Sexual risk related behaviour among youth living with HIV in central Uganda: implications for HIV prevention

Introduction: As young people living with HIV grow their sexual behaviour and it's implication on HIV prevention is of concern. This study describes the sexual risk related-behaviours and factors associated with abstinence among Youth Living with HIV in central Uganda. Methods: We conducted a cross-sectional study among 338 unmarried youth between 15 and 24 years accessing HIV care in central Uganda. Data was collected using interviewer administered structured questionnaires. Adjusted prevalence proportion ratios (adj. PPRs) of factors associated with sexual abstinence for at least six months were determined by multivariable log-binomial regression. Results: Overall, 79% (269/338) of respondents were abstaining from sexual intercourse for atleast six months, although, 45% (150/338) had ever been sexually active. Of the 283 respondents who desired to get married in future, 40% preferred negative marriage partners. Only 31% (39/126) of respondents in boy/girl relationships had disclosed their HIV status to their partners. Among those currently sexually active (n=69), 57% did not consistently use condoms and 30% had more than one sexual partner in the past six months. The adj.PRR of abstinence was higher among youth between 15 and 19 years compared to those between 20 and 24 years (adj. PPR=1.26, 95% CI; 1.08-1.46). The prevalence of abstinence was significantly lower among respondent who consumed alcohol (adj. PPR=0.31, 95% CI 0.16-0.61). Conclusion: Tailored interventions promoting disclosure, consistent condoms use and discouraging alcohol consumption among sero-positive youth could reduce HIV transmission risk.Pan African Medical Journal 2016; 2

HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda

BACKGROUND: Disclosure of HIV status supports risk reduction and facilitates access to prevention and care services, but can be inhibited by the fear of negative repercussions. We explored the short and long-term outcomes of disclosure among clients attending an urban HIV clinic in Uganda. METHODS: Qualitative semi-structured interviews were administered to a purposeful sample of 40 adult HIV clients that was stratified by gender. The information elicited included their lived experiences and outcomes of disclosure in the short and long term. A text data management software (ATLAS.ti) was used for data analysis. Codes were exported to MS Excel and pivot tables, and code counts made to generate statistical data. RESULTS: Of the 134 short-term responses elicited during the interview regarding disclosure events, most responses were supportive including encouragement, advice and support regarding HIV care and treatment. The results show on-disclosing to spouse, there was more trust, and use of condoms for HIV prevention. Only one third were negative responses, like emotional shock and feeling of distress. The negative reactions to the spouses included rejection, shock and distress in the short term. Even then, none of these events led to drastic change such as divorce. Other responses reflected HIV prevention and call for behavioural change and advice to change sexual behaviour, recipient seeking HIV testing or care. Women reported more responses of encouragement compared to men. Men reported more preventive behaviour compared to women. Of the 137 long-term outcomes elicited during disclosure, three quarters were positive followed by behavioral change and prevention, and then negative responses. Men reported increased care and support when they disclosed to fellow men compared to when women disclosed to women. There was better or not change in relationship when women disclosed to women than when women disclosed to men. CONCLUSIONS: There is overwhelming support to individuals that disclose their HIV status, especially in the long term. Besides, gender appears to influence responses to HIV disclosure, highlighting the need for gender specific disclosure support strategies

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study

Introduction: gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015. Methods: we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics. Results: a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected. Conclusion: road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions

Adolescent motherhood in Uganda : Dilemmas, health seeking behaviour and coping responses

