HIV Prevention in Care and Treatment Settings: Baseline Risk Behaviors among HIV Patients in Kenya, Namibia, and Tanzania.

HIV care and treatment settings provide an opportunity to reach people living with HIV/AIDS (PLHIV) with prevention messages and services. Population-based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV, yet data are limited regarding HIV risk behaviors of PLHIV in clinical care. This paper describes the baseline sociodemographic, HIV transmission risk behaviors, and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa. The study was a longitudinal group-randomized trial in 9 intervention clinics and 9 comparison clinics in Kenya, Namibia, and Tanzania (N = 3538). Baseline participants were mostly female, married, had less than a primary education, and were relatively recently diagnosed with HIV. Fifty-two percent of participants had a partner of negative or unknown status, 24% were not using condoms consistently, and 11% reported STI symptoms in the last 6 months. There were differences in demographic and HIV transmission risk variables by country, indicating the need to consider local context in designing studies and using caution when generalizing findings across African countries. Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors, which supports the need for prevention with PLHIV (PwP). TRIAL REGISTRATION: ClinicalTrials.gov NCT01256463

Smarter Programming of the Female Condom: Increasing Its Impact on HIV Prevention in the Developing World

The purpose of this study was to investigate the relative value of the female condom for HIV prevention within heterosexual relationships in the developing world. In the last ten years, the world has witnessed both historic financial commitments to HIV/AIDS and new prevention options, including biomedical prevention research, male circumcision, and a dramatic scale-up of voluntary counseling and testing. At the same time, where HIV remains at epidemic levels in many countries, there has been a growing commitment to treatment access alongside prevention programs. However, portions of populations, particularly youth and women, remain highly vulnerable to HIV infection. Accordingly, the global health community can benefit from a better understanding of how existing prevention options should be effectively and efficiently delivered to reduce HIV in the developing world. This report provides guidance for the global health community for considering how the female condom fits within the set of prevention interventions currently available

Cross-sectional study assessing HIV related knowledge, attitudes and behavior in Namibian public sector employees in capital and regional settings

The study objective was to assess the current status of HIV knowledge, attitudes and behavior (KAB) among employees of Namibian ministries. As most HIV campaigning takes place in the capital of Windhoek, an additional aim was to compare Windhoek to four regions (Hardap, Erongo, Oshana, and Caprivi). Between January and March 2011 a cross-sectional survey was conducted in two Namibian ministries, with participants selected randomly from the workforce. Data collection was based on questionnaires. 832 participants were included in the study (51.6% male). Nearly 90% of participants reported to have been tested for HIV before. Knowledge about HIV transmission ranged from 67% to 95% of correct answers, with few differences between the capital and regions. However, a knowledge gap regarding HIV transmission and prevention was seen. In particular, we found significantly lower knowledge regarding transmission from mother-to-child during pregnancy and higher rate of belief in a supernatural role in HIV transmission. In addition, despite many years of HIV prevention activities, a substantial proportion of employees had well-known HIV risk factors including multiple concurrent partnership rates (21%), intergenerational sex (19%), and lower testing rates for men (82% compared to women with 91%)

The strategic use and potential demand for an HIV vaccine in Southern Africa

HIV prevalence in Southern Africa is the highest in the world and the impact of HIV/AIDS in the region are devastating at all levels of society, including the wider economy. Government response has lagged behind the pace of the epidemic, but programs are now beginning to focus on a broad range of interventions to combat its further spread and to mitigate its impact. The authors investigate the issues around the targeting of an eventual HIV vaccine. There is at present no vaccine against HIV. Although several candidates are in the trial stage, it is not likely that a vaccine effective against the sub-type of the virus prevalent in Southern Africa will be available for 10-15 years. When it is, it may be expensive, only partially effective, and confer immunity for a limited period only. Vaccination programs will need to make the best use of the vaccine that is available and effective targeting will be essential. The authors identify potential target groups for a vaccine, and estimate how many individuals would be in need of vaccination. They develop a method for estimating how many cases of HIV infection are likely to be avoided for each vaccinated individual. The cases avoided are of two kinds: primary-the individual case that might have occurred in people who are vaccinated, and secondary-the number of people that the vaccinated individual would otherwise have caused to become infected. Both ofthese depend on assumptions about the efficacy and duration of vaccine protection and the extent and nature of sexual risk behavior in the population groups. The authors distinguish between the HIV cases averted per vaccination and the cases averted per 100 recruits into a vaccination program. The cases averted per 100 recruits is used to develop a priority ranking of the identified population groups for vaccination. The authors discuss the issue of ease of access to those groups and how the differential costs would affect the vaccination strategy. They conclude that an expensive vaccine should be administered to commercial sex workers first, while an inexpensive vaccine would be better administered first to general population groups, in particular, schoolchildren. The authors conclude with a discussion of current levels of public and private expenditure on HIV prevention and treatment, and the implications for an assessment of the willingness to pay for an eventual HIV vaccine.Disease Control&Prevention,Health Monitoring&Evaluation,HIV AIDS,Public Health Promotion,Early Child and Children's Health,Adolescent Health,Health Economics&Finance,HIV AIDS and Business,Health Monitoring&Evaluation,HIV AIDS

