An assessment of HIV and AIDS knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape

Thesis (MPhil)--Stellenbosch University, 2015.ENGLISH ABSTRACT: The objective of this study was to measure the level of HIV and Aids knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape. The study served to recommend guidelines for effective and enhanced targeted intervention response for MSM student community. A total of 36 MSM students aged between 19 and 36 (of which most were South African, black and Xhosa speaking) were recruited to take part in the study. Selection was done via snowball sampling. Respondents completed questionnaires upon consenting to participate in the study. The study found moderately high levels of basic HIV knowledge among the sampled MSM population. There were, however, lower levels of knowledge reported regarding the associated risk and effective prevention strategies of anal sex when compared to similar information about vaginal sex and oral sex. Findings also show that participants had very positive attitudes towards HIV testing, condom use and a non-discriminating environment. Respondents lacked confidence in both management and student leadership with regards to their responsibility in mitigating homophobia/discrimination against MSM student population. Furthermore, a high number of respondents reported having sex with men and women as well as multiple sexual partnerships. Self-reported alcohol and drug use were found to be very low, with the majority of participants indicating non-use. Participants stated little challenges accessing health care services. However, respondents felt MSM specific information about health care related rights and needs were lacking. Recommendations from this study include current HIV and Aids policy reform, mainstreaming MSM-friendly health care services, introducing combination HIV prevention programmes such as Mpowerment and addressing the human rights needs of MSM.AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die vlakke van MIV en Vigs kennis, houdings en veilige seksuele praktyke onder manlike studente wat seks het met mans (MSM) by 'n hoër onderwys instansie in die Wes-Kaap te meet. Die studie het gepoog om riglyne daar te stel vir die bewerkstelling van effektiewe en verbeterde geteikende intervensies vir die MSM studente gemeenskap. Daar was 36 MSM studente tussen die ouderdomme van 19 en 36 (meestal Suid-Afrikaans, swart en Xhosa-sprekend) gewerf vir die studie. Seleksie is gedoen deur middel van die sneeubal steekproef-metode. Deelnemers het 'n vraelys voltooi nadat hulle ingewillig het om deel te neem aan die studie. Deelnemers het matig tot hoë vlakke van basiese MIV en Vigs kennis getoon. Daar was egter laer vlakke van kennis oor gepaardgaande risiko’s en effektiewe voorkoming strategieë ten opsigte van anale seks in vergelyking met dieselfde informasie oor vaginale en orale seks. Die studie het verder bevind dat deelnemers baie positiewe houdings gehad het teenoor MIV-toetsing, die gebruik van kondome en 'n nie-diskriminerende omgewing. Verder het hulle min vertroue getoon in beide die bestuur en studente leierskap se vermoë om sake wat verband hou met homofobie en/of diskriminasie teen die MSM studente bevolking, effektief te hanteer. Daar is gevind dat baie respondente seks het met mans en vroue en ook verskeie seksuele maats het. Self-gerapporteerde alkohol- en dwelmgebruik was relatief laag onder respondente met die meerderheid wat aangedui het hulle glad nie alkohol of dwelms gebruik nie. Deelnemers het ook rapporteer dat gesondheidsdienste vir hulle maklik toeganklik is. Respondente het ook gevoel dat MSM spesifieke informasie oor gesondheidsverwante regte en behoeftes tans ontbreek. Aanbevelings wat voortspruit uit hierdie studie sluit in die hersien van die huidige MIV en Vigs beleid, die skepping van MSM-vriendelike dienste, die implementering van MIV-voorkomingsprogramme soos Mpowerment en die bevordering van menseregte wat verband hou met MSM

Anti-Retroviral Treatment Outcomes among Older Adults in Zomba District, Malawi

BACKGROUND: There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes. METHODS: A retrospective cohort analysis was performed using routinely collected data with Malawi Ministry of Health monitoring tools from facilities providing antiretroviral therapy services in Zomba district. Patients aged 25 years and older initiated on treatment from July 2005 to June 2010 were included. Differences in survival, by age group, were determined using Kaplan-Meier survival plots and Cox proportional hazards regression models. RESULTS: There were 10,888 patients aged 25 and older. Patients aged 50 and older (N = 1419) were more likely to be male (P<0.0001) and located in rural areas (P = 0.003) than those aged 25-49. Crude survival estimates among those aged 50-59 were not statistically different from those aged 25-49 (P = 0.925). However, survival among those aged 60 and older (N = 345) was worse (P = 0.019) than among those 25-59. In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25-49. CONCLUSIONS: Treatment outcomes of those aged 50-59 are similar to those aged 25-49. A better understanding of how older adults present for and respond to treatment is critical to improving HIV services

An assessment of HIV and AIDS knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape

