Reproductive health options among HIV-infected persons in the low-income Niger Delta of Nigeria

Osaro Erhabor1, Chris I Akani2, Cosmos E Eyindah21Department of Haematology and Immunology, College of Health Sciences, University of Port Harcourt, 2Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, NigeriaBackground: With the advent and widespread use of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), persons living with HIV/acquired immune deficiency syndrome (AIDS) are living good quality, longer, and healthier lives. Many couples affected by HIV, both serodiscordant and seroconcordant, are beginning to consider options for safer reproduction. The aim of this study was to assess the reproductive health concerns among persons living with HIV/AIDS in the Niger Delta of Nigeria.Methods and results: The subjects were aged 18–58 (mean 41.25 ± 11.50) years, with 88 males (45.1%) and 107 females (54.9). Of the 195 subjects studied, 111 (56.9%) indicated a desire to have children. The main reasons for wanting to procreate included ensuring lineage continuity and posterity (52.3%), securing relationships (27.0%), and pressure from relatives to reproduce (20.7%). Single subjects were more inclined to have children (76.3%) compared with married (51.5%), widowed (18.2%), and separated/divorced subjects (11.1%, P = 0.03). Of the 111 subjects who indicated their desire to have children, women were more inclined to have children (64.5%) than men (47.7%). The major concern among the 84 (43.1%) subjects not desiring more children were the fear of infecting a serodiscordant partner and baby (57.1%), fear of dying and leaving behind orphans (28.6%), and fear that they may become too ill and unable to support the child financially (14.3%). Persons with no formal education were more likely to have children irrespective of their positive HIV status (66.7%) than persons educated to tertiary education level (37.0%, P = 0.01). Of 111 subjects who desired to have children, only 58% had attended reproductive health counseling with HIV counselors. Reasons for not seeking advice were anticipated negative reactions and discrimination from counselors. A significant number of subjects were only aware of some of the reproductive health options available to reduce the risk of infecting their partners and/or baby, such as artificial vaginal insemination, intrauterine insemination, cesarean section, avoidance of breast feeding, and offering prenatal pre-exposure prophylaxis to the fetus. They were unaware of other options, such as sperm washing, in vitro fertilization, and intracytoplasmic sperm injection. Of the 43.1% not anticipating more children, 36.9% were anticipating adoption.Conclusion: Our study has shown that a significant number of HIV-infected persons in the Niger Delta of Nigeria desire to have children irrespective of their positive serostatus. There is the need to support the sexual and reproductive rights of HIV-infected individuals. Additional training needs to be offered to HIV counselors on evidence-based best and affordable practices regarding reproductive health issues among persons living with HIV. Policies that support availability and accessibility to relevant reproductive and sexual health services, including contraception and procreation, need to be developed. Public enlightenment programs on HIV are needed to reduce the stigmatization that HIV-infected persons face from family members and their communities.Keywords: reproductive health, human immunodeficiency virus, low income, Niger Delta, Nigeri

Mapping soil moisture across the UK: assimilating cosmic-ray neutron sensors, remotely-sensed indices, rainfall radar and catchment water balance data in a Bayesian hierarchical model

Soil moisture is important in many hydrological and ecological processes. However, data sets which are currently available have issues with accuracy and resolution. To translate remotely-sensed data to an absolute measure of soil moisture requires mapped estimates of soil hydrological properties and estimates of vegetation properties, and this introduces considerable uncertainty. We present an alternative methodology for producing daily maps of soil moisture over the UK at 2-km resolution ("SMUK"). The method is based on a simple empirical model, calibrated with five years of daily data from cosmic-ray neutron sensors at ~40 sites across the country. The model is driven by precipitation, humidity, a remotely-sensed "soil water index" satellite product, and soil porosity. The model explains around 70 % of the variance in the daily observations. The spatial variation in the parameter describing the soil water retention (and thereby the response to precipitation) was estimated using daily water balance data from ~1200 catchments with good coverage across the country. The model parameters were estimated by Bayesian calibration using a Markov chain Monte Carlo method, so as to characterise the posterior uncertainty in the parameters and predictions. We found that the simple model could emulate the behaviour of a more complex process-based model. Given the high resolution of the inputs in time and space, the model can predict the very detailed variation in soil moisture which arises from the sporadic nature of precipitation events, including the small-scale and short-term variations associated with orographic and convective rainfall. Predictions over the period 2016 to 2023 demonstrated realistic patterns following the passage of weather fronts and prolonged droughts. The model has negligible computation time, and inputs and predictions are updated daily, lagging approximately one week behind real time