1
|
Ekholuenetale M, Barrow A. Decomposing Education-Based Inequalities in Pre-Exposure Prophylaxis Knowledge for HIV Prevention Among Women in Cote d'Ivoire. Int J Womens Health 2024; 16:1113-1125. [PMID: 38903155 PMCID: PMC11187275 DOI: 10.2147/ijwh.s464008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
Background Antiretroviral chemoprophylaxis is a promising strategy for preventing the spread of human immunodeficiency virus (HIV). The knowledge of pre-exposure prophylaxis (PrEP) is required for intervention uptake and adherence to prevent the spread of HIV. This study aimed to decompose education-based inequalities in PrEP knowledge for HIV prevention among reproductive-aged women in Cote d'Ivoire. Methods A cross-sectional study design with a nationally representative sample of 12,934 women aged 15-49 years was analyzed from the 2021 Cote d'Ivoire Demographic and Health Survey. The survey was conducted between September to December, 2021. The outcome variable was the knowledge of PrEP for HIV prevention. Statistical analysis was conducted using percentage, concentration index, and Lorenz curve. The level of significance was set at p<0.05. Results A weighted prevalence of 14.5% (95% CI: 12.5-16.3%) was estimated for PrEP knowledge for HIV prevention. Overall, educated women had a higher knowledge of PrEP for HIV prevention (Conc. Index= 0.225; SE= 0.012; p<0.001). Across the levels of women's characteristics, the results showed higher PrEP knowledge for HIV prevention among educated women. Education (Contri: 40.7327%, Ec: 0.5390), exposure to internet (Contri: 20.1039%, Ec: 0.3484), place of residence (Contri: 12.9801%, Ec: -0.0537), household wealth (Contri: 10.0062%, Ec: 0.0642) and religion (Contri: 5.7509%, Ec: 0.0354) were positive contributors to PrEP knowledge for HIV prevention. On the other hand, age (Contri: -8.8298%, Ec: -0.0950) and region (Contri: -3.5942, Ec: -0.0768) were negative contributors to PrEP knowledge regarding HIV prevention among women of reproductive age in Cote d'Ivoire. Conclusion There is limited knowledge of PrEP for HIV prevention among women in Cote d'Ivoire. Educated women had greater knowledge of PrEP for HIV prevention. The results of this study could guide interventions targeted to enhance the knowledge of PrEP as an HIV prevention option.
Collapse
Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria
| | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia
- Department of Epidemiology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| |
Collapse
|
2
|
Owino L, Johnson-Peretz J, Lee J, Getahun M, Coppock-Pector D, Maeri I, Onyango A, Cohen CR, Bukusi EA, Kabami J, Ayieko J, Petersen M, Kamya MR, Charlebois E, Havlir D, Camlin CS. Exploring HIV risk perception mechanisms among youth in a test-and-treat trial in Kenya and Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002922. [PMID: 38696376 PMCID: PMC11065277 DOI: 10.1371/journal.pgph.0002922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/24/2024] [Indexed: 05/04/2024]
Abstract
Understanding risk perception and risk-taking among youth can inform targeted prevention efforts. Using a health beliefs model-informed framework, we analysed 8 semi-structured, gender-specific focus group discussions with 93 youth 15-24 years old (48% male, 52% female), drawn from the SEARCH trial in rural Kenya and Uganda in 2017-2018, coinciding with the widespread introduction of PrEP. Highly connected social networks and widespread uptake of antiretrovirals shaped youth HIV risk perception. Amid conflicting information about HIV prevention methods, youth felt exposed to multiple HIV risk factors like the high prevalence of HIV, belief that people with HIV(PWH) purposefully infect others, dislike of condoms, and doubts about PrEP efficacy. Young women also reported minimal sexual autonomy in the context of economic disadvantages, the ubiquity of intergenerational and transactional sex, and peer pressure from other women to have many boyfriends. Young men likewise reported vulnerability to intergenerational sex, but also adopted a sexual conquest mentality. Comprehensive sexuality education and economic empowerment, through credible and trusted sources, may moderate risk-taking. Messaging should leverage youth's social networks to spread fact-based, gender- and age-appropriate information. PrEP should be offered alongside other reproductive health services to address both pregnancy concerns and reduce HIV risk.
