Socio-demographic predictors of gender inequality among heterosexual couples expecting a child in south-central Uganda

Background: Gender inequality is a pervasive problem in sub-Saharan Africa, and has negative effects on health and development. Objective: Here, we sought to identify socioeconomic predictors of gender inequality (measured by low decision-making power and high acceptance of intimate partner violence) within heterosexual couples expecting a child in south-central Uganda. Method: We used data from a two-arm cluster randomized controlled HIV self-testing intervention trial conducted in three antenatal clinics in south-central Uganda among 1,618 enrolled women and 1,198 male partners. Analysis included Cochran Mantel-Haenzel, proportional odds models, logistic regression, and generalized linear mixed model framework to account for site-level clustering. Results: Overall, we found that 31.1% of men had high acceptance of IPV, and 15.9% of women had low decision-making power. We found religion, education, HIV status, age, and marital status to significantly predict gender equality. Specifically, we observed lower gender equality among Catholics, those with lower education, those who were married, HIV positive women, and older women. Conclusion: By better understanding the prevalence and predictors of gender inequality, this knowledge will allow us to better target interventions (increasing education, reducing HIV prevalence in women, targeting interventions different religions and married couples) to decrease inequalities and improve health care delivery to underserved populations in Uganda

Relationship Gender Equality and HIV Self-Testing Among Heterosexual Couples Expecting a Child in Central Kenya and South-Central Uganda

Gender equality refers to equal rights, responsibilities and opportunities for women and men. Equality between women and men is both a human rights issue and is necessary for sustainable societal development. However, in most sub-Saharan African societies, men have substantial power over women, and many national advancements in reproductive health, empowerment, and labor market participation have been impeded by gender inequality. Gender inequality has been correlated with intimate partner violence (IPV), which is in turn positively correlated with risk of HIV, and has also been associated with higher risk of HIV infection independent of IPV. Thus, factors that diminish gender inequality may decrease IPV and risk of HIV infection. Moreover, there is a lack of studies assessing factors predictive of gender equality in a pregnancy context. Compared to current blood-based methods of clinical HIV testing, HIV self-testing kits are a relatively new technology, and hold great potential to increase testing rates and HIV awareness, maintain patient privacy, and lead to both prevention of HIV and improved treatment. However, no studies have queried the correlation between relationship gender equality and HIV self-testing behavior. This dissertation research examined the relationships between individual social and economic factors related to decision-making power and personal attitudes towards IPV within heterosexual couples expecting a child. In addition, the work explored the correlation between relationship gender equality and HIV self-testing uptake. This study addressed these questions in four specific aims: 1. Identify social and economic predictors of low decision-making power and high acceptance of IPV within heterosexual couples expecting a child in central Kenya. 2. Determine the association between high gender equality (measured by high decision-making power and low acceptance of IPV) and couples’ uptake of HIV self-testing kits in central Kenya. 3. Identify social and economic predictors of low decision-making power and high acceptance of IPV within heterosexual couples expecting a child in south-central Uganda. 4. Determine the association between high gender equality (measured by high decision-making power and low acceptance of IPV) and male partners’ uptake of HIV self-testing kits in south-central Uganda. This study used data collected from two randomized controlled trials (RCTs) assessing the effectiveness of HIV self-testing kits to increase HIV testing for male partners of pregnant women in Kenya and Uganda (n=1,410 and n=1,618, respectively). We found, through Aims 1 and 3, that there are potential targets to improve specific social and economic variables associated with lower gender equality (e.g., to increase men and women’s education levels, equality in earnings between partners, and reduce HIV prevalence). Furthermore, interventions could be created for specific populations (e.g., targeted towards different religions or wealth status and married couples) to improve gender equality in heterosexual couples expecting a child in Kenya and Uganda. We found, through Aims 2 and 4, that there was no association between decision-making power and uptake of HIV self-testing, either as a couple (in Aim 2), or the male partner alone (Aim 4). There was also no association between male partner’s attitudes towards IPV and uptake of HIV self-testing from the male partner alone (Aim 4), but men with low acceptance of IPV were 2.5 times more likely to use the HIV self-testing kits as part of a couple compared to men with high acceptance of IPV (Aim 2), and in couples where the female partner had medium or low acceptance of IPV, the male partners were 1.76 and 1.82 times more likely to use the HIV self-testing kits than in couples where the female partner had high acceptance of IPV. Overall, this dissertation fills a gap in research on sociodemographic predictors of gender equality within a pregnancy context in Kenya and Uganda, and in research regarding the associations between gender equality and HIV self-testing uptake. Fighting the AIDS epidemic needs to involve efforts at all levels of the HIV continuum of care, as underscored by the 90:90:90 goal set forth by UNAIDS, in which 90% of all individuals living with HIV around the world should know their HIV status. This present work showing the importance of low acceptance of IPV in increasing HIV self-testing (both as a couple and the male partner alone) and discovering additional influences of HIV self-testing uptake are vitally important as we work towards achieving the first 90% of the tripartite goal

