkina Faso
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Jody Heymann
- Fielding School of Public Health, The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Timothy F Brewer
- David Geffen School of Medicine, The University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
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Transition to Parenthood and HIV Infection in Rural Zimbabwe. PLoS One 2016; 11:e0163730. [PMID: 27684998 PMCID: PMC5042509 DOI: 10.1371/journal.pone.0163730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The relationship between the risk of acquiring human immunodeficiency virus (HIV) infection and people's choices about life course events describing the transition to parenthood-sexual debut, union (in the form of marriage, cohabitation, or long-term relationship), and parenthood-is still unclear. A crucial role in shaping this relationship may be played by the sequence of these events and by their timing. This suggests the opportunity to focus on the life courses in their entirety rather than on the specific events, thus adopting a holistic approach that regards each individual's life course trajectory as a whole. METHODS We summarise the individual life courses describing the transition to parenthood using ordered sequences of the three considered events. We aim to (i) investigate the association between the sequences and HIV infection, and (ii) understand how these sequences interact with known mechanisms for HIV transmission, such as the length of sexual exposure and the experience of non-regular sexual partnerships. For this purpose, we use data from a general population cohort study run in Manicaland (Zimbabwe), a Sub-Saharan African area characterised by high HIV prevalence. RESULTS For both genders, individuals who experienced either premarital or delayed childbearing have higher HIV risk compared to individuals following more standard transitions. This can be explained by the interplay of the sequences with known HIV proximate determinants, e.g., a longer exposure to sexual activity and higher rates of premarital sex. Moreover, we found that people in the younger birth cohorts experience more normative and safer sequences. CONCLUSIONS The shift of younger generations towards more normative transitions to parenthood is a sign of behaviour change that might have contributed to the observed reduction in HIV prevalence in the area. On the other hand, for people with less normative transitions, targeted strategies are essential for HIV prevention.
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Furnas HE. Capturing Complexities of Relationship-Level Family Planning Trajectories in Malawi. Stud Fam Plann 2016; 47:205-21. [PMID: 27517867 DOI: 10.1111/j.1728-4465.2016.00064.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In a transitioning fertility climate, preferences and decisions surrounding family planning are constantly in flux. Malawi provides an ideal case study of family planning complexities as fertility preferences are flexible, the relationship context is unstable, and childbearing begins early. I use intensive longitudinal data from Tsogolo la Thanzi-a research project in Malawi that follows young adults in romantic partnerships through the course of their relationship. I examine two questions: (1) What are the typical patterns of family planning as young adults transition through a relationship? (2) How are family planning trajectories related to individual and relationship-level characteristics? I use sequence analysis to order family planning across time and to contextualize it within each relationship. I generate and cluster the family planning trajectories and find six distinct groups of young adults who engage in family planning in similar ways. I find that family planning is complex, dynamic, and unique to each relationship. I argue that (a) family planning research should use the relationship as the unit of analysis and (b) family planning behaviors and preferences should be sequenced over time for a better understanding of key concepts, such as unmet need.
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Affiliation(s)
- Hannah E Furnas
- The Pennsylvania State University, 211 Oswald Tower, Department of Sociology and Criminology and Population Research Institute, University Park, PA 16802.
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24
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Grant MJ, Soler-Hampejsek E. HIV Risk Perceptions, the Transition to Marriage, and Divorce in Southern Malawi. Stud Fam Plann 2016; 45:315-37. [PMID: 25207495 DOI: 10.1111/j.1728-4465.2014.00394.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Little is known about whether the timing of marriage is used as a strategy to avoid HIV infection among young people in sub-Saharan Africa. Analyzing five rounds of longitudinal data from the Malawi Schooling and Adolescent Survey, we do not find support for the hypothesis that young women's perceived chances of future HIV infection are associated with the transition to marriage, but we do find evidence that young married women who see themselves as at risk of future infection have a greater likelihood of divorcing than do women who perceive no chance of future infection. We also use individual-level fixed-effects regressions to examine how the transition to marriage affects respondents' expectations of future HIV infection. Respondents are consistently more likely to perceive any chance of future HIV infection in the years following marriage than in the years preceding it. Our findings suggest that young women revise their risk perceptions based on their marital experiences and that divorce may serve as a protective strategy for young married women concerned about their chance of future HIV infection.