Collapse
Affiliation(s)
- Lawrence Owino
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Jason Johnson-Peretz
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Joi Lee
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Dana Coppock-Pector
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Irene Maeri
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Jane Kabami
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Maya Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin Charlebois
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Diane Havlir
- HIV, Infectious Disease and Global Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
3
|
Methazia JJ, Bessenaar TP, Baum SE. " We mostly focus on preventing pregnancy, we don't really focus on preventing HIV … ": Young people's perceptions and priorities when preventing unplanned pregnancy and HIV. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2024:1-11. [PMID: 38426482 DOI: 10.2989/16085906.2023.2279646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 03/02/2024]
Abstract
In South Africa, the high rate of human immunodeficiency virus (HIV) infection among young people and unplanned pregnancies remains a concern. Using a qualitative approach, this study aimed to explore how young people between 18 and 24 years old perceive the risk of unplanned pregnancy and HIV, and how they give priority to and act to prevent both concerns. Fifty-four young people were recruited from three provinces in South Africa: KwaZulu-Natal, Eastern Cape, and Gauteng. Data collection took place between May and June in 2016. All data collection was carried out in person using a standardised discussion guide and a semi-structured interview guide in English. We conducted eight focus group discussions with young people and three in-depth interviews with young people who had become parents in their teens. We utilised thematic analysis grounded in a social constructionist framework to assess patterns and associations in the data. Respondents reported unplanned pregnancy and HIV as prevalent among their peers, but prioritised both concerns differently. Preventing pregnancy was a greater priority and threat than HIV. Respondents were less concerned about being infected with HIV which was perceived as invisible and not a death sentence because of the efficacy and ease of use of treatment. HIV was considered comparatively more manageable and less burdensome than other chronic illnesses and unplanned pregnancy. Our study suggests unplanned pregnancy and HIV prevention interventions should prioritise responding to young people's primary desire to control their fertility, but also encourage them to have holistic sexual and reproductive health goals that include HIV prevention. Our findings suggest a pressing need for biomedical therapies that offer combined HIV and pregnancy prevention for young people. Future programmes need to be agile and innovative in addressing young people's tendency to prioritise HIV and pregnancy differently, and they need to revive the sense of urgency to prevent HIV.
Collapse
|
4
|
Qoza P, van Heerden A, Essack Z. The dynamics of sexual risk amongst South African youth in age-disparate relationships. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1125552. [PMID: 37533508 PMCID: PMC10390765 DOI: 10.3389/frph.2023.1125552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/22/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction South Africa has the highest burden of HIV in the world with over 8 million people living with HIV. Young women and girls account for a quarter of new HIV infections while making up only 10% of the population. A key driver of HIV incidence is transactional and survival sex between adolescent girls or young women and older men (the latter referred to as 'sugar-daddies' or 'blessers'). This paper expands on the existing literature on age-disparate and intergenerational relationships to provide social and behavioural interpretations of how young men, commonly omitted from studies on this topic, and women in concurrent relationships with both their peers and older partners perceive and navigate sexual risk. Method We conducted a qualitative study in a rural setting of uMgungundlovu District, KwaZulu-Natal Province, with purposively selected male and female participants aged 18-24 years old in age-disparate relationships. Semi-structured in-depth interviews (IDI) were conducted and analysed using interpretative phenomenological analysis (IPA) to explore existing information, motivations, and behavioural practices around relationships and sexual risk. Results The themes and related sub-themes found through IPA included the following: (1) navigating dating: narratives that show a strong preference for being in an age-disparate relationship; the challenges that young people face when choosing an older person as a side partner; and social media applications seen as creating opportunities to meet side partners; and (2) the distribution of love and trust in a multi-party sexual network: condom (mis)use differentiates between straights-those in a serious relationship-and sides; and the power of eye-test seroguessing, the praxis of testing people visually for HIV in nullifying existing knowledge about sexual and reproductive health risk. Discussion This research offers an understanding of how schemas of non-condom use are organised. We observed that while condom-less sex is often viewed as essential to building social capital in a serious relationship, it is not the only factor that determines sexual relationship power. Eye-test seroguessing not only develops consortium (trust, reciprocity, and solidarity), but it fulfils the psycho-social need to belong to a network of serious relationships. Moreover, it is critical to the enactment of masculinities because it consolidates femininity to keep men happy, i.e., by being passive in the sexual encounter, women constrain their self-efficacy to act contrary to the conventions of reputable women. Therefore, it is plausible that in the serosorting that occurs prior to unprotected sexual acts, the power of eye-test seroguessing limits the ability to engage in safe sexual practices.
