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Logie CH, Okumu M, Berry I, Loutet M, Hakiza R, Kibuuka Musoke D, Mwima S, Kiera UM, MacNamee C, Kyambadde P. Social contextual factors associated with lifetime HIV testing among the Tushirikiane urban refugee youth cohort in Kampala, Uganda: Cross-sectional findings. Int J STD AIDS 2022; 33:374-384. [PMID: 35125037 PMCID: PMC8958564 DOI: 10.1177/09564624211069236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Urban refugee youth may live in social contexts characterized by structural drivers of HIV such as poverty and violence. Knowledge gaps remain regarding HIV testing practices among urban refugee youth, despite the increasing trend toward refugee settlement in urban contexts. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda. Methods We conducted a community-based study with a peer-recruited cohort of urban refugee youth aged 16–24 years living in Kampala’s informal settlements, and present baseline cross-sectional findings. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., gender and age), material (e.g., income insecurity and education), relational (e.g., social support), and symbolic contexts (e.g., HIV-related stigma and intimate partner violence (IPV]) associated with lifetime HIV testing. Results Participants (n = 450) had a mean age of 20.4 years (standard deviation: 2.4 years), most lived in Uganda for 1–5 years (53.2%), and less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio (aOR]: 2.30, 95% confidence interval (CI]: 1.27–4.17), currently employed (aOR: 1.79, 95% CI: 1.03–3.10), and reporting IPV (aOR: 3.61, 95% CI: 1.43–9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95% CI: 0.98–4.81, p = 0.052). Conclusions Findings demonstrate suboptimal HIV testing and the importance of tailored strategies to reach urban refugee youth who are unemployed and have limited formal education. There is a need to meaningfully engage urban refugee youth to create enabling environments for sexual health.
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Affiliation(s)
- Carmen H Logie
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- United Nations University Institute for Water, Environment & Health (UNU-INWEH), Hamilton, ON, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Isha Berry
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Miranda Loutet
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | | | - Simon Mwima
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Bukedi Prevention Institute, Kampala, Uganda
| | - Uwase Mimy Kiera
- Young African Refugees for Integral Development, Kampala, Uganda
- Bukedi Prevention Institute, Kampala, Uganda
| | - Clara MacNamee
- Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Peter Kyambadde
- National AIDS Coordinating Program, Ugandan Ministry of Health, Kampala, Uganda
- Most At Risk Population Initiative, Mulago Hospital, Kampala, Uganda
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Seidu AA, Oduro JK, Ahinkorah BO, Budu E, Appiah F, Baatiema L, Ameyaw EK, Sambah F. Women's healthcare decision-making capacity and HIV testing in sub-Saharan Africa: a multi-country analysis of demographic and health surveys. BMC Public Health 2020; 20:1592. [PMID: 33092556 PMCID: PMC7583279 DOI: 10.1186/s12889-020-09660-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 10/08/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Global commitment to stop Human Immunodeficiency Virus (HIV) and ensure access to HIV treatment calls for women empowerment, as these efforts play major roles in mother-to-child transmission. We examined the association between women's healthcare decision-making capacity and uptake of HIV testing in sub-Saharan Africa. METHODS We used data from the current Demographic and Health Surveys (DHS) of 28 countries in sub-Saharan Africa, conducted between January 1, 2010 and December 31, 2018. At the descriptive level, we calculated the prevalence of HIV testing in each of the countries. This was followed by the distribution of HIV testing across the socio-demographic characteristics of women. Finally, we used binary logistic regression assess the likelihood of HIV testing uptake by women's health care decision-making capacity and socio-demographic characteristics. The results were presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals signifying precision. Statistical significance was set at p-value < 0.05. RESULTS We found that prevalence of HIV testing uptake in the 28 sub-Saharan African countries was 64.4%, with Congo DR having the least (20.2%) and the highest occurred in Rwanda (97.4%). Women who took healthcare decisions alone [COR = 3.183, CI = 2.880-3.519] or with their partners [COR = 2.577, CI = 2.335-2.844] were more likely to test for HIV, compared to those whose healthcare decisions were taken by others, and this persisted after controlling for significant covariates: [AOR = 1.507, CI = 1.321-1.720] and [AOR = 1.518, CI = 1.334-1.728] respectively. CONCLUSION Sub-Saharan African countries intending to improve HIV testing need to incorporate women's healthcare decision-making capacity strategies. These strategies can include education and counselling. This is essential because our study indicates that the capacity of women to make healthcare decisions has an association with decision to test for their HIV status.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Joseph Kojo Oduro
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Francis Appiah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- Berekum College of Education, Berekum, BA Ghana
| | - Linus Baatiema
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Francis Sambah
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
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Pepito VCF, Newton S. Determinants of HIV testing among Filipino women: Results from the 2013 Philippine National Demographic and Health Survey. PLoS One 2020; 15:e0232620. [PMID: 32396559 PMCID: PMC7217462 DOI: 10.1371/journal.pone.0232620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of having ever tested for HIV in the Philippines is very low and is far from the 90% target of the Philippine Department of Health (DOH) and UNAIDS, thus the need to identify the factors associated with ever testing for HIV among Filipino women. Methods We analysed the 2013 Philippine National Demographic and Health Survey (NDHS). The NDHS is a nationally representative survey which utilized a two-stage stratified design to sample Filipino women aged 15–49. We considered the following exposures in our study: socio-demographic characteristics of respondent and her partner (i.e., age of respondent, age of partner, wealth index, etc.), sexual practices and contraception (i.e., age at first intercourse, condom use, etc.), media access, tobacco use, HIV knowledge, tolerance to domestic violence, and women’s empowerment. The outcome variable is HIV testing. We used logistic regression for survey data to study the said associations. Results Out of 16,155 respondents, only 372 (2.4%) have ever tested for HIV. After adjusting for confounders, having tertiary education (adjusted odds ratio (aOR) = 2.15; 95% Confidence Interval (CI): 1.15–4.04), living with partner (aOR = 1.72; 95% CI: 1.19–2.48), tobacco use (aOR = 1.87; 95% CI: 1.13–3.11); belonging to the middle class (aOR = 2.72; 95% CI: 1.30–5.67), richer (aOR = 3.00; 95% CI: 1.37–5.68), and richest (aOR = 4.14; 95% CI: 1.80–5.91) populations, having weekly television access (aOR = 1.75; 95% CI: 1.04–2.94) or internet access (aOR = 2.01; 95% CI: 1.35–3.00), living in a rural area (aOR = 1.87; 95% CI: 1.34–2.61); and being a Muslim (aOR = 2.30; 95% CI: 1.15–4.57) were associated with ever testing for HIV. Conclusions The low percentage of respondents who test for HIV is a call to further strengthen efforts to promote HIV testing among Filipino women. Information on its determinants can be used to guide the crafting and implementation of interventions to promote HIV testing to meet DOH and UNAIDS targets.