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Affiliation(s)
- Monica J Grant
- Assistant Professor, Department of Sociology, 8128 William H. Sewell Social Science Building, 1180 Observatory Drive, University of Wisconsin, Madison, WI 53703..
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25
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Weitzman A. Do Fathers' Sexual Behaviors Vary with the Sex of Firstborns? Evidence from 37 Countries. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2015; 56:495-513. [PMID: 26646743 DOI: 10.1177/0022146515611732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article investigates whether men's sexual behavior is influenced by the sex of their firstborn children and, if so, at what stage of firstborns' development this occurs. Using standardized data from 37 Demographic and Health Surveys (N = 61,801), I compare the sexual activities, sexually transmitted infection symptoms, and sexual ideologies of fathers with firstborn sons and fathers with firstborn daughters. I also explore whether fathers' attitudes mediate the effects of firstborn sex. The findings indicate that fathers with firstborn sons are less likely to report using condoms and more likely to report paying for sex and having genital ulcers than fathers with firstborn daughters. These differences are limited to the firstborn's adolescent years and are slightly mediated by attitudinal differences. Together, these results raise new questions about the underlying mechanisms linking men's sexual behavior to their children's gendered development.
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Fedor TM, Kohler HP, Behrman JR. The Impact of Married Individuals Learning HIV Status in Malawi: Divorce, Number of Sexual Partners, and Condom Use With Spouses. Demography 2015; 52:259-80. [PMID: 25582891 DOI: 10.1007/s13524-014-0364-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This article assesses how married individuals' knowledge of HIV status gained through HIV testing and counseling (HTC) affects divorce, the number of sexual partners, and the use of condoms within marriage. This study improves upon previous studies on this topic because the randomized incentives affecting the propensity to be tested for HIV permit control for selective testing. Instrumental variable probit and linear models are estimated, using a randomized experiment administered as part of the Malawi Longitudinal Study of Families and Health (MLSFH). The results indicate that knowledge of HIV status (1) does not affect chances of divorce for either HIV-negative or HIV-positive respondents; (2) reduces the number of reported sexual partners among HIV-positive respondents; and (3) increases reported condom use with spouses for both HIV-negative and HIV-positive respondents. These results imply that individuals actively respond to information about their HIV status that they learn during HTC, invoking protective behavior against future risk of HIV/AIDS for themselves and their actual and potential sexual partners. Some limitations of this study are a small sample size for those who are HIV-positive and dependence on self-reported sexual behaviors.
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Affiliation(s)
- Theresa M Fedor
- University of Pennsylvania, 3718 Locust Walk, 266 McNeil Building, Philadelphia, PA, 19104-6298, USA,
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27
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Sexual networks, partnership mixing, and the female-to-male ratio of HIV infections in generalized epidemics. DEMOGRAPHIC RESEARCH 2015. [DOI: 10.4054/demres.2015.33.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Although parents might not live with their children for a variety of reasons, existing accounts of parental absence often examine one cause in isolation. Using detailed longitudinal demographic surveillance data from Rufiji, Tanzania, this article examines parental absence due to death, migration, child relocation, union dissolution, and union formation from 2001-2011. Employing survival analysis, the article quantifies children's risk of absence by cause and investigates sociodemographic variation in this risk. Of children born into two-parent households, 25% experience maternal absence by age 10, and 40% experience paternal absence by the same age. Roughly one-quarter of children are born into single-mother families with an absent father at birth, and nearly 70% of these children experience maternal absence as well by age 10. Despite the emphasis on orphanhood in the research and policy communities, parental death is the least common cause of absence. Furthermore, although demographic and socioeconomic characteristics are strong predictors of absence, variation in these relationships across causes underscores the distinctiveness and similarity of different reasons for absence.