Gender Disparities in Receipt of HIV Testing Results in Six Sub-Saharan African Countries

Purpose: Receipt of HIV testing results is vital for individuals to know their status and make decisions that would improve their access to HIV prevention, treatment, and care. The objective of this study is to determine the association of HIV testing and receipt of results with three key exposure variables (HIV stigma, HIV knowledge, and media use) stratified by gender and country. Methods: Data from a random sample of adults aged 15–49 years from Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda were abstracted from country-specific Demographic and Health Surveys or AIDS Indicators Surveys. Individuals were asked questions regarding demographics, socioeconomic status, sexual behaviors/attitudes, HIV knowledge, HIV stigma, and media-consumption. Weighted logistic regression was used to determine the association between receipt of HIV testing with key risk factors stratified by gender and country. Results: Gender disparities in HIV testing and receipt of results, HIV stigma, and HIV knowledge remain high. More women have recently tested for HIV and received their results than men. HIV stigma was associated with decreased recent HIV testing in all six countries for women, and for men except in Ethiopia, Tanzania, and Uganda. HIV knowledge was positively related to recent testing in all countries, except Uganda for women and Kenya and Tanzania for men. In Burundi and Rwanda, women had more HIV knowledge than men, while in Kenya, Ethiopia, Tanzania, and Uganda, men had more HIV knowledge than women. Conclusion: Given the importance of HIV testing for effective management of HIV in sub-Saharan Africa, it is crucial for these countries to exchange information on gender-specific policies and strategies that have the most impact on increasing HIV knowledge and decreasing HIV stigma

Analysis of Hyperphagia Questionnaire for Clinical Trials (HQ-CT) scores in typically developing individuals and those with Prader-Willi syndrome

Abstract The Hyperphagia Questionnaire for Clinical Trials (HQ-CT) is an observer-reported outcome measure that has been widely used in interventional studies to assess changes in hyperphagic behaviors in individuals with Prader-Willi syndrome (PWS). However, HQ-CT scores in the wider PWS population and the general population have not been reported. Here we report HQ-CT scores from more than 400 individuals with PWS and 600 typical individuals, aged 5–26. Overall, HQ-CT scores were significantly higher in those with PWS compared to typically developing individuals at all ages evaluated. In addition, while HQ-CT scores in the typically developing population decreased with age, scores increased with age in PWS. To further understand the variability of HQ-CT scores in the PWS population, semi-structured interviews were conducted with caregivers of a small subset of adults with PWS who had unexpectedly low HQ-CT scores. These caregivers reported that strict adherence to a food routine, food security measures and supervised food preparation reduced the frequency and intensity of hyperphagic behaviors measured by HQ-CT. Thus, hyperphagic behaviors are captured by the HQ-CT for most individuals with PWS, but for some individuals residing in settings with highly structured food routines, HQ-CT scores may not fully reflect the extent of PWS-associated hyperphagia

Characteristics and relationship between hyperphagia, anxiety, behavioral challenges and caregiver burden in Prader-Willi syndrome.

