Current research and good practice in HIV and AIDS treatment education

This report was prepared by UNESCO and WHO for presentation at the HIV and AIDS Treatment Education Technical Consultation in Paris, November 22–23, 2005. There is a growing realization among program managers and donors that merely providing antiretroviral therapy (ART) and training health providers is not sufficient and that unless efforts are made to engage communities and individuals to improve their knowledge and understanding of HIV, AIDS, and ART, programs will not meet the targets set by these initiatives and will fall short of contributing to the goal of attaining universal access to treatment. This report describes current research and field experiences related to HIV and AIDS treatment education undertaken with individuals and communities and focuses on a select number of treatment education programs and a treatment literacy intervention. Programs in Africa and Asia were selected because they represent a range of treatment education and adherence support interventions that target individuals and/or communities in developing countries, where documentation has been more limited. The report highlights some of the successes of these programs and identifies the gaps and problems experienced while conducting treatment education

Looking back, moving forward: Access to antiretroviral therapy for HIV infected adults and children in developing countries: Horizons Studies, 2002 to 2008

In 1997, the Population Council initiated the Horizons Program—a decade-long USAID-funded collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, PATH, Tulane University, Family Health International, and Johns Hopkins University—designing, implementing, evaluating, and expanding innovative strategies for HIV prevention and care. Horizons developed and tested ways to optimize HIV prevention, care, and treatment programs; worked to reduce stigma and improve gender-biased behaviors; and greatly expanded knowledge about the best ways to support, protect, and treat children affected by HIV and AIDS. In all its projects, Horizons strengthened the capacity of local institutions by providing support and training to colleagues. This synthesis paper presents lessons learned and best practices on one of the key topics that Horizons investigated: access to antiretroviral therapy

Prevention with positives: How do we reach them in the community?

In the past, HIV prevention efforts have focused primarily on developing risk-reduction interventions for those presumed to be HIV-negative and therefore at risk of becoming infected with HIV. In recognition of the need for prevention among people living with HIV (PLHIV), programs have been initiated in Africa, but primarily in clinical settings for those who are on antiretroviral therapy (ART). There is little knowledge about how to reach those PLHIV not on ART, and therefore not in regular contact with the health system or with effective prevention messages. This diagnostic study aimed to address the gap in information on how to identify and access HIV-positive persons who are not accessing care and treatment services as a first step in designing and implementing a community-based project in Mombasa, Kenya. The study found gaps in HIV knowledge, high levels of sexual risk behaviors, and unmet need for HIV-related information and education. Recommendations aim to improve the reach and content of HIV-prevention programs

Examining adherence and sexual behavior among patients on antriretroviral therapy in India

"Very high levels of patient adherence (greater than 95 percent) are required for antiretroviral therapy (ART) to be effective and to prevent the emergence of resistant viral strains (Paterson et al. 2000; Ickovics et al. 2002). Since 1997, antiretroviral (ARV) medications have been available in India through the private sector and some employer-supported health insurance programs. It is estimated that India has 5.1 million HIV-infected persons (NACO 2004), some of whom have been on ART for several years. However, very little information is available on the levels of adherence to ART among people living with HIV/AIDS in India. With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. But, optimism related to ART's success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. Determining the sexual behavior of HIV-positive persons on ART is therefore an area of special interest and concern. To meet these knowledge gaps, the Horizons Program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and determine their sexual risk behaviors. The study also examined the economic burden of ART on the household. Findings from the study provide important insights that are immediately relevant to the scale-up of the national ART program, which was launched in April 2004." [OCLC Accession No.: 70645391

Examining adherence and sexual behavior among patients on antiretroviral therapy in India

With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. However, optimism related to ART’s success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. To determining the sexual behavior of HIV-positive persons on ART, the Horizons program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and determine their sexual risk behaviors. The study also examined the economic burden of ART on the household. The findings from the study presented in this report provide important insights that are immediately relevant to the scale-up of the national ART program, including a need to expand the scope of prevention programs to include HIV-positive populations, with a special focus on facilitating disclosure of HIV status and consistent condom use with regular partners

Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India

Objectives: To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes. Design: Qualitative study design using semi-structured in-depth interviews. Participants: Twenty women who injected drugs in the past 3months and 28 women who reported using drugs through non-injecting routes in the past 1month. Setting: Interviews were conducted at community-based, drop-in centres in Delhi, India. Results: Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships were reported and many participants engaged in unsafe sex. Factors which affected safe sex behaviours included: gender power imbalance, limited agency for decision-making, lack of accurate information for correct self-risk assessment, and being under the influence of drugs. Despite high awareness, low and inconsistent contraceptive use was reported. Some participants were coerced to conceive while a few others reported their inability to conceive. Violence was a key determinant for SRH outcomes. Perception of certain adverse health outcomes (such as infertility) to be ‘common and expected among WUD’ influenced access to healthcare. Further, healthcare providers’ stigmatising attitudes and lack of women-centric services deterred women from uptake of healthcare services. Conclusion: Findings highlight that SRH-related behaviours and needs of this group are a complex interplay of multiple determinants which need to be addressed at all levels: individual, family, community and institutional. It is imperative to roll out a ‘one-stopshop’ for a comprehensive package of health services. Expansion of existing drop-in-centres could be considered for setting-up community-based women-centric services with appropriate linkage to drug dependence treatment and reproductive health services

If you build it, will they come? Kenya healthy start pediatric HIV study: A diagnostic study investigating barriers to HIV treatment and care among children

In Kenya the proportion of eligible HIV-positive children receiving ART treatment is only 11 percent. This study explored and documented possible barriers in the community to accessing pediatric HIV testing and treatment, to guide the development of new interventions to encourage uptake. The study identified barriers such as cost, use of traditional healers, low knowledge of treatment options, attitudinal barriers, stigma, unique treatment issues, and dissatisfaction with available services. Additionally, healthcare workers missed opportunities to provide services and cited numerous service-side challenges. The study recommends prioritizing community awareness, mobile clinics, strengthening capacity of healthcare workers, supporting family-based HIV testing, and strategies to reach HIV-positive adolescents and young adults

Impact of antiretroviral therapy on household economics: Findings from Mombasa, Kenya

While the clinical impact of receiving antiretroviral therapy (ART) on individuals living with HIV is well documented, less is known about how the receipt of ART affects household economics. This analysis examined the direct and indirect effects of receiving ART on household economics. A direct effect is reduced spending on health services as a result of the improved health status of the household member on ART. The potential indirect effects include increased labor-force participation by the household member on ART, a change in how other household members spend their time (working or in school), and a shift in composition of household expenditures. This brief describes the experiences of a cohort of people living with HIV who were receiving ART through a program coordinated by the Coast Provincial General Hospital in Mombasa, Kenya. A longitudinal study of clients on ART found that perceived health improved, reported incidence of illness and use of health services declined, and labor-force participation increased within 12 months of initiating therapy

Prevalence and determinants of unprotected sex in intimate partnerships of men who inject drugs: findings from a prospective intervention study

Unprotected sex, common among people who inject drugs, puts them and their partners at risk of sexually transmitted infections including human immunodeficiency virus (HIV). This analysis assesses the changes in sexual risk behavior with regular female partners (RFPs), among married men who inject drugs, before and after implementation of a HIV prevention intervention, and identifies correlates of unprotected sex. People who inject drugs (PWID) were assessed at three points: baseline, preintervention follow-up visit (FV)1, and postintervention FV2. Descriptive analysis was used for reporting changes in sexual behavior over time. Generalized estimating equation assessed the population-averaged change in self-reported unprotected sex with an RFP, attributable to intervention uptake. Multivariable logistic regression determined correlates of self-reported unprotected sex with an RFP at FV2. Findings suggest that the proportion of men reporting any unprotected sex remained high (baseline = 46.0%, FV1 = 43.5%, FV2 = 37.0%). A reduction was observed in unprotected sex after the intervention phase, but this could not be attributed to uptake of the intervention. Higher odds of self-reported unprotected sex with an RFP in the past three months at FV2 were associated with self-reported unprotected sex at baseline, living with family, and being HIV-negative. Married male PWID should receive counseling for safe sex with RFPs, especially those who are HIV-negative and live with their families

Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

<p>Abstract</p> <p>Background</p> <p>HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.</p> <p>Results</p> <p>Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.</p> <p>Conclusions</p> <p>High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.</p