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Affiliation(s)
- Lauren Gaydosh
- Department of Sociology and Office of Population Research, Princeton University, 227 Wallace Hall, Princeton, NJ, 08544, USA,
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SURPRISING RESULTS: HIV TESTING AND CHANGES IN CONTRACEPTIVE PRACTICES AMONG YOUNG WOMEN IN MALAWI. J Biosoc Sci 2015; 48:174-91. [PMID: 26160156 DOI: 10.1017/s002193201500022x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study uses eight waves of data from the population-based Tsogolo la Thanzi study (2009-2011) in rural Malawi to examine changes in young women's contraceptive practices, including the use of condoms, non-barrier contraceptive methods and abstinence, following positive and negative HIV tests. The analysis factors in women's prior perceptions of their HIV status that may already be shaping their behaviour and separates surprise HIV test results from those that merely confirm what was already believed. Fixed-effects logistic regression models show that HIV testing frequently affects the contraceptive practices of young Malawian women, particularly when the test yields an unexpected result. Specifically, women who are surprised to test HIV positive increase their condom use and are more likely to use condoms consistently. Following an HIV-negative test (whether a surprise or expected), women increase their use of condoms and decrease their use of non-barrier contraceptives; the latter may be due to an increase in abstinence following a surprise negative result. Changes in condom use following HIV testing are robust to the inclusion of potential explanatory mechanisms, including fertility preferences, relationship status and the perception that a partner is HIV positive. The results demonstrate that both positive and negative tests can influence women's sexual and reproductive behaviours, and emphasize the importance of conceptualizing of HIV testing as offering new information only insofar as results deviate from prior perceptions of HIV status.
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Gummerson E. Have the educated changed HIV risk behaviours more in Africa? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 12:161-72. [PMID: 25860322 DOI: 10.2989/16085906.2013.863216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Theory predicts that when new health information becomes available, more educated individuals may adopt healthy behaviours sooner, resulting in lower morbidity and mortality among the highly educated. This may be the case for HIV in sub-Saharan Africa: Recent empirical work shows that incidence is falling and the reduction is concentrated in more educated populations. However, it is unclear whether the educated have indeed adopted HIV risk-reducing behaviours to a greater extent than the less educated. I used two rounds of demographic and health surveys (DHS) in eight African countries to examine whether HIV-related behavioural change over time is greater among the more highly educated. I examined changes in condom use, age of marriage, number of partners, extramarital partnerships, and HIV testing. Results showed that education has a robust positive association with condom use and HIV testing, but also with having more sexual partners. I found that the probability of HIV testing increased more between rounds among the more educated, relative to the less educated. More educated men also appeared to have larger reductions in the number of sexual partners and there was evidence that younger, more educated women may be marrying earlier than their predecessors did. The education gradient did not change significantly over time for condom use. These changes in behaviour may signal a shift in the future burden of the epidemic towards more marginalised and less educated populations.
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Affiliation(s)
- Elizabeth Gummerson
- a Centre for Social Science Research, Leslie Social Sciences Building , University of Cape Town , Rondebosch , South Africa Author's
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Mugweni E, Omar M, Pearson S. Understanding barriers to safer sex practice in Zimbabwean marriages: implications for future HIV prevention interventions. HEALTH EDUCATION RESEARCH 2015; 30:388-399. [PMID: 25503579 DOI: 10.1093/her/cyu073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
Against the backdrop of high human immunodeficiency virus (HIV) prevalence in stable relationships in Southern Africa, our study presents sociocultural barriers to safer sex practice in Zimbabwean marriages. We conducted 36 in-depth interviews and four focus group discussions with married men and women in Zimbabwe in 2008. Our aim was to identify barriers faced by married women when negotiating for safer sex. Participants identified individual, relational and community-level barriers. Individual level barriers made women voiceless to negotiate for safer sex. Being voiceless emanated from lack sexual decision-making power, economic dependence, low self-efficacy or fear of actual or perceived consequences of negotiating for safer sex. Relational barriers included trust and self-disclosure. At the community level, extended family members and religious leaders were said to explicitly or implicitly discourage women's safer sex negotiation. Given the complexity and multi-levelled nature of barriers affecting sexual behaviour in marriage, our findings suggest that HIV prevention interventions targeted at married women would benefit from empowering individual women, couples and also addressing the wider community.
