Partnership duration, concurrency, and HIV in sub-Saharan Africa

Making sense of fidelity: young Africans' cross-national and longitudinal representations of fidelity and infidelity in their HIV-related creative narratives, 1997-2014

Mutual fidelity and partner reduction have been identified as key behavioural strategies to prevent HIV transmission in sub-Saharan Africa, particularly following recognition of the role that multiple concurrent sexual partnerships play in driving generalised HIV epidemics. We analysed social representations of fidelity and infidelity in a sample of 1,343 narratives about HIV written by young Africans between 1997 and 2014. The narratives were written at four different time points (1997, 2005, 2008, 2014) by authors aged 10-24 in urban and rural areas of Senegal, Burkina Faso, South-east Nigeria, Kenya and Eswatini. We combined three analytical approaches: descriptive statistics of quantifiable characteristics of the narratives, thematic data analysis and a narrative-based approach. In the sample, fidelity is often promoted as the ideal by narrators, peers and romantic partners, in line with broader discourses around HIV prevention, romantic relationships, familial obligations, and religious and moral imperatives. However, mutual fidelity is rarely modelled in the narratives and representations of combining methods to prevent HIV from entering relationships via infidelity are uncommon. Representations of fidelity reflect loss-framed fear arousal techniques that perpetuate HIV-related stigma. Narrative-based approaches that facilitate skills-building, critical reflection and address stigma can better address fidelity and partner reduction.

Understanding ethnic variations in HIV prevalence in Kenya: the role of cultural practices

Patterns of HIV prevalence in Kenya suggest that areas where various cultural practices are prevalent bear a disproportionate burden of HIV. This paper examines (i) the contextual effects of cultural practices (polygyny, male circumcision) and related sexual behaviour factors on HIV prevalence and (ii) the extent to which specific cultural practices in a community/county might explain existing ethnic variations in HIV prevalence in Kenya. The analysis applies multilevel logistic regression to data from the 2012/13 Kenya AIDS Indicator Survey. The results reveal striking ethnic variations in HIV prevalence in Kenya. The prevalence of polygyny in a community is positively associated with HIV prevalence, while a higher level of male circumcision in a county is protective for both men and women. The effects of these factors are stronger for men than women at both individual and contextual (community/county) levels. These cultural practices and associated risk factors partly explain existing ethnic differences in HIV prevalence in Kenya, but there remain significant ethnic variations that are not explained by these cultural practices or related sexual behaviour factors. These call for stronger empirical evidence to offer stronger theoretical explanations and inform effective policy and practice to address HIV epidemic in adversely affected communities in Kenya and similar settings in sub-Saharan Africa.

Concurrency measures in the era of temporal network epidemiology: a review

Diseases spread over temporal networks of interaction events between individuals. Structures of these temporal networks hold the keys to understanding epidemic propagation. One early concept of the literature to aid in discussing these structures is concurrency-quantifying individuals' tendency to form time-overlapping 'partnerships'. Although conflicting evaluations and an overabundance of operational definitions have marred the history of concurrency, it remains important, especially in the area of sexually transmitted infections. Today, much of theoretical epidemiology uses more direct models of contact patterns, and there is an emerging body of literature trying to connect methods to the concurrency literature. In this review, we will cover the development of the concept of concurrency and these new approaches.

Design, formulation and evaluation of novel dissolving microarray patches containing a long-acting rilpivirine nanosuspension

One means of combating the spread of human immunodeficiency virus (HIV) is through the delivery of long-acting, antiretroviral (ARV) drugs for prevention and treatment. The development of a discreet, self-administered and self-disabling delivery vehicle to deliver such ARV drugs could obviate compliance issues with daily oral regimens. Alternatives in development, such as long-acting intramuscular (IM) injections, require regular access to health care facilities and disposal facilities for sharps. Consequently, this proof of concept study was developed to evaluate the use of dissolving microarray patches (MAPs) containing a long-acting (LA) nanosuspension of the candidate ARV drug, rilpivirine (RPV). MAPs were mechanically strong and penetrated skin in vitro, delivering RPV intradermally. In in vivo studies, the mean plasma concentration of RPV in rats (431 ng/ml at the Day 7 time point) was approximately ten-fold greater than the trough concentration observed after a single-dose in previous clinical studies. These results are the first to indicate, by the determination of relative exposures between IM and MAP administration, that larger multi-array dissolving MAPs could potentially be used to effectively deliver human doses of RPV LA. Importantly, RPV was also detected in the lymph nodes, indicating the potential to deliver this ARV agent into one of the primary sites of HIV replication over extended durations. These MAPs could potentially improve patient acceptability and adherence to HIV prevention and treatment regimens and combat instances of needle-stick injury and the transmission of blood-borne diseases, which would have far-reaching benefits, particularly to those in the developing world.