Introduction: Maternal mortality remains one of the most daunting public health problems in resource limited settings. Maternal health services play a critical role in the improvement of sexual and reproductive health and rights, especially for adolescent mothers. Adolescence is a time of rapid change and transition that can be stressful and difficult; pregnancy can further complicate this period. In Uganda, morbidity and mortality among adolescent mothers and their children are high. In order to better understand this situation, studies (I-IV) were conducted with the following objectives: to describe experiences and problems of pregnant adolescents (I); to describe health seeking behaviour (II) and analyze coping responses (III) of adolescents during pregnancy, delivery and early motherhood; and to compare health seeking practices of adolescents and adult mothers during pregnancy and early motherhood (IV). Methods: Qualitative (I-III) and quantitative (IV) studies were carried out in Wakiso district, Uganda. In study I, six focus group discussions (FGDs) were held with adolescent mothers and pregnant adolescents, and six key informant interviews (KIIs) were conducted with community leaders, persons in-charge of health units, and traditional birth attendants. In study II, 13 FGDs were conducted with married pregnant adolescents (5), unmarried pregnant adolescents (3) and married or unmarried adolescents with children (5). Semi-structured interviews were held with six KIs who were in-charge of maternity units. In study III we prospectively followed 24 pregnant adolescents (married and unmarried). Qualitative interviews about their experiences and coping responses were conducted at six months of pregnancy, one week post partum and at six months after delivery. All qualitative interviews and FGDs were tape-recorded. Content analysis (I-II) and narrative analysis (III) were done. In study IV, we conducted a cross sectional study in which 762 women (442 adolescents and 320 adults) were interviewed using a structured questionnaire. We assessed odds ratios (with 95% CI) for health care seeking during antenatal and postnatal periods, comparing adolescents to adult first-time mothers. Results: In study I, results revealed that pregnant adolescents faced domestic physical violence. Furthermore, they were psychologically violated by parents and partners as well as the community. Pregnant adolescents were treated inhumanely, overworked with household chores and had inadequate food to eat. Adolescents experienced stigma and, as a result, some carried out unsafe abortions. Both KIs and FGDs revealed that health workers were rude and unsympathetic to pregnant adolescents, which contributed to delays in seeking healthcare. Two main themes emerged in study II; 'feeling exposed and powerless', and seeking safety and empathy‟. The categories identified in the first theme were the dilemma of becoming an adolescent mother and lack of decision making power . In the second theme the following categories were identified: cultural practices and beliefs about birth , expectations and experiences , transport, a key determinant to health seeking , and dealing with constraints . Adolescents felt exposed and powerless due to the dilemma of early motherhood and lack of decision-making power. The adolescent mothers seemed to be in continuous quest for safety and empathy. In study III, two narrative types and one narrative case emerged from the data: 'dealing with problems' (DWP), 'avoidance and shame' (AS) and 'violence and grief' (VG). The DWP type was characterized by wanting to solve her problems e.g. seeking healthcare, social support or initiating innovative ways to earn a living. Married adolescents seemed to cope better. The AS type was more resigned and helpless, avoiding realities, while the VG case was in crisis reaction and grief, and did not see any future. The first narrative type can be classified as 'problem-focused coping' and the last two narrative types as 'emotion-focused coping'. Lastly, study IV revealed that adolescent mothers were significantly more disadvantaged in terms of healthcare seeking for reproductive health services and faced more challenges during pregnancy and early motherhood compared to adult mothers. Adolescent mothers were more likely to have dropped out of school due to pregnancy (OR=3.61, 95% CI: 2.40-5.44), less likely to earn a salary (OR=0.43, 95% CI: 0.24-0.76), and less likely to attend antenatal care (OR=1.52, 95% CI: 1.12-2.07) compared to adult mothers. Adolescents were also more likely to experience violence from parents (OR=2.07, 95% CI: 1.39-3.08) and to be stigmatized by the community (CI=1.58, 95% CI: 1.09-2.59). In early motherhood, adolescent mothers were less likely to seek second and third vaccine doses for their infants [Polio2 (OR=0.73, 95% CI: 0.55-0.98), Polio3 (OR=0.70: 95% CI: 0.51-0.95), DPT2 (OR=0.71, 95% CI: 0.53-0.96), DPT3 (OR=0.68, 95% CI: 0.50-0.92)] compared to adult mothers. Conclusions: Pregnant adolescents often lack basic needs like shelter, food and security. They also face relational problems with families, partners and the community (I). In search of safety and empathy, pregnant adolescents seek healthcare both in the modern and the traditional health sectors. They are in dilemma as they feel ashamed to meet their peers and also fear to visit health facilities (II). Married adolescents or those in committed relationships seem to cope better (problem-focused) with stressors during pregnancy and early motherhood than unmarried adolescents (III). Adolescents show poorer health seeking behaviour for themselves and their children, and increased community stigmatization and violence compared to adult mothers. This suggests bigger challenges to the adolescent mothers in terms of social support (IV). Adolescent friendly interventions such as pregnancy groups targeting pregnant adolescents with information of pregnancy, delivery and early childhood care could be introduced and implemented to improve adolescent mothers‟ health and that of their infants