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Affiliation(s)
- Esther Mugweni
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Mayeh Omar
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
| | - Stephen Pearson
- Department of Infection and Population Health, University College London, Mortimer Market Centre off Capper Street, London WC1E 6JB, UK and Nuffield Centre for International Health and Development, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK
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Anglewicz P, Reniers G. HIV status, gender, and marriage dynamics among adults in Rural Malawi. Stud Fam Plann 2015; 45:415-28. [PMID: 25469927 DOI: 10.1111/j.1728-4465.2014.00005.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Awareness of and responses to HIV health risks stemming from relations between sexual partners have been well documented in sub-Saharan Africa, but few studies have estimated the effects of observed HIV status on marriage decisions and outcomes. We study marriage dissolution and remarriage in rural Malawi using longitudinal data with repeated HIV and marital status measurements. Results indicate that HIV-positive individuals face greater risks of union dissolution (via both widowhood and divorce) and lower remarriage rates. Modeling studies suggest that the exclusion of HIV-positive individuals from the marriage or partnership pools will reduce the spread of HIV.
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Affiliation(s)
- Philip Anglewicz
- Assistant Professor, Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112..
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Trinitapoli J, Richou C. Sida et vie religieuse au Malawi : repenser l’influence de la dynamique démographique sur les comportements culturels. POPULATION 2015. [DOI: 10.3917/popu.1502.0265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3-14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children's current foster homes offers new insights into the reasons children are sent to live with others besides their parents.
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Affiliation(s)
- Monica J Grant
- Department of Sociology, Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, USA,
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Kwena ZA, Mwanzo IJ, Bukusi EA, Achiro LF, Shisanya CA. A cross-sectional survey of prevalence and correlates of couple sexual concurrency among married couples in fishing communities along Lake Victoria in Kisumu, Kenya. Sex Transm Infect 2014; 90:139-44. [PMID: 24154655 PMCID: PMC5608652 DOI: 10.1136/sextrans-2013-051168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Sexual concurrency has been associated with HIV infection. Since HIV in sub-Saharan Africa is mostly spread within the context of heterosexual couples, it is necessary that intervention is focused on such couples. We sought to establish the correlates of couple sexual concurrency in Kisumu, Kenya. METHODS We conducted 1090 gender-matched interviews in 545 couples in a cross-sectional survey. A random sample of fishermen and their spouses from 33 fish-landing beaches along the shores of Lake Victoria in Kisumu were asked to enrol in the study. Couples were separated into different private rooms for simultaneous interviews that documented socioeconomic and behavioural characteristics, and information on number of sexual partnerships in the preceding 6 months and their status. Based on reported concurrency status of the spouses, a couple was categorised as either concurrent when at least one spouse reported a concurrent sexual relationship or non-concurrent. RESULTS Overall, 32.1% of the men and 6.2% of the women had concurrent sexual relationships in the 6 months preceding the study, resulting in 37.6% of the couples being sexually concurrent. Unmet sexual desire, intra-spousal suspicions of infidelity, male dominance scripts, domestic violence, couples' children and women's age were the correlates of couple sexual concurrency. CONCLUSIONS Unmet sexual desires, inter-spousal infidelity suspicions, male dominance scripts and domestic violence were the main correlates of couple sexual concurrency in these fishing communities.
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Affiliation(s)
- Zachary A Kwena
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Isaac J Mwanzo
- Department of Community Health, Kenyatta University, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lilian F Achiro
- Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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Abstract
BACKGROUND Marriage histories are a valuable data source for investigating nuptiality. While researchers typically acknowledge the problems associated with their use, it is unknown to what extent these problems occur and how marriage analyses are affected. OBJECTIVE This paper seeks to investigate the quality of marriage histories by measuring levels of misreporting, examining the characteristics associated with misreporting, and assessing whether misreporting biases marriage indicators. METHODS Using data from the Malawi Longitudinal Study of Families and Health (MLSFH), I compare marriage histories reported by the same respondents at two different points in time. I investigate whether respondents consistently report their spouses (by name), status of marriage, and dates of marriage. I use multivariate regression models to investigate the characteristics associated with misreporting. Finally, I examine whether misreporting marriages and marriage dates affects marriage indicators. RESULTS Results indicate that 28.3% of men and 17.9% of women omitted at least one marriage in one of the survey waves. Multivariate regression models show that misreporting is not random: marriage, individual, interviewer, and survey characteristics are associated with marriage omission and marriage date inconsistencies. Misreporting also affects marriage indicators. CONCLUSIONS This is the first study of its kind to examine the reliability of marriage histories collected in the context of Sub-Saharan Africa. Although marriage histories are frequently used to study marriage dynamics, until now no knowledge has existed on the degree of misreporting. Misreporting in marriage histories is shown to be non-negligent and could potentially affect analyses.
