HIV risk perception and behavior among medically and traditionally circumcised males in South Africa

Abstract Background In South Africa, voluntary medical male circumcision (VMMC) has recently been implemented as a strategy for reducing the risk of heterosexual HIV acquisition among men. However, there is some concern that VMMC may lead to low risk perception and more risky sexual behavior. This study investigated HIV risk perception and risk behaviors among men who have undergone either VMMC or traditional male circumcision (TMC) compared to those that had not been circumcised. Methods Data collected from the 2012 South African national population-based household survey for males aged 15 years and older were analyzed using bivariate and multivariate multinomial logistic regression, and relative risk ratios (RRRs) with 95 % confidence interval (CI) were used to assess factors associated with each type of circumcision relative no circumcision. Results Of the 11,086 males that indicated that they were circumcised or not, 19.5 % (95 % CI: 17.9–21.4) were medically circumcised, 27.2 % (95 % CI: 24.7–29.8) were traditionally circumcised and 53.3 % (95 % CI: 50.9–55.6) were not circumcised. In the final multivariate models, relative to uncircumcised males, males who reported VMMC were significantly more likely to have had more than two sexual partners (RRR = 1.67, p = 0.009), and males who reported TMC were significantly less likely to be low risk alcohol users (RRR = 0.72, p < 0.001). Conclusion There is a need to strengthen and improve the quality of the counselling component of VMMC with the focus on education about the real and present risk for HIV infection associated with multiple sexual partners and alcohol abuse following circumcision

Determinants of excellent/good self-rated health among HIV positive individuals in South Africa: evidence from a 2012 nationally representative household survey

Background: In South Africa, HIV is increasingly becoming a chronic disease as a result of advances in HIV treatment and prevention in the last three decades. This has changed the perception from a life threating to a potentially manageable disease. However, little is known about self-perceived health status of HIV-infected individuals. Self-rated health (SRH) has been shown to be a sensitive indicator of health-relatedchanges directly linked to HIV, but can also be influenced by differences in social and material conditions. The aim of this paper was to identify determinants of excellent/good SRH among HIV-infected individuals using socio-demographic, life style and health related data. Methods: The study used data from the nationally representative 2012 South African population-based household survey on HIV prevalence, incidence and behaviour conducted using multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression models were used to identify determinants of SRH among HIV-infected individuals. Results: Out of a total of 2632 HIV positive participants 74.1% (95% CI: 68.4-74.2) reported excellent/good SRH. Increased likelihood of reporting excellent/good SRH was significantly associated with being Black African [OR= 1.97 (95%CI: 1.12-3.46), p = 0.019] and belonging to least poor household [OR= 3.13 (95%CI: 1.26-7.78), p = 0.014]. Decreased likelihood of reporting excellent/good SRH was significantly associated with those aged 25 to 34 years [OR= 0.49 (95% CI: 0.31-0.78), p = 0.003], 35 to 44 years[OR= 0.27 (95% CI: 0.17-0.44), p < 0.001], 45 to 54 years [OR= 0. 20 (95% CI: 0.12-0.34), p < 0.001], and those 55 years and older [OR= 0.15 (95% CI: 0.09-0.26), p < 0.001], hospitalization in the past twelve months [OR= 0.40 (95% CI: 0.26-0.60), p < 0.001]. Conclusion: To have positive health effects and improve the perceived health status for PLWH social interventions should seek to enhance to support for the elderly HIV-positive individuals, and address the challenge of socioeconomic inequalities and underlying comorbid conditions resulting in hospitalization

Psychological distress and traumatic stress neglected in mental health

South Africa has a high prevalence of mental health disorders - a substantial number of which remain undiagnosed and untreated. A South African population-based study found a 28.4% prevalence of psychological distress among participants 15 years and older. The SANHANES-I team reports.

Social determinants for HIV prevalence among South African educators

HIV prevalence among women in South Africa continues to be high despite the availability of a comprehensive plan for the control of HIV/AIDS and a plethora of prevention programmes. Any explanation for the ongoing high HIV prevalence continues to be elusive. The objective of this study was to understand the relationship between HIV, gender, race and socioeconomic status among South African public sector educators in order to inform prevention programmes. A cross-sectional survey involving a probability sample of 1,766 schools out of 26,713 in the Department of Education Register of School Needs was selected. A sample of 24,200 respondents out of 356,749 public sector educators participated in the study. Nurses registered with the South African Nursing Council were recruited, trained to conduct interviews and to collect specimens for HIV testing. The study found an association between HIV, gender, race and socioeconomic status among educators. African educators showed a higher HIV prevalence than other race groups. Among females, the highest HIV prevalence was among educators aged 25-35 years and in males aged 36-49 years. Further, educators with a high income and educational qualifications had a lower HIV prevalence compared to educators with low income and low educational qualifications, regardless of sex. Migration and marital factors were also found to play a role in HIV infection. The results suggest that HIV prevention needs to take into account critical issues around empowerment of vulnerable groups such as women and certain race groups to be able to implement safe sexual practices and therefore reduce HIV infections.

HIV risk exposure among young children: a study of 2-9 year olds served by public health facilities in the Free State, South Africa

South Africa has, until now, focused its HIV prevention efforts on youth and adults, and now needs to expand its focus to include children. Much is already known about vertical transmission, which is the dominant mode of HIV transmission among children. However, little investigation has been done into the potential for horizontal transmission of HIV on the population below reproductive age. This report focuses on children aged 2-9 years and, using a combination of quantitative and qualitative methods, presents evidence on the potential for HIV transmission in dental, maternity and paediatric services in public health facilities. A new finding concerns the practice of shared breastfeeding

The South African National Health and Nutrition Examination Survey, 2012: SANHANES-1: the health and nutritional status of the nation

South Africa is undergoing a process of epidemiological transition from infectious to non-communicable diseases (NCDs). While the burden of infectious diseases such as HIV and TB remains high, there are now other emerging epidemics of NCDs. NCDs, mainly cardiovascular diseases, cancers, chronic respiratory diseases and diabetes represent a leading threat to human health and development. According to World Health Organization (WHO) statistics, these four diseases are the world's biggest killers, causing an estimated 35 million deaths each year 60% of all deaths globally with 80% in low- and middle-income countries (WHO, 2008). These diseases are preventable. Up to 80% of heart disease, stroke, and type 2 diabetes and over a third of cancers could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. Unless addressed with urgency, the mortality and disease burden from these health problems will continue to increase in our country. There is therefore a great need for a better understanding of both the prevalence of NCDs and the associated risk factors among South Africans and a need to translate such information into effective health policies, health programmes and services. It is timely that the HSRC and its various partners including the Medical Research Council (MRC) and several South African universities have been able to come together and undertake this fundamental survey, the first South African National Health and Nutrition Examination Survey (SANHANES-1). Indeed, this survey report could not have come at a better time as we now begin the enormous task to implement the National Health Insurance (NHI) system. It is also important to note that one of the Ten Point Plan actions for the Department of Health is the introduction of this type of survey that will assess the health and nutritional status of adults and children in South Africa. The Government's Strategic Priority: 'Improve the health profile of all South Africans' requires a dedicated survey such as SANHANES-1 that addresses the National Department of Health's (NDoH) priority health indicators. The uniqueness of SANHANES-1 is its ability to integrate findings from personal interviews with standardised physical examinations, diagnostic procedures, and a variety of laboratory tests. The results provide information on a broad range of health topics and associated risk factors that were beyond the scope of previous Demographic and Health Surveys (DHS). SANHANES-1 data will provide critical information for establishing national standards for weight, height, and blood pressure.