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Affiliation(s)
- Veincent Christian F. Pepito
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
- Center for Research and Innovation, School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- * E-mail:
| | - Sam Newton
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Yaya S, Shibre G, Idriss-Wheeler D, Uthman OA. Women's Empowerment and HIV Testing Uptake: A Meta-analysis of Demographic and Health Surveys from 33 Sub-Saharan African Countries. Int J MCH AIDS 2020; 9:274-286. [PMID: 32742742 PMCID: PMC7384337 DOI: 10.21106/ijma.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is a growing body of evidence suggesting that women's empowerment can help achieve better health behaviours and outcomes. However, few have looked at the impact of women's empowerment on HIV testing in Sub-Saharan Africa (SSA). This study investigated the association between women's empowerment and HIV testing among women in 33 countries across SSA. METHODS Cross-sectional data from the most recent Demographic and Health Surveys (2005-2018) of 33 countries in SSA were used. Confounder adjusted logistic regression analysis was completed separately for each of the 33 DHS datasets to produce the adjusted Odds Ratio (OR) for the association between women empowerment and HIV testing. The regression analysis strictly accounted for the three design elements (weight, cluster and strata) to produce an estimate representative of the respective countries. Finally, an Individual Participant Data (IPD) meta-analysis approach was used to statistically pool the effect of women empowerment on HIV testing. RESULTS There was a wide variation in the percentage of women who were empowered among the countries studied, with only a few countries such as South Africa, Angola and Ghana having a high prevalence of negative attitudes toward wife beating. HIV testing was higher in Angola, Lesotho, Uganda and South Africa. While participation in one or two of the three decisions had been marginally associated with lower odds of HIV testing across the SSA regions (0.89; 95%CI: 0.83, 0.97); the corresponding prediction interval crossed the null. Being involved in the three decisions (0.92; 95%CI: 0.84, 1.00) and disagreement to wife-beating (0.99; 95%CI: 0.94, 1.05) had no statistical relationship with HIV testing uptake. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS The two indirect indicators of women empowerment could not predict HIV testing uptake. Further studies are recommended to establish the nature of the relationship between HIV testing and women's empowerment that is measured through standard tools.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.,The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| | - Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Tonen-Wolyec S, Mbopi-Kéou FX, Koyalta D, Filali M, Batina-Agasa S, Bélec L. Human Immunodeficiency Virus Self-Testing in Adolescents Living in Sub-Saharan Africa: An Advocacy. Niger Med J 2019; 60:165-168. [PMID: 31831933 PMCID: PMC6892330 DOI: 10.4103/nmj.nmj_75_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 11/04/2022] Open
Abstract
Acquired immune deficiency syndrome (AIDS) has become the leading cause of death among adolescents (aged 10-19) in sub-Saharan Africa. Less than 20% of African adolescents know their human immunodeficiency virus (HIV) status, whereas HIV testing remains the gateway to care. To end the AIDS epidemic by 2030 according to the Joint United Nations Programme on HIV/AIDS target, it is necessary to introduce scalable HIV testing strategies specific to different settings such as age groups, populations, and geographical areas. Demonstrated evidence on HIV self-testing (HIVST) in sub-Saharan Africa settings is reported, including data among adolescents. The All In initiative, which is the current international platform for the fight against HIV in adolescents is a good opportunity to address the challenge of HIV testing, including HIVST. Adapted strategies of HIVST such as (i) implementation of several listening and recreation centers for adolescents, (ii) door-to-door HIVST approach, and (iii) reducing the age of consent is urgently needed to promote HIV testing among adolescents living in Africa.
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Affiliation(s)
- Serge Tonen-Wolyec
- Ecole Doctorale Régionale D'Afrique Centrale en Infectiologie Tropicale, Franceville, Gabon.,Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - François-Xavier Mbopi-Kéou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I.,The Institute for the Development of Africa, Yaounde
| | | | | | - Salomon Batina-Agasa
- Faculty of Medicine and Pharmacy, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Laurent Bélec
- Laboratory of Virology, Hôpital Européen Georges Pompidou, Paris Descartes University, Paris, France
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