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Sia D, Onadja Y, Nandi A, Foro A, Brewer T. What lies behind gender inequalities in HIV/AIDS in sub-Saharan African countries: evidence from Kenya, Lesotho and Tanzania. Health Policy Plan 2013; 29:938-49. [PMID: 24345343 DOI: 10.1093/heapol/czt075] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Within sub-Saharan Africa, women are disproportionately at risk for acquiring and having human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). It is important to clarify whether gender inequalities in HIV prevalence in this region are explained by differences in the distributions of HIV risk factors, differences in the effects of these risk factors or some combination of both. We used an extension of the Blinder-Oaxaca decomposition approach to explain gender inequalities in HIV/AIDS in Kenya, Lesotho and Tanzania using data from the demographic and health and AIDS indicator surveys. After adjusting for covariates using Poisson regression models, female gender was associated with a higher prevalence of HIV/AIDS in Kenya [prevalence ratio (PR) = 1.73, 95% confidence interval (CI) = 1.33, 2.23 in 2003] and Lesotho (PR = 1.39, 95% CI = 1.20, 1.62 in 2004/05), but not in Tanzania. Decomposition analyses demonstrated two distinct patterns over time. In Tanzania, the gender inequality in HIV/AIDS was explained by differences in the distributions of HIV risk factors between men and women. In contrast, in Kenya and Lesotho, this inequality was partly explained by differences in the effects across men and women of measured HIV/AIDS risk factors, including socio-demographic characteristics (age and marital status) and sexual behaviours (age at first sex); these results imply that gender inequalities in HIV/AIDS would persist in Kenya and Lesotho even if men and women had similar distributions of HIV risk factors. The production of gender inequalities may vary across countries, with inequalities attributable to the unequal distribution of risk factors among men and women in some countries and the differential effect of these factors between groups in others. These different patterns have important implications for policies to reduce gender inequalities in HIV/AIDS.
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Affiliation(s)
- Drissa Sia
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montréal, QC, H3A 1A3, Canada, Department of Demography, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3C 3J7, Canada, École Nationale D'adminstration Publique, 4750 avenue Henri-Julien, 5e étage, Montréal, QC, H2T 3E5, Canada and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
| | - Yentéma Onadja
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montréal, QC, H3A 1A3, Canada, Department of Demography, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3C 3J7, Canada, École Nationale D'adminstration Publique, 4750 avenue Henri-Julien, 5e étage, Montréal, QC, H2T 3E5, Canada and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
| | - Arijit Nandi
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montréal, QC, H3A 1A3, Canada, Department of Demography, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3C 3J7, Canada, École Nationale D'adminstration Publique, 4750 avenue Henri-Julien, 5e étage, Montréal, QC, H2T 3E5, Canada and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
| | - Anne Foro
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montréal, QC, H3A 1A3, Canada, Department of Demography, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3C 3J7, Canada, École Nationale D'adminstration Publique, 4750 avenue Henri-Julien, 5e étage, Montréal, QC, H2T 3E5, Canada and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
| | - Timothy Brewer
- Institute for Health and Social Policy, McGill University, 1130 Pine Avenue West, Montréal, QC, H3A 1A3, Canada, Department of Demography, Université de Montréal, 3150 rue Jean-Brillant, Montréal, QC, H3C 3J7, Canada, École Nationale D'adminstration Publique, 4750 avenue Henri-Julien, 5e étage, Montréal, QC, H2T 3E5, Canada and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada
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Masquelier B, Reniers G, Pison G. Divergences in trends in child and adult mortality in sub-Saharan Africa: survey evidence on the survival of children and siblings. Population Studies 2013; 68:161-77. [PMID: 24303913 DOI: 10.1080/00324728.2013.856458] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper provides an overview of trends in mortality in children aged under 5 and adults between the ages of 15 and 60 in sub-Saharan Africa, using data on the survival of the children and siblings collected in Demographic and Health Surveys. If conspicuous stalls in the 1990s are disregarded, child mortality levels have generally declined and converged over the last 30-40 years. In contrast, adult mortality in many East and Southern African countries has increased markedly, echoing earlier increases in the incidence of HIV. In recent years, adult mortality levels have begun to decline once again in East Africa, in some instances before the large-scale expansion of antiretroviral therapy programmes. More surprising is the lack of sustained improvements in adult survival in some countries that have not experienced severe HIV epidemics. Because trends in child and adult mortality do not always evolve in tandem, we argue that model-based estimates, inferred by matching indices of child survival onto standard mortality schedules, can be very misleading.
