Abstinence And Faithfulness Programmes For Prevention Of Hiv/Aids Among Young People: What Are The Current Debates?

Questions have been raised on whether abstinence and faithfulness programs work, particularly for young people. Research is needed for evidence-based documentation of the effectiveness or otherwise of abstinence and faithfulness programmes in young people. This review was conducted in three stages: identification of relevant studies, classification of these studies, review of data and analysis of findings. Different sources of published and unpublished research literature were searched to locate studies relevant to abstinence and faithfulness (AB) interventions. A few researchers supported the view that AB work and indicated that Uganda provided the clearest example that HIV is preventable if populations are mobilized to avoid risk. This is confirmed by a 70% decline in HIV prevalence, linked to a 60% reduction in casual sex, in Uganda since the early 1990s. However, most of the literature claiming effectiveness of abstinence and faithfulness interventions is based on personal opinions and qualitative assessment of small projects. The question on whether abstinence and fidelity work as HIV/AIDS prevention strategies among young people was never answered with convincing evidence. Several research studies found that abstinence and faithfulness interventions were not effective in the prevention of HIV/AIDS. They cited several interventions as reasons for the decline in HIV prevalence, such as increased condom use, use of cleaner needles and a combination of abstinence, be faithful and condomise (ABC). They also cite the death of AIDS patients as reasons for the decline in HIV prevalence. It can be concluded from the research provided in this review that not only are there question marks over exactly what defines abstinence and what makes it sustainable; there is no clear evidence that it works. A systematic review of U.S. programmes to reduce teenage pregnancy identified three studies evaluating the impact of abstinence-only programmes and found that none of these studies had any effect on sexual behaviour. There is no conclusive proof that abstinence-only programmes have been successful in reducing HIV transmission. Evidence is also growing that abstinence-only programmes have failed to prevent the spread of sexually transmitted infections and teenage pregnancy. A rigorous, five-year evaluation of 11 abstinence-only programmes, conducted in the U.S in 2006 concluded that abstinence-only interventions have failed to change youth behaviour in the USA. South African Family Practice Vol. 49 (8) 2007: pp. 5-1

A Generation at Risk: The Global Impact of HIV/AIDS on Orphans and Vulnerable Children

Edited by: G Foster, C Levi and J Williamson. Cambridge University Press, 2005. ISBN 978-0-521-65264-3This publication helps us to understand the impacts of HIV/AIDS on OVC in the family and community-based care, households and communities; needs of OVC and responses in the