18 research outputs found
Male Circumcision; Willingness to undergo Safe Male Circumcision and HIV Risk Behaviors among Men in Botswana
This paper uses data from the 2008 Botswana AIDS Impact Survey to explore the association between male circumcision or willingness to undergo safe male circumcision, and menâs sexual and HIV risk behaviours in Botswana. Bivariate and multivariate regression analysis techniques are used. The results show that being circumcised, or expressing willingness to be circumcised, was associated with significant increase in the likelihood of having two or more current sexual partners, and having had sex with multiple partners during the year leading to the survey, even after controlling for confounding variables. There is a need for further research to examine the association between male circumcision and menâs sexual practices in Botswana. Such context specific research will provide the necessary evidence base for HIV prevention and impact mitigation programs, interventions and strategies and to provide rigorous estimates of the extent menâs sexual risk compensation and âsexual disinhibitionâ associated with the reduced risk of HIV infection accorded by safe male circumcision. Current efforts to promote male circumcision as an integral part of the countryâs HIV prevention and control strategy need to be accompanied by continuous education to address myths and misconceptions relating to safe male circumcision
Men, masculinities and sexual and reproductive health in Botswana.
This thesis investigates the role of masculinities on menâs sexual and reproductive
health in Botswana. Botswana is currently in the throes of a severe heterosexually
driven HIV/AIDS epidemic that has eroded some of the developmental gains the
country had achieved since independence. A unique feature of Botswanaâs HIV
epidemic is the rapid and phenomenal increase in infection and prevalence rates in the
face of good levels of knowledge of HIV prevention and an early and comprehensive
HIV prevention strategy that guaranteed access to free HIV prevention and treatment
services, including ARV treatment.
The lack of effectiveness of the countryâs HIV efforts and subsequent increase in
infection rates have been blamed on menâs risky sexual behavior and lack of support of
their partnersâ decisions to utilize these services. In fact, quantitative studies on menâs
sexual behavior and HIV such as the Botswana AIDS Impact Surveys show that men are
less likely to use VCT services and more likely to engage in risky sexual behavior that
increases risk of HIV infection to themselves and their partners. While studies provide
the evidence that implicates men in the rapid growth Botswanaâs HIV epidemic, the
studies provide little or no explanation of factors that motivate menâs behavior in
reproductive health. This lack of insights on factors that motivate menâs behavior leads
to stereotypes about male promiscuity and may contribute to the lack of effectiveness of
HIV prevention strategies.
The current HIV epidemic has thus thrust heterosexual masculinities at the centre of
HIV prevention efforts and provides an opportunity for research to interrogate the role
of heterosexual masculinities in reproductive health, especially HIV transmission and
prevention. The thesis employs qualitative data to provide in-depth appreciation of the
prevalent masculine norms and beliefs and to highlight contextual factors and processes
that shape and give rise to various masculinities. It further uses quantitative data to
provide measures of levels of menâs masculine and gender role beliefs that may
influence HIV prevention and transmission and to test the association between
masculinities and menâs sexual and reproductive health attitudes and practices.
The results show that menâs sense of identity is socially constructed, and revolves
around the notion of superiority to women, independence and having and being in
control of the family. However, men face many challenges to the realization of this
masculine ideal. Menâs perceived difficulty or failure to live up to socially constructed
Men, Masculinities and Sexual and Reproductive Health in Botswana
vii
notions of masculinities affects their experience of sexual and reproductive health
programs, especially womenâs empowerment and HIV prevention programs. By their
nature, these programs tend to challenge menâs dominance of womenâs decision on
sexuality, and are therefore experienced as a threat to some menâs sense of identity.
Quantitative results indicate an association between masculinities and sexual and
reproductive health. While menâs sense of masculinities is not the overriding factor
determining their sexual and reproductive health attitudes and practices, the results
show a strong association traditional masculine beliefs and negative sexual and
reproductive health beliefs and practices.
However, there is also strong evidence that men and masculinities are responding to
contextual factors, such as the HIV epidemic, which has become a specific stress on the
local construction of masculinities. In focus group discussions, many men challenged
traditional masculine norms, beliefs and practices that increase their vulnerability to
HIV infection and those that either encourage or condone violence within intimate
relationships. Significantly high proportions of men had positive attitudes towards HIV
prevention programs. It is evident that now more than ever (and thanks to the
HIV/AIDS epidemic) many men are ready to question the predominant masculine
norms, beliefs and practices that increase their vulnerability to infection and disease.
These voices of change represent a window of opportunity for research and programs
can meaningfully engage with men and masculinities on issues of sexuality, gender
roles, sexual and reproductive health and HIV/AIDS prevention and transmission.