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Chin YM. Does HIV increase the risk of spousal violence in sub-Saharan Africa? JOURNAL OF HEALTH ECONOMICS 2013; 32:997-1006. [PMID: 24012689 DOI: 10.1016/j.jhealeco.2013.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 04/10/2013] [Accepted: 07/22/2013] [Indexed: 06/02/2023]
Abstract
Although a positive association is found between HIV prevalence and intimate partner violence, a causal interpretation is hard to establish due to the endogeneity of HIV prevalence. Using the distance from the origin of the virus as an instrument, I find that an exogenous increase in HIV prevalence in a cluster has a sizable positive effect on the risk of physical and sexual violence against women within marriage. The results of this study confirm a gender-specific negative externality of the disease and encourage policy efforts to incorporate services for violence against women into existing HIV programs.
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Affiliation(s)
- Yoo-Mi Chin
- Department of Economics, Missouri University of Science and Technology, Rolla, MO 65409, USA.
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Abstract
Epidemiological, economic, and social forces have produced high levels of volatility in family and household structure for young people growing up in sub-Saharan Africa in recent decades. However, scholarship on the family to date has not examined the influence of this family instability on young people's well-being. The current study employs unique life history calendar data from Western Kenya to investigate the relationship between instability in caregiving and early initiation of sexual activity. It draws on a body of work on parental union instability in the United States, and examines new dimensions of family change. Analyses reveal a positive association between transitions in primary caregiver and the likelihood of early sexual debut that is rapidly manifested following caregiver change and persists for a short period. The association is strongest at early ages, and there is a cumulative effect of multiple caregiver changes. The results highlight the importance of studying family stability in sub-Saharan Africa, as distinct from family structure, and for attention to dimensions such as age and recency.
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The effect of marriage and HIV risks on condom use acceptability in rural Malawi. Soc Sci Med 2013; 97:29-40. [PMID: 24161086 DOI: 10.1016/j.socscimed.2013.06.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 05/22/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022]
Abstract
A large and increasing proportion of HIV transmissions in sub-Saharan Africa occur within marriage. Condom use within marriage could, therefore, be an important prevention strategy, but there is considerable debate about whether married couples would be willing to use condoms. This paper contributes to this debate by identifying key factors that affect the acceptability of condom use within marriage and actual condom use among men and women in rural Malawi, using three waves of longitudinal data from 2004, 2006 and 2008. Specifically, we focused on the effect of (1) entry into first marriage, (2) respondent's HIV status, HIV perceptions, and risk behaviors, and (3) spouse's HIV characteristics on condom use acceptability within marriage and actual condom use with a spouse or steady partner. Using fixed-effects regression, we found that getting married coincides with a pronounced attitudinal shift regarding the acceptability of condom use within marriage that cannot be explained by differences in fertility status or selection into marriage. In addition, we found that, for women, perceived HIV status of the respondent and spouse generally had greater influence than actual HIV status on the acceptability of condom use within marriage and actual condom use with a spouse or steady partner, even after HIV status is known; while actual HIV status and HIV risk behaviors are generally more important among men. Although condom use within marriage remained low, these findings suggest that attitudes about and use of condoms are susceptible to change and that both marital status and perceptions of risk are important influences on condom use.