A comparison of sexual risk behaviours and HIV seroprevalence among circumcised and uncircumcised men before and after implementation of the safe male circumcision programme in Uganda

Background: Although male circumcision reduces the heterosexual HIV transmission risk, its effect may be attenuated if circumcised men increase sexual risk behaviours (SRB) due to perceived low risk. In Uganda information about the protective effects of circumcision has been publicly disseminated since 2007. If increased awareness of the protection increases SRB among circumcised men, it is likely that differences in prevalence of SRB among circumcised versus uncircumcised men will change over time. This study aimed at comparing SRBs and HIV sero-status of circumcised and uncircumcised men before and after the launch of the safe male circumcision programme. Methods: Data from the 2004 and 2011 Uganda AIDS Indicator Surveys (UAIS) were used. The analyses were based on generalized linear models, obtaining prevalence ratios (PR) as measures of association between circumcision status and multiple sexual partners, transactional sex, sex with non-marital partners, condom use at last non-marital sex, and HIV infection. In addition we conducted multivariate analyses adjusted for sociodemographic characteristics, and the multivariate models for HIV status were also adjusted for SRB. Results: Twenty six percent of men were circumcised in 2004 and 28 % in 2011. Prevalence of SRB was higher among circumcised men in both surveys. In the unadjusted analysis, circumcision was associated with having multiple sexual partners and non-marital partners. Condom use was not associated with circumcision in 2004, but in 2011 circumcised men were less likely to report condom use with the last non-marital partner. The associations between the other sexual risk behaviours and circumcision status were stable across the two surveys.” In both surveys, circumcised men were less likely to be HIV positive (Adj PR 0.55; CI: 0.41–0.73 in 2004 and Adj PR 0.64; CI: 0.49–0.83 in 2011). Conclusions: There was higher prevalence of SRBs among circumcised men in both surveys, but the only significant change from 2004 to 2011 was a lower prevalence of condom use among the circumcised. Nevertheless, HIV prevalence was lower among circumcised men. Targeted messages for circumcised men and their sexual partners to continue using condoms even after circumcision should be enhanced to avoid risk compensation

Use of mobile phone consultations during home visits by Community Health Workers for maternal and newborn care: community experiences from Masindi and Kiryandongo districts, Uganda

Background: Home visits by Community Health Workers [In Uganda Community Health Workers are given the collective term of Village Health Teams (VHTs). Hereafter referred to as VHTs] is recommended to improve maternal and newborn care. We investigated perceived maternal and newborn benefits of home visits made by VHTs, combined with mobile phone consultations with professional health workers for advice. Methods: A qualitative study was conducted in Masindi and Kiryandongo districts, Uganda, in December-2013 to March-2014. Study participants were drawn from the intervention arm of a randomised community-intervention trial. In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs; 5 group discussions and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers. Data were analysed using latent content analysis techniques. Results: Majority women and VHTs contend that the intervention improved access to maternal and newborn information; reduced costs of accessing care and facilitated referral. Women, VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practices. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community. A minority of VHTs perceived the implementation of recommended maternal and newborn care practices as difficult. Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs. For a range of reasons, a number of professional health workers were not always available on phone or at the health centre to address VHT concerns. Conclusions: Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted. Our study highlights potential benefits of combining home visits with phone consultations between VHTs and professional health workers. However, the challenge of attitudinal change among VHTs towards certain strongly culturally-embedded behavioural post-partum practices, resistance from part of the professional health workforce to collaborate with VHTs and the problematic availability of professional health workers are important systemic problems that need to be addressed

Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda.

INTRODUCTION:About 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences men's circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district. METHODS:Data were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis. FINDINGS:Safe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were 'misleading' and feared risk compensation within the community. CONCLUSIONS:Participants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male circumcision, would ensure all clients are well informed, especially about post-circumcision sexual behaviour that is key to prevention of risk compensation