There is need for future research and interventions to move away from focusing
exclusively on individual models of preventive health behaviors to more multilevel,
cultural and contextual explanations. Taking account of multilevel, cultural and
contextual factors that shape masculinities and menâs sense of identity will ensure
increased effectiveness of sexual and reproductive health programs, especially
HIV/AIDS prevention programs. On the other hand, failure to account for cultural and
contextual factors that shape individualsâ behavior will only ensure that the
shortcomings of such intervention program will continue to be blamed on the
individual
Early uptake of HIV counseling and testing among pregnant women at different levels of health facilities - experiences from a community-based study in Northern Vietnam
<p>Abstract</p> <p>Background</p> <p>HIV counselling and testing for pregnant women is a key factor for successful prevention of mother to child transmission of HIV. Women's access to testing can be improved by scaling up the distribution of this service at all levels of health facilities. However, this strategy will only be effective if pregnant women are tested early and provided enough counselling.</p> <p>Objective</p> <p>To assess early uptake of HIV testing and the provision of HIV counselling among pregnant women who attend antenatal care at primary and higher level health facilities.</p> <p>Methods</p> <p>A community based study was conducted among 1108 nursing mothers. Data was collected during interviews using a structured questionnaire focused on socio-economic background, reproductive history, experience with antenatal HIV counselling and testing as well as types of health facility providing the services.</p> <p>Results</p> <p>In all 91.0% of the women interviewed had attended antenatal care and 90.3% had been tested for HIV during their most recent pregnancy. Women who had their first antenatal checkup at primary health facilities were significantly more likely to be tested before 34 weeks of gestation (OR = 43.2, CI: 18.9-98.1). The reported HIV counselling provision was also higher at primary health facilities, where women in comparison with women attending higher level health facilities were nearly three or and four times more likely to receive pre-test (OR = 2.7; CI:2.1-3.5) and post-test counseling (OR = 4.0; CI: 2.3-6.8).</p> <p>Conclusions</p> <p>The results suggest that antenatal HIV counseling and testing can be scaled up to primary heath facilities and that such scaling up may enhance early uptake of testing and provision of counseling.</p
Assessment of the community-based natural resource management approach and its impact on the Basarwa
âThey are less worthy than us, but they are better than womenâŠ.â Attitudes towards Homosexuality & Men Who Have Sex with Men (MSM) In Botswana
This paper presents the results of a study on Men, Masculinities and HIV/AIDS in Botswana[i]. The legal status of same sex relationships, especially homosexuality, is quite a controversial issue in many countries in sub-Saharan Africa, where same sex relationships are not recognised by law or even criminalised. This makes it difficult or even impossible for sexual and reproductive health programs, including HIV prevention and treatment programs, to address the sexual and reproductive health needs of sexual minorities. At the same time, evidence from research shows that because they are neglected by intervention programs, sexual minorities become at higher risk of HIV infection and other negative SRH outcomes. Because of lack of legal recognition, sexual minorities also tend to maintain heterosexual relationships as a cover and thus form a bridge across which their elevated risk of HIV infection is transmitted to the rest of the population. It is for this reason that sexual minorities are important component to HIV prevention efforts; and also why attitudes towards sexual minorities are important.This paper uses qualitative data derived from 12 focus group discussions and 6 in-depth interviews to explore men and womenâs attitudes towards homosexuality and men who have sex with men (MSM). The focus groups consisted of different groups of men and women, based on age; place of residence and occupation. Womenâs attitudes were more positive, with some indicating that some men or women may opt to have same sex relationship as a strategy to deal with issues of violence and vulnerability to HIV infection that currently characterises heterosexual sexual relationships. Menâs attitudes on the other hand tended to be overly negative, preferring to view MSM as un-natural, shameful and an abomination. However, even among men, there were those who held less conservative view. However, even among these men, they felt that MSM were not real men like themselves, and that they can only earn the trust; respect and ultimately acceptance of heterosexual men by distinguishing themselves and demonstrating that they have the same character as other men, such as bravery and dependability
Sexuality Education and Menâs Sexual and Reproductive Health Practices in a high HIV Prevalence Setting: Does Exposure to Sexuality Education Improve Sexual and Reproductive Health Outcomes in Botswana?