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Goldberg RE. Family Instability and Pathways to Adulthood in Urban South Africa. POPULATION AND DEVELOPMENT REVIEW 2013; 39:231-256. [PMID: 25067862 PMCID: PMC4107716 DOI: 10.1111/j.1728-4457.2013.00590.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Social, political, epidemiological, and economic forces have produced family instability during childhood for many young people transitioning to adulthood in South Africa. This study identifies pathways to adulthood for youth in Cape Town that capture the timing and sequencing of role transitions across the life domains of school, work, and family formation. It then uses these pathways to investigate the relationship between childhood family instability and the way young people's lives unfold during the transition to adulthood. Results indicate that changes in co-residence with parents are associated with following less advantageous pathways into adulthood, independent of particular family structure or orphan status. Overall, the findings suggest that family instability influences not only single transitions for youth, but also combinations of transitions. They also indicate the value of a multi-dimensional conceptualization of the transition to adulthood in empirical work.
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Affiliation(s)
- Rachel E Goldberg
- Office of Population Research and Bendheim-Thoman Center for Research on Child Wellbeing, Princeton University,
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Emina JBO, Madise N, Kuepie M, Zulu EM, Ye Y. Identifying HIV most-at-risk groups in Malawi for targeted interventions. A classification tree model. BMJ Open 2013; 3:bmjopen-2012-002459. [PMID: 23793677 PMCID: PMC3657656 DOI: 10.1136/bmjopen-2012-002459] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify HIV-socioeconomic predictors as well as the most-at-risk groups of women in Malawi. DESIGN A cross-sectional survey. SETTING Malawi PARTICIPANTS The study used a sample of 6395 women aged 15-49 years from the 2010 Malawi Health and Demographic Surveys. INTERVENTIONS N/A PRIMARY AND SECONDARY OUTCOME MEASURES Individual HIV status: positive or not. RESULTS Findings from the Pearson χ(2) and χ(2) Automatic Interaction Detector analyses revealed that marital status is the most significant predictor of HIV. Women who are no longer in union and living in the highest wealth quintiles households constitute the most-at-risk group, whereas the less-at-risk group includes young women (15-24) never married or in union and living in rural areas. CONCLUSIONS In the light of these findings, this study recommends: (1) that the design and implementation of targeted interventions should consider the magnitude of HIV prevalence and demographic size of most-at-risk groups. Preventive interventions should prioritise couples and never married people aged 25-49 years and living in rural areas because this group accounts for 49% of the study population and 40% of women living with HIV in Malawi; (2) with reference to treatment and care, higher priority must be given to promoting HIV test, monitoring and evaluation of equity in access to treatment among women in union disruption and never married or women in union aged 30-49 years and living in urban areas; (3) community health workers, households-based campaign, reproductive-health services and reproductive-health courses at school could be used as canons to achieve universal prevention strategy, testing, counselling and treatment.
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Affiliation(s)
- Jacques B O Emina
- Department of Population and Development Studies, University of Kinshasa, Kinshasa XI, Democratic Republic of Congo
- AFRILUX, CEPS/INSTEAD 3, Esch-sur-Alzette, Luxembourg
- Research Coordination, INDEPTH Network, Accra, Ghana
| | - Nyovani Madise
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | | | - Eliya M Zulu
- African Institute for Development Policy (AFIDEP), Westlands, Nairobi, Kenya
| | - Yazoume Ye
- ICF International, Calverton, Maryland, USA
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Mkandawire-Valhmu L, Wendland C, Stevens PE, Kako PM, Dressel A, Kibicho J. Marriage as a risk factor for HIV: learning from the experiences of HIV-infected women in Malawi. Glob Public Health 2013; 8:187-201. [PMID: 23350930 DOI: 10.1080/17441692.2012.761261] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.
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de Walque D, Kline R. The association between remarriage and HIV infection in 13 sub-Saharan African countries. Stud Fam Plann 2013. [PMID: 23185867 DOI: 10.1111/j.1728-4465.2012.00297.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Separated, divorced, and widowed individuals in Africa are at significantly increased risk for HIV infection. Using nationally representative data from 13 sub-Saharan African countries, this study confirms that finding and goes further by examining those who have experienced a marital dissolution and are now remarried. Results show that remarried individuals form a large portion of the population and have a higher-than-average HIV prevalence. HIV-positive remarried individuals are at risk of transmitting the infection to their spouse, because many of the couples are serodiscordant. The large number of high-risk remarried individuals is a source of vulnerability and further infection, and should be acknowledged and taken into account by prevention strategies that rarely address this population.
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Affiliation(s)
- Damien de Walque
- Development Research Group, World Bank, 1818 H Street NW, Washington, DC 20433, USA.
