Socio-demographic, marital and psychosocial predictors of safe sex behaviour among Mozambican women at risk for HIV/AIDS

The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial

BACKGROUND

Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence.

METHOD AND FINDINGS

We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects.

CONCLUSION

The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV.

TRIAL REGISTRATION

The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021.

Predicting the individualized risk of human immunodeficiency virus infection among sexually active women in Ethiopia using a nomogram: prediction model development and validation

Introduction

Women are more vulnerable to HIV infection due to biological and socioeconomic reasons. Developing a predictive model for these vulnerable populations to estimate individualized risk for HIV infection is relevant for targeted preventive interventions. The objective of the study was to develop and validate a risk prediction model that allows easy estimations of HIV infection risk among sexually active women in Ethiopia.

Methods

Data from the 2016 Ethiopian Demographic and Health Survey, which comprised 10,253 representative sexually active women, were used for model development. Variables were selected using the least absolute shrinkage and selection operator (LASSO). Variables selected by LASSO were incorporated into the multivariable mixed-effect logistic regression model. Based on the multivariable model, an easy-to-use nomogram was developed to facilitate its applicability. The performance of the nomogram was evaluated using discrimination and calibration abilities, Brier score, sensitivity, and specificity. Internal validation was carried out using the bootstrapping method.

Results

The model selected seven predictors of HIV infection, namely, age, education, marital status, sex of the household head, age at first sex, multiple sexual partners during their lifetime, and residence. The nomogram had a discriminatory power of 89.7% (95% CI: 88.0, 91.5) and a calibration p-value of 0.536. In addition, the sensitivity and specificity of the nomogram were 74.1% (95% CI: 68.4, 79.2) and 80.9% (95% CI: 80.2, 81.7), respectively. The internally validated model had a discriminatory ability of 89.4% (95% CI: 87.7, 91.1) and a calibration p-value of 0.195. Sensitivity and specificity after validation were 72.9% (95% CI: 67.2, 78.2) and 80.1% (95% CI: 79.3, 80.9), respectively.

Conclusion

A new prediction model that quantifies the individualized risk of HIV infection has been developed in the form of a nomogram and internally validated. It has very good discriminatory power and good calibration ability. This model can facilitate the identification of sexually active women at high risk of HIV infection for targeted preventive measures.

Determinants of intimate partner controlling behavior targeting women in Türkiye

Background/aim

Intimate partner controlling behavior toward women is an important form of intimate partner violence (IPV), both in terms of limiting women's daily lives and in terms of reproducing patriarchal culture and male dominance in societies at the micro level. A limited number of studies in the literature have identified the male intimate partner's controlling behavior as a dependent variable, which is important for understanding the determinants of this type of IPV. There is also a significant gap in the literature in terms of studies focusing on the case of Türkiye. Thus, the main aim of this study was to determine the socio-demographic, economic and violence-related factors that have an effect on women's status in terms of exposure to control behavior in Türkiye.

Methods

These factors were examined by using binary logistic regression analysis, based on the micro data set collected by the Hacettepe University's Institute of Population Studies in the 2014-dated National Research on Domestic Violence against Women in Türkiye. A total of 7,462 women between the ages of 15 and 59 were interviewed face-to-face.

Results

The findings of the study revealed that women are more likely to be exposed to controlling behavior if they live in rural areas, are unmarried, speak Turkish as their mother tongue, have bad or very bad health conditions, justify men's violence and are afraid of their intimate partners. As women's age, level of education and income contribution increase, their likelihood of exposure to controlling behavior decreases. However, women's exposure to economic, physical and emotional violence also increases their likelihood of exposure to controlling behavior.

Conclusion

The findings highlighted the importance of creating public policies that make women less vulnerable to men's controlling behavior, providing women with methods and mechanisms of resistance and raising public awareness of the exacerbating effects of controlling behavior on social inequalities.