Thesis (MPhil)--Stellenbosch University, 2015.ENGLISH ABSTRACT: The objective of this study was to measure the level of HIV and Aids knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape. The study served to recommend guidelines for effective and enhanced targeted intervention response for MSM student community. A total of 36 MSM students aged between 19 and 36 (of which most were South African, black and Xhosa speaking) were recruited to take part in the study. Selection was done via snowball sampling. Respondents completed questionnaires upon consenting to participate in the study. The study found moderately high levels of basic HIV knowledge among the sampled MSM population. There were, however, lower levels of knowledge reported regarding the associated risk and effective prevention strategies of anal sex when compared to similar information about vaginal sex and oral sex. Findings also show that participants had very positive attitudes towards HIV testing, condom use and a non-discriminating environment. Respondents lacked confidence in both management and student leadership with regards to their responsibility in mitigating homophobia/discrimination against MSM student population. Furthermore, a high number of respondents reported having sex with men and women as well as multiple sexual partnerships. Self-reported alcohol and drug use were found to be very low, with the majority of participants indicating non-use. Participants stated little challenges accessing health care services. However, respondents felt MSM specific information about health care related rights and needs were lacking. Recommendations from this study include current HIV and Aids policy reform, mainstreaming MSM-friendly health care services, introducing combination HIV prevention programmes such as Mpowerment and addressing the human rights needs of MSM.AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die vlakke van MIV en Vigs kennis, houdings en veilige seksuele praktyke onder manlike studente wat seks het met mans (MSM) by 'n hoër onderwys instansie in die Wes-Kaap te meet. Die studie het gepoog om riglyne daar te stel vir die bewerkstelling van effektiewe en verbeterde geteikende intervensies vir die MSM studente gemeenskap. Daar was 36 MSM studente tussen die ouderdomme van 19 en 36 (meestal Suid-Afrikaans, swart en Xhosa-sprekend) gewerf vir die studie. Seleksie is gedoen deur middel van die sneeubal steekproef-metode. Deelnemers het 'n vraelys voltooi nadat hulle ingewillig het om deel te neem aan die studie. Deelnemers het matig tot hoë vlakke van basiese MIV en Vigs kennis getoon. Daar was egter laer vlakke van kennis oor gepaardgaande risiko’s en effektiewe voorkoming strategieë ten opsigte van anale seks in vergelyking met dieselfde informasie oor vaginale en orale seks. Die studie het verder bevind dat deelnemers baie positiewe houdings gehad het teenoor MIV-toetsing, die gebruik van kondome en 'n nie-diskriminerende omgewing. Verder het hulle min vertroue getoon in beide die bestuur en studente leierskap se vermoë om sake wat verband hou met homofobie en/of diskriminasie teen die MSM studente bevolking, effektief te hanteer. Daar is gevind dat baie respondente seks het met mans en vroue en ook verskeie seksuele maats het. Self-gerapporteerde alkohol- en dwelmgebruik was relatief laag onder respondente met die meerderheid wat aangedui het hulle glad nie alkohol of dwelms gebruik nie. Deelnemers het ook rapporteer dat gesondheidsdienste vir hulle maklik toeganklik is. Respondente het ook gevoel dat MSM spesifieke informasie oor gesondheidsverwante regte en behoeftes tans ontbreek. Aanbevelings wat voortspruit uit hierdie studie sluit in die hersien van die huidige MIV en Vigs beleid, die skepping van MSM-vriendelike dienste, die implementering van MIV-voorkomingsprogramme soos Mpowerment en die bevordering van menseregte wat verband hou met MSM

Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi

Abstract Background Retention in antiretroviral therapy (ART) programmes remains a challenge in many settings including Malawi, in part due to high numbers of losses to follow-up. Concept Mapping (CM), a mix-method participatory approach, was used to explore why patients on ART are lost to follow-up (LTFU) by identifying: 1) factors that influence patient losses to follow-up and 2) barriers to effective and efficient tracing in Zomba, Malawi. Methods CM sessions (brainstorming, sorting and rating, interpretation) were conducted in urban and rural settings in Zomba, Malawi. Participants included ART patients, ART providers, Health Surveillance Assistants, and health managers from the Zomba District Health Office. In brainstorming, participants generated statements in response to “A specific reason why an individual on ART becomes lost to follow-up is…” Participants then sorted and rated the consolidated list of brainstormed items. Analysis included inductive qualitative methods for grouping of data and quantitative cluster identification to produce visual maps which were then interpreted by participants. Results In total, 90 individuals brainstormed 371 statements, 64 consolidated statements were sorted (participant n = 46), and rated on importance and feasibility (participant n = 69). A nine-cluster concept map was generated and included both patient- and healthcare-related clusters such as: Stigma and Fears, Beliefs, Acceptance and Knowledge of ART, Access to ART, Poor Documentation, Social and Financial Support Issues, Health Worker Attitudes, Resources Needed for Effective Tracing, and Health Worker Issues Related to Tracing. Strategies to respond to the clusters were generated in Interpretation. Conclusions Multiple patient- and healthcare focused factors influence why patients become LTFU. Findings have implications particularly for programs with limited resources struggling with the retention of ART patients

Survival estimates by age.

<p>Kaplan-Meier survival estimates by age group for those aged 25 and older who initiated treatment in Zomba District between 1 July 2005 and 30 June 2010. Blue is 25–49 (N = 7297); Red is 50–59 (N = 839); Green is 60+ (N = 276).</p

Characteristics of patients at initiation of antiretroviral therapy.

a<p>Missing values not included in percentages in categories above.</p><p>Zomba District by age category 25–49,50–59 and 60 and older who initiated treatment from July 2005 to June 2010.</p