Collapse
Affiliation(s)
- Phiwokazi Qoza
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- School of Law, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| |
Collapse
|
5
|
Ekholuenetale M, Owobi OU, Barrow A. Achieving the UNAIDS first '95' in prenuptial HIV/AIDS testing among reproductive-aged Rwandese women: A multilevel analysis of 2019-20 population-based data. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001033. [PMID: 36962990 PMCID: PMC10021437 DOI: 10.1371/journal.pgph.0001033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
A significant public health concern that disproportionately affects women is human immunodeficiency virus (HIV). Prenuptial HIV testing is no doubt a major step for people to learn their HIV status. In this study, the coverage of prenuptial HIV testing and its associated factors were examined among reproductive-aged Rwandese women. This study included a total of 14,634 reproductive-aged Rwandese women using 2019-20 Rwanda Demographic and Health Survey (RDHS). The coverage of prenuptial HIV/AIDS testing and the variables influencing it were evaluated using percentage and multilevel logit model. The level of significance was set at p<0.05. The weighted prevalence of prenuptial HIV/AIDS testing was 45.9% (95%CI: 44.8%-47.1%). The respondents who attained primary and secondary+ education had 31% (OR = 1.31; 95%CI: 1.09-1.59) and 56% (OR = 1.56; 95%CI: 1.25-1.95) higher odds of prenuptial HIV/AIDS testing, when compared with uneducated women. Those who got married or had their first sex at an adult age (18+ years), had higher odds of prenuptial HIV/AIDS testing, when compared with women who got married before age 18 years or never had sex respectively. Women's age, nativity and region were associated with prenuptial HIV testing. Women with knowledge of HIV test kits, had higher odds of prenuptial HIV/AIDS testing (OR = 1.45; 95%CI: 1.30-1.63), when compared with those with no knowledge of HIV test kits. The respondents from female-headed households had 12% reduction in prenuptial HIV/AIDS testing (OR = 0.88; 95%CI: 0.80-0.97), when compared with their male-headed counterparts. The moderately (OR = 1.16; 95%CI: 1.03-1.31) and highly (OR = 1.55; 95%CI: 1.37-1.75) enlightened women had higher odds of prenuptial HIV/AIDS testing, when compared with those with low enlightenment. The uptake of prenuptial HIV/AIDS testing was relatively low among Rwandese women. We recommend improving women's education, enlightenment, delay in sexual debut, marriage at adult age (18years) and increasing knowledge about HIV testing among women.
Collapse
Affiliation(s)
- Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olah Uloko Owobi
- Faculty of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Amadou Barrow
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, The Gambia
| |
Collapse
|
6
|
Vereeken S, Peckham E, Gilbody S. Can we better understand severe mental illness through the lens of Syndemics? Front Psychiatry 2022; 13:1092964. [PMID: 36683979 PMCID: PMC9853558 DOI: 10.3389/fpsyt.2022.1092964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Current health care systems do not sufficiently address contributors, also known as modifiable behavior factors, to severe mental illnesses (SMI). Instead treatment is focused on decreasing symptom-experience rather than reducing the detrimental effect of biological predisposition and behavioral influences on illness. Health care services and patients alike call for a more comprehensive, individual approach to mental health care, especially for people with SMI. A Syndemics framework has been previously used to identify ecological and social contributors to an HIV epidemic in the 1990s, and the same framework is transferable to mental health research to identify the relationship between contributing factors and the outcomes of SMI. Using this approach, a holistic insight into mental illness experience could inform more effective health care strategies that lessen the burden of disease on people with SMI. In this review, the components of a Syndemic framework, the scientific contributions to the topic so far, and the possible future of mental health research under the implementation of a Syndemic framework approach are examined.
Collapse
Affiliation(s)
- Silke Vereeken
- Mental Health and Addiction, Health Sciences, University of York, York, United Kingdom
| | - Emily Peckham
- Mental Health and Addiction, Health Sciences, University of York, York, United Kingdom
| | - Simon Gilbody
- Mental Health and Addiction, Health Sciences, University of York, York, United Kingdom.,Hull York Medical School, York, United Kingdom
| |
Collapse
|
7
|
Nsibandze BS, Downing C, Poggenpoel M, Myburgh CP. “I have been rejected so many times” experiences of female adolescents living with HIV in rural Manzini, Eswatini: A case study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|