Association Between Domestic Violence and HIV Serostatus Among Married and Formerly Married Women in Kenya

The prevalence of both domestic violence (DV) and HIV among Kenyan women is known to be high, but the relationship between them is unknown. Nationally representative cross-sectional data from married and formerly married (MFM) women responding to the Kenya Demographic and Health Survey 2008/2009 were analyzed adjusting for complex survey design. Multivariable logistic regressions were used to assess the covariate-adjusted associations between HIV serostatus and any reported DV as well as four constituent DV measures: physical, emotional, sexual, and aggravated bodily harm, adjusting for co-variates entered into each model using a forward stepwise selection process. Co-variates of a priori interest included those representing marriage history, risky sexual behavior, substance use, perceived HIV risk, and socio-demographic characteristics. The prevalence of HIV among MFM women was 10.7% (any DV: 13.1%, no DV: 8.6%); overall prevalence of DV was 43.4%. Among all DV measures, only physical DV was associated with HIV (11.9%; adjusted odds ratio: 2.01, p < 0.05). Efforts by the government and women's groups to monitor and improve policies to reduce DV, such as the Sexual Offences Act of 2006, are urgently needed to curb HIV, as are policies that seek to provide DV counseling and treatment to MFM women

Health Literacy and Computer-Assisted Instruction: Usability and Patient Preference

The authors investigated the feasibility of using computer-assisted instruction in patients of varying literacy levels by examining patients’ preferences for learning and their ability to use 2 computer-based educational programs. A total of 263 participants 50–74 years of age with varying health literacy levels interacted with 1 of 2 educational computer programs as part of a randomized trial of a colorectal cancer screening decision aid. A baseline and postprogram evaluation survey were completed. More than half (56%) of the participants had limited health literacy. Regardless of literacy level, doctors were the most commonly used source of medical information—used frequently by 85% of limited and adequate literacy patients. In multivariate logistic regression, only those with health insurance (OR = 2.35, p = .06) and computer use experience (OR = 0.39, p .03) predicted the ability to complete the programs without assistance compared with those without health insurance or prior computer use, respectively. Although patients with limited health literacy had less computer experience, the majority completed the programs without any assistance and stated that they learned more than they would have from a brochure. Future research should investigate ways that computer-assisted instruction can be incorporated in medical care to enhance patient understanding

The association of patient trust and self-care among patients with diabetes mellitus

BACKGROUND: Diabetes requires significant alterations to lifestyle and completion of self management tasks to obtain good control of disease. The objective of this study was to determine if patient trust is associated with reduced difficulty and hassles in altering lifestyle and completing self care tasks. METHODS: A cross-sectional telephone survey and medical record review was performed to measure patient trust and difficulty in completing diabetes tasks among 320 medically underserved patients attending diabetes programs in rural North Carolina, USA. Diabetes tasks were measured three ways: perceived hassles of diabetic care activities, difficulty in completing diabetes-related care activities, and a global assessment of overall ability to complete diabetes care activities. The association of patient trust with self-management was examined after controlling for patient demographics, physical functioning, mental health and co-morbidities. RESULTS: Level of patient trust was high (median 22, possible max 25). Higher trust levels were associated with lower levels of hassles (p = 0.006) and lower difficulty in completing care activities (p = 0.001). Patients with higher trust had better global assessments of overall ability to complete diabetes care activities (p < 0.0001). CONCLUSION: Higher patient trust in physicians is associated with reduced difficulty in completing disease specific tasks by patients. Further studies are needed to determine the causal relationship of this association, the effect of trust on other outcomes, and the potential modifiability of trus

Importance of the Media in Scaling-Up HIV Testing in Kenya

The main objective of this study was to examine the association between media exposure and voluntary counseling and testing (VCT), and factors that influenced VCT among Kenyan women and men. Retrospective cross-sectional data from Kenya Demographic and Health Survey 2003 were used, adjusting for weights and strata to account for survey complex design. The study sample comprised women aged 15 to 49 (n = 8,050) and men aged 15 to 54 (n = 3,539). Among those who read newspapers/magazines almost every day, fewer women (15%) had been tested for HIV than men (31%), p < .001. Among women, those who read newspapers/magazines at least once a week (adjusted odds ratio [AOR] = 1.29, p < .001) and almost every day (AOR = 1.3, p < .001) were more likely to be tested than those who did not read at all. Among men, this was nonsignificant. However, those who read newspapers/magazines almost every day (AOR = 1.14, p < .05) were more likely to be tested than those who did not read at all. Significant odds of being tested for HIV were observed among men who watched television almost every day (AOR = 1.21, p < .001) versus women (AOR = 1.07, p < .05) compared with those who did not watch television at all. Results suggest a need to increase HIV messages in all media to scaling-up HIV testing in Kenya

Delaying sexual debut as a strategy for reducing HIV epidemic in Kenya

The study purpose was to determine the association between sexual debut and HIV sero-status, and factors contributing to a positive HIV sero-status. Retrospective cross-sectional data from the Kenya Demographic and Health Survey-2003 were used. Data on women aged 15-49 (n=3,273) and men aged 15-54 (n=2,917) accepting HIV testing were retained from three datasets. Stata version 10.1 was used for analyses, p<0.05. Nine percent of women and 5% of men tested positive for HIV, of whom 46% and 49%, p<0.001 were aged 16-21 respectively. After adjusting for confounding, women and men who had sexual debut aged 16-21 were 2.31 (95% CI: 1.52-3.51), p<0.001 and 1.83 (95% CI: 1.07-3.13), p<0.05 times more likely to test positive for HIV compared to those who never had sex respectively. Early sexual debut continues to be a major risk factor for acquiring HIV infection later in life, suggesting earlier interventions could have a major impact towards fighting the disease. (Afr J Reprod Health 2013; 17[2]: 46-57).Le but de l&apos;étude était de déterminer l&apos;association entre l&apos;activité sexuelle et situation sérologique du VIH et les facteurs qui contribuent à un effet positif de la situation sérologique du VIH. Nous nous sommes servis des données transversales rétrospectives de l&apos;Enquête démographique et de santé au Kenya -2003. Les données sur les femmes âgées de 15-49 ans (n = 3273) et les hommes âges de 15-54 ans (n = 2917) qui ont accepte le dépistage du VIH ont été retenus à partir de trois ensembles de données. La version Stata 10.1 a été utilisé pour les analyses, p <0,05. Les analyses ont révélé la présence du VIH chez neuf pour cent des femmes et 5% des hommes, dont 46% et 49%, p <0,001 étaient âgés de 16 à 21 ans respectivement. Après l’ajustement pour les facteurs confondants, les femmes et les hommes qui ont eu leurs premiers rapports sexuels a l’âge de 16 à 21 ans étaient 2,31 (IC à 95%: 1,52 à 3,51), p <0,001 et 1,83 (IC à 95%: 1.7 à 3.13), p <0,05 fois plus susceptibles d’avoir le résultat positif dans les analyses pour déterminer la présence du VIH par rapport à ceux qui n&apos;ont jamais eu des rapports sexuels, respectivement. L&apos;initiation au rapport sexuel précoce continue d&apos;être un facteur de risque majeur de contracter l&apos;infection du VIH plus tard dans la vie, ce qui suggère que les interventions antérieures pourraient avoir un impact majeur vers la lutte contre la maladie. (Afr J Reprod Health 2013; 17[2]: 46-57)