Vulnerability to human immunodeficiency virus infection and associated factors among married women in northwest Ethiopia: a cross-sectional study

PURPOSE

This study investigated the vulnerability to human immunodeficiency virus (HIV) infection and associated factors among married women in northwest Ethiopia.

METHODS

A community-based cross-sectional survey (n=657) was conducted from April 1 to 15,2020, in Metema District, northwest Ethiopia, in four randomly selected kebele administrations (thelowest level of local government). The inclusion criteria were married women aged ≥18 years residing with their husbands. Logistic regression analysis was conducted to identify factors associatedwith married women's vulnerability to HIV infection.

RESULTS

Participants were on average 33.70±9.50 years and nearly one-fourth (n=148, 22.5%) wereidentified as vulnerable to HIV infection (i.e., experienced sexually transmitted disease symptoms oran extramarital affair of either spouse within the past 12 months). Only 18.9% reported sexual communication with their husband. Respondents who did not discuss the risk of HIV infection withtheir husbands had fivefold odds of vulnerability (adjusted odds ratio [AOR], 5.02; 95% confidenceinterval [CI], 1.43-17.5). Those who did not have premarital sex (AOR, 0.20; 95% CI, 0.05-0.77)had no worries about HIV infection (AOR, 0.27; 95% CI, 0.08-0.94), sufficient income (AOR,0.56; 95% CI, 0.16-0.86), and less than four children (AOR, 0.69; 95% CI, 0.50-0.97) had decreased odds of being vulnerable to HIV than their counterparts.

CONCLUSION

Not discussing risk of HIV infection with husband was a major factor of vulnerabilityto HIV infection as was premarital sex, worry about HIV, income, and number of children. Measuresto strengthen couple's sexual communication and support economical stability is important for decreasing HIV vulnerability.

Controlling risky behavior associated with AIDS: the role of social support, family functioning, self-efficacy and AIDS risk perception

OBJECTIVES

We believe that major steps can be taken towards Acquired Immunodeficiency Syndrome (AIDS) prevention through identifying the relevant factors that are apt to predict risky behavior. The main purpose of the present study was to analyze and evaluate the relationship of social support, family functioning, self-efficacy and AIDS risk perception to controlling risky behavior associated with AIDS.

METHODS

To conduct this cross-sectional study, 765 subjects (59% female) were selected from the youth inhabiting the western provinces of Iran through cluster sampling. Five questionnaires were used: AIDS risk perception, self-efficacy in controlling risky behavior associated with AIDS, controlling risky behavior associated with AIDS, the multidimensional scale of perceived social support, and the family assessment device.

RESULTS

The results demonstrated that all two models enjoyed acceptable fitness, and the mediating roles of self-efficacy and AIDS risk perception were confirmed. Moreover, family functioning and perceived social support together could predict 20% of the variance of controlling risky behavior associated with AIDS. The results also indicated that family functioning with a standardized coefficient of - 0.24 and self-efficacy in controlling risky behavior associated with AIDS with a standardized coefficient of 0.58 could predict the controlling risky behavior associated with AIDS (p < 0.01).

CONCLUSIONS

Our findings suggest that self-efficacy and AIDS risk perception play major roles in controlling risky behavior associated with AIDS. Therefore, it is recommended that families and psychologists promote self-efficacy in order to prevent the occurrence of high-risk behaviors.

Testing the Effectiveness of Two Psychosocial Interventions on Socio-Cognitive Risk Factors for HIV/AIDS in Mozambican Women: A Randomized Controlled Trial

The objective of this study was to evaluate the efficacy of two psychosocial interventions (Didactic and ACCENT) on socio-cognitive risk factors, in vulnerable Mozambican women at risk for HIV/AIDS infection. The study design was a randomized controlled trial on Mozambican women at HIV/AIDS risk (n = 150). The participants were randomized into three groups: Didactic Intervention (experimental group), ACCENT intervention (experimental group), and control group. We used an adapted version of the Women's Health Questionnaire, which includes a series of scales and questionnaires assessing psychosocial relevant dimensions to female protection towards HIV/AIDS: HIV/AIDS knowledge, condom use negotiation self-efficacy, and perceived barriers against safer sex. Both interventions were equally effective in increasing HIV/AIDS knowledge. The ACCENT intervention was especially effective in promoting condom use negotiation self-efficacy and in decreasing perceived barriers against safer sex, essential variables for sexual protection. These results support the adaptation of Western interventions to the African context.