ObjectivesPrader-Willi syndrome (PWS) is a rare genetic disorder characterized by maladaptive behaviors, amongst which hyperphagia is a life-long concern for individuals with PWS and their caregivers. The current study examined the contribution of hyperphagia and other factors to caregiver burden across lifespan, in 204 caregivers of individuals with PWS living in the US, using the Zarit Burden Interview (ZBI) and the hyperphagia questionnaire (HQ-CT).ResultsWe found a strong relationship between ZBI and HQ-CT especially in individuals with PWS older than 4 y and showed that HQ-CT scores of individuals with PWS is positively correlated with ZBI scores of their caregivers. The weight status of individuals with PWS was not associated with HQ-CT and ZBI scores, except for obese individuals who had significantly higher HQ-CT scores when compared to normal weight PWS individuals. We looked at PWS symptoms and care-related issues that impacted individuals and caregivers the most. We found that care-related tasks had the biggest negative impact on caregivers of children aged 0-4 y, whereas anxiety, temper tantrums, and oppositional behaviors of older individuals with PWS had the biggest impact on their caregivers concomitant with their high caregiver burden. Finally, we assessed the variability of HQ-CT and ZBI over 6 months in a subgroup of 83 participants. Overall, neither measure differed between 6 months and baseline. Most individual's absolute HQ-CT score changes were between 0-2 units, whereas absolute ZBI score changes were between 0-6 points. Changes in the caregiver's or individual's life had little or no effect on HQ-CT and ZBI scores.ConclusionsThis study demonstrates a relationship between hyperphagia and caregiver burden and sheds light on predominant symptoms in children and adolescents that likely underly PWS caregiver burden. The stability and relationship between HQ-CT and ZBI support ZBI as an additional outcome measure in PWS clinical trials

Thrombosis Risk History and D-dimer Levels in Asymptomatic Individuals with Prader–Willi Syndrome

Individuals with Prader–Willi syndrome (PWS) may be at higher risk of developing blood clots as compared to the typical population, but this risk is poorly understood. It is also unclear if laboratory testing of D-dimer concentration might be useful to screen for thrombosis in PWS. Here, we surveyed the thrombosis history of 883 individuals with PWS and evaluated the D-dimer concentration in a subset of 214 asymptomatic individuals, ages 5–55. A history of at least one blood clot was reported by 3.6% of respondents. Thrombosis increased with age, but no significant difference was found on the basis of sex or family history. Genetic subtype was a significant factor when considering only those with a known subtype, and individuals with a history of edema had significantly more blood clots. In the D-dimer sub-study, ≈15% of participants had high D-dimer concentrations, and 3.7% had D-dimer values more than twice the normal upper limit. One participant with a high D-dimer result was found to have a blood clot. No significant differences in D-dimer results were found on the basis of age, sex, genetic subtype, family history of blood clots, edema history, or BMI. The D-dimer test does not appear to be a sensitive and specific screening tool for blood clots in asymptomatic individuals with PWS

Low acceptance of intimate partner violence by pregnant women in Uganda predicts higher uptake of HIV self-testing among their male partners

Introduction: Heterosexual couples are at high risk for HIV acquisition in sub-Saharan Africa, and HIV self-testing (HST) is an additional approach to expand access to HIV testing services. However, it is not well known how gender equality is associated with HST.Methods: We used intervention-arm data from a cluster-randomised controlled HST intervention trial (N = 1 618) conducted in Uganda to determine the association between attitudes towards intimate partner violence (IPV), decision-making power and male partner’s uptake of HST among heterosexual couples expecting a child in south-central Uganda. The original study question was to assess the impact of providing pregnant women with HST kits to improve male partner’s HIV testing rates. For this analysis, the primary exposures were gender equality (measured by male partner’s and female partner’s attitudes towards IPV and the female partner’s household decision-making power), and the primary outcome was the male partner’s uptake of HST. Multivariate logistic regression was used for analysis.Results: We found that male partner HST uptake did not vary depending on male partner’s attitudes towards IPV or decision-making power; however, male partner HST uptake did depend on the female partner’s attitude towards IPV, with 1.76 times more testing (95% CI 1.06–2.92) in couples where the woman had “medium” versus “high” acceptance of IPV, and 1.82 times more testing (95% CI 1.08–3.08) in couples where the woman had “low” versus “high” acceptance of IPV.Conclusions: This study shows the importance of appropriate negative attitudes by women to IPV in increasing male partner’s HST uptake to integrate HST into national health care policies