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Reniers G, Armbruster B. HIV status awareness, partnership dissolution and HIV transmission in generalized epidemics. PLoS One 2012; 7:e50669. [PMID: 23284641 PMCID: PMC3524232 DOI: 10.1371/journal.pone.0050669] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/16/2012] [Indexed: 12/02/2022] Open
Abstract
Objectives HIV status aware couples with at least one HIV positive partner are characterized by high separation and divorce rates. This phenomenon is often described as a corollary of couples HIV Testing and Counseling (HTC) that ought to be minimized. In this contribution, we demonstrate the implications of partnership dissolution in serodiscordant couples for the propagation of HIV. Methods We develop a compartmental model to study epidemic outcomes of elevated partnership dissolution rates in serodiscordant couples and parameterize it with estimates from population-based data (Rakai, Uganda). Results Via its effect on partnership dissolution, every percentage point increase in HIV status awareness reduces HIV incidence in monogamous populations by 0.27 percent for women and 0.63 percent for men. These effects are even larger when the assumption of monogamy can be relaxed, but are moderated by other behavior changes (e.g., increased condom use) in HIV status aware serodiscordant partnerships. When these behavior changes are taken into account, each percentage point increase in HIV status awareness reduces HIV incidence by 0.13 and 0.32 percent for women and men, respectively (assuming monogamy). The partnership dissolution effect exists because it decreases the fraction of serodiscordant couples in the population and prolongs the time that individuals spend outside partnerships. Conclusion Our model predicts that elevated partnership dissolution rates in HIV status aware serodiscordant couples reduce the spread of HIV. As a consequence, the full impact of couples HTC for HIV prevention is probably larger than recognized to date. Particularly high partnership dissolution rates in female positive serodiscordant couples contribute to the gender imbalance in HIV infections.
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Affiliation(s)
- Georges Reniers
- Office of Population Research, Princeton University, Princeton, New Jersey, United States of America.
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Abstract
Although HIV-prevalence and fertility rates in sub-Saharan Africa are among the highest in the world, little is known about how HIV infection affects the fertility preferences of men and women in the region. A quasi-experimental design and in-depth interviews conducted in rural Malawi are employed to examine how and through what pathways learning that one is HIV positive alters a person's childbearing desires. Among rural Malawians, particularly men, the desire to have more children decreases after receiving a positive HIV-test result. The motivations underlying this effect are greatly influenced by gender: women fear the physical health consequences of HIV-positive pregnancies and childbearing, whereas men see childbearing as futile because they anticipate their own early death and the deaths of their future children. Considerable ambivalence remains, nevertheless, particularly among women who strategize to live normal lives in spite of their infection, but whose definitions of "normal" vary.
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Affiliation(s)
- Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver, 1201 5th Street, Suite 280, Campus Box 188, Post Office Box 173364, Denver, CO 80217, USA.
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Abstract
We study the relationship between polygyny and HIV infection using nationally representative survey data with linked serostatus information from 20 African countries. Our results indicate that junior wives in polygynous unions are more likely to be HIV positive than spouses of monogamous men, but also that HIV prevalence is lower in populations with more polygyny. With these results in mind, we investigate four explanations for the contrasting individual- and ecological-level associations. These relate to (1) the adverse selection of HIV-positive women into polygynous unions, (2) the sexual network structure characteristic of polygyny, (3) the relatively low coital frequency in conjugal dyads of polygynous marriages (coital dilution), and (4) the restricted access to sexual partners for younger men in populations where polygynous men presumably monopolize the women in their community (monopolizing polygynists). We find evidence for some of these mechanisms, and together they support the proposition that polygynous marriage systems impede the spread of HIV. We relate these results to the debate about partnership concurrency as a primary behavioral driver for the fast propagation of HIV in some parts of sub-Saharan Africa.
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Evolving strategies, opportunistic implementation: HIV risk reduction in Tanzania in the context of an incentive-based HIV prevention intervention. PLoS One 2012; 7:e44058. [PMID: 22952872 PMCID: PMC3428320 DOI: 10.1371/journal.pone.0044058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection. METHODS In 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction. RESULTS We found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence. CONCLUSIONS Our results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.
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