Individual and contextual predictors of comprehensive HIV and AIDS knowledge among young females in Ghana

Sub-Saharan Africa is a region that is severely affected by the HIV and AIDS pandemic with females disproportionately affected. Having accurate and comprehensive knowledge about HIV and AIDS is a major strategy in the fight against the pandemic. This study sought to examine the individual and contextual predictors of comprehensive HIV and AIDS knowledge among young women in Ghana. The study used the females' file from the 2014 Ghana Demographic and Health Survey dataset. A total of 1 407 young women were used for the analysis. Both bivariate and multivariate analyses were done. The results showed that about 22% of the respondents had comprehensive HIV and AIDS knowledge. Young women with secondary and higher levels of education (AOR = 2.85, p < 0.01) and those from the Upper East Region (AOR = 7.15, p < 0.001) had higher odds of comprehensive HIV and AIDS knowledge. However, those cohabiting (AOR = 0.57, p < 0.01) and those who do not watch TV at all (AOR = 0.50, p < 0.01) had lower odds of comprehensive HIV and AIDS knowledge. Comprehensive HIV and AIDS knowledge is low among young women in Ghana and the predictors are both individual (marital status and education) and contextual (region, watching television and listening to radio). A concerted effort is needed to improve the HIV and AIDS knowledge of young people. Mass media campaigns aimed at improving comprehensive HIV and AIDS knowledge should appreciate the individual and contextual factors that influence the comprehensive HIV & AIDS knowledge of young women.

Access to sexual and reproductive health services for women living with HIV in Latin America and the Caribbean: systematic review of the literature

INTRODUCTION

Systematic reviews show that women living with HIV (WLHIV) have high unmet sexual and reproductive health (SRH) needs due to barriers to access sexual and reproductive health services (SRHS). In Latin America and the Caribbean (LAC), as of 2016, there were nearly one million WLHIV, but the existing evidence of their SRH needs comes from a few individual studies. This systematic review provides an overview of these women's needs to help define new and/or adapt existing public health strategies to the local context. This review synthesizes the evidence from the literature on the use of and access to SRHS related to family planning, antenatal care, abortion services and violence against WLHIV in LAC.

METHODS

Using a systematic review of mixed studies, a search was performed in MEDLINE, EMBASE, LILACS, INASP, POPLINE, SCOPUS, for studies conducted in LAC, from 2004 to 2017, as well as contact with authors and hand search as needed. Two independent reviewers evaluated the quality of the studies using the Mixed Methods Appraisal Tool; inclusion was conducted according to the PRISMA flow diagram. An exploratory narrative synthesis followed by quantitative synthesis data was undertaken. Group analysis or meta-analysis was not considered appropriate given the level of heterogeneity of the studies.

RESULTS

A total of 18 studies in 13 LAC countries for a population of 5672 WLHIV were included. Data from individual studies reported unmet family planning needs; higher, but inconsistent use of condom as the sole contraceptive method OR=1.46 [1.26 to 1.69]; lesser use of other non-permanent contraceptive methods OR=0.26 [0.22 to 0.31]; more unplanned pregnancies OR=1.30 [1.02 to 1.66]; more induced abortions OR=1.96 [1.60 to 2.39]; higher risk of immediate postpartum sterilization; and higher exposure to sexual and institutional violence by WLHIV when compared with women without HIV.

CONCLUSIONS

This review presents evidence from LAC about the SRH unmet needs of WLHIV that must be addressed by decreasing institutional and structural barriers, facilitating services and reducing stigma, and discrimination among healthcare providers to improve access to SRHS based on human rights, so women independently of their HIV status can make their own reproductive decisions, free of violence and coercion.