Exposure to sexuality education is expected to have a positive effect on an individualâs sexual and HIV risk practices and behaviors in later life. This paper uses data from the 2007 Botswana Family Health survey (BFHS-2007) to investigate the association between exposure to sexuality education in schools and menâs sexual and reproductive health practices. The BFHS-2007 sampled 4030 men between ages of 12-29 years, and solicited responses on a wide range of issues, including exposure to sexuality education, sexual and reproductive practices; fertility as well as partner characteristics. About 82% of men were exposed to sexuality education, of which silightly more than 50% have had sexual initiation. A high percentage of respondents who have not received sexuality education would have not used a condom at sexual debut and would have desired a child. The paper concludes that if introduced early, sexuality education improves life skills in sexual initiation, condom use and childbearin
The geography of HIV/AIDS prevalence rates in Botswana
Ngianga-Bakwin Kandala,1 Eugene K Campbell,2 Serai Dan Rakgoasi,2 Banyana C Madi-Segwagwe,3 Thabo T Fako41University of Warwick, Warwick Medical School, Division of Health Sciences; Populations, Evidence and Technologies Group, Warwick Evidence, Coventry, UK; 2Department of Population Studies, University of Botswana, 3SADC Secretariat, Directorate of Social and Human Development and Special Programmes, 4Vice Chancellor&#39;s Office, University of Botswana, Gaborone, BotswanaBackground: Botswana has the second-highest human immunodeficiency virus (HIV) infection rate in the world, with one in three adults infected. However, there is significant geographic variation at the district level and HIV prevalence is heterogeneous with the highest prevalence recorded in Selebi-Phikwe and North East. There is a lack of age-and location-adjusted prevalence maps that could be used for targeting HIV educational programs and efficient allocation of resources to higher risk groups.Methods: We used a nationally representative household survey to investigate and explain district level inequalities in HIV rates. A Bayesian geoadditive mixed model based on Markov Chain Monte Carlo techniques was applied to map the geographic distribution of HIV prevalence in the 26 districts, accounting simultaneously for individual, household, and area factors using the 2008 Botswana HIV Impact Survey.Results: Overall, HIV prevalence was 17.6%, which was higher among females (20.4%) than males (14.3%). HIV prevalence was higher in cities and towns (20.3%) than in urban villages and rural areas (16.6% and 16.9%, respectively). We also observed an inverse U-shape association between age and prevalence of HIV, which had a different pattern in males and females. HIV prevalence was lowest among those aged 24 years or less and HIV affected over a third of those aged 25&ndash;35 years, before reaching a peak among the 36&ndash;49-year age group, after which the rate of HIV infection decreased by more than half among those aged 50 years and over. In a multivariate analysis, there was a statistically significant higher likelihood of HIV among females compared with males, and in clerical workers compared with professionals. The district-specific net spatial effects of HIV indicated a significantly higher HIV rate of 66% (posterior odds ratio of 1.66) in the northeast districts (Selebi-Phikwe, Sowa, and Francistown) and a reduced rate of 27% (posterior odds ratio of 0.73) in Kgalagadi North and Kweneng West districts.Conclusion: This study showed a clear geographic distribution of the HIV epidemic, with the highest prevalence in the east-central districts. This study provides age- and location-adjusted prevalence maps that could be used for the targeting of HIV educational programs and efficient allocation of resources to higher risk groups. There is need for further research to determine the social, cultural, economic, behavioral, and other distal factors that might explain the high infection rates in some of the high-risk areas in Botswana.Keywords: Botswana, HIV prevalence, geographic location, spatial autocorrelatio
The geography of HIV/AIDS prevalence rates in Botswana
Background
Botswana has the second-highest human immunodeficiency virus (HIV) infection rate in the world, with one in three adults infected. However, there is significant geographic variation at the district level and HIV prevalence is heterogeneous with the highest prevalence recorded in Selebi-Phikwe and North East. There is a lack of age-and location-adjusted prevalence maps that could be used for targeting HIV educational programs and efficient allocation of resources to higher risk groups.
Methods
We used a nationally representative household survey to investigate and explain district level inequalities in HIV rates. A Bayesian geoadditive mixed model based on Markov Chain Monte Carlo techniques was applied to map the geographic distribution of HIV prevalence in the 26 districts, accounting simultaneously for individual, household, and area factors using the 2008 Botswana HIV Impact Survey.
Results
Overall, HIV prevalence was 17.6%, which was higher among females (20.4%) than males (14.3%). HIV prevalence was higher in cities and towns (20.3%) than in urban villages and rural areas (16.6% and 16.9%, respectively). We also observed an inverse U-shape association between age and prevalence of HIV, which had a different pattern in males and females. HIV prevalence was lowest among those aged 24 years or less and HIV affected over a third of those aged 25â35 years, before reaching a peak among the 36â49-year age group, after which the rate of HIV infection decreased by more than half among those aged 50 years and over. In a multivariate analysis, there was a statistically significant higher likelihood of HIV among females compared with males, and in clerical workers compared with professionals. The district-specific net spatial effects of HIV indicated a significantly higher HIV rate of 66% (posterior odds ratio of 1.66) in the northeast districts (Selebi-Phikwe, Sowa, and Francistown) and a reduced rate of 27% (posterior odds ratio of 0.73) in Kgalagadi North and Kweneng West districts.
Conclusion
This study showed a clear geographic distribution of the HIV epidemic, with the highest prevalence in the east-central districts. This study provides age- and location-adjusted prevalence maps that could be used for the targeting of HIV educational programs and efficient allocation of resources to higher risk groups. There is need for further research to determine the social, cultural, economic, behavioral, and other distal factors that might explain the high infection rates in some of the high-risk areas in Botswana