Global HIV Prevention: The Access, Funding, and Leadership Gaps

Outlines the limited access to HIV prevention services in middle- to low-income countries, insufficient funding to scale-up effective programs, and the lack of global and national leadership on prevention that impedes broader delivery of proven methods

An analysis of the role of VCT in the prevention of HIV infection in Sub-Saharan Africa : Swakopmund, Namibia case study

Asignment (MPhil)--University of Stellenbosch, 2006.ENGLISH ABSTRACT: This research paper looks at the role of VCT (Voluntary Counselling and Testing) services in the prevention of HIV – a growing trend throughout Sub-Saharan Africa. The benefits of VCT on the HIV positive segment of the population are clear, i.e. psychosocial support, access to further resources etc. However, the impact of VCT services on the HIV negative segment of society, as a preventive tool, has not been closely studied. Many organizations are implementing HIV workplace programmes but not emphasising voluntary counselling and testing services, often due to the often high cost of these services and the fact that employees miss out on work time in order to be tested. Organizations need to strive to ensure that their HIV positive employees remain healthy enough to work and also that their HIV negative employees remain negative. Behaviour change is at the root of HIV prevention. How to bring about behaviour change, however, still remains a major stumbling block to HIV prevention. This is especially true when looking at the multi-cultural environment in Sub-Saharan Africa. This study was conducted in Swakopmund, Namibia. Data was gathered on individuals voluntarily making use of VCT services. The study focuses on 221 clients who have attended VCT services, tested negative on their initial visit and returned after a three month period for further counselling and testing. Data gathered includes background information, high risk activities, and was gathered during both visits. Information gathered during both visits was then compared and analysed. An analysis of the data has shown that indeed VCT services can produce behaviour change and therefore reduce risk to HIV. Clients returning to the VCT centre for further counselling and testing showed a decrease in high risk activities such as unprotected sex, sex while intoxicated and number of sexual partners. This may help to reshape how we think about VCT and to assist in further integrating VCT services into successful HIV/AIDS management programmes.AFRIKAANSE OPSOMMING: Hierdie navorsing behandel die rol van V.C.T ( Voluntary Counselling and Testing ) – dienste vir die voorkoming van MIV/ VIGS – wat merkbare groei in Sub-Sahara-Afrika toon. Die voordele wat V.C.T vir die MIV – positiewe deel van die bevolking inhou spreek vanself nl. sielkundige hulp, die toegang tot ander hulpbronne ens. Maal hul effek op die MIV negatiewe deel van die gemeenskap is tot hede nog nie van naderby gebestudeer nie. Vele organisasies is tans besig om MIV programme by werkplekke te implimenteer, maar beklemtoon ongelukkig nie vrywillige raadgewing, -voorligting en, -toetsing genoeg nie. Dikwels is dit toe te skryf an die hoë koste, en ook dat werknemers tyd by hulle werk sou verloor om getoets te kan word. Werkgewers behoort te poog dat MIV-positiewe werknemers gesond genoeg bly om werk te kan verrig, en dat MIV- negatiewe werknemers negatief bly. Van die belangrikste aspekte vir MIV-voorkoming en bekamping is gedragspatrone en lewenswyse wat noodwendig sal moet verander. Om hierdie verandering te hulp bewerkstellig is en bly steeds ń groot probleem. Dit geld veral vir die multikulturele bevolking van Suid- Sahara-Afrika. Hierdie studie is in Swakopmund, Namibia gedoen. Data is by individue wat vrywillig van V.C.T.- dienste gebruik maak het, verkry. Die studie fokus op 221 kliente wat hierdie dienste bygewoon het, negatief getoets is met die eerste besoek, en dan na drie maande teruggekeer het vir verdere berading en toetsing. Die data sluit al die kliente se agtergrond inligting, hoë risiko aktiwiteite, en is ingewin by beide besoeke. Die twee stelle inligting is dan vergelyk en geanaliseer. Analise van die data toon dat V.C.T-dienste inderdaad gedragsveranderinge tot vevolg kan he en derhalwe die gevaar van MIV kan verminder. Kliente wat opvolgsbesoeke an die V.C.Tsentrum gebring het, het na voorligting en toetse ń afname in hoë risiko bedrywighede. getoon

A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa

Background The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Methods Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Results Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. Conclusion There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions

Proceedings of the international workshop responding to HIV and AIDS in the fishery sector in Africa

HIV (Viruses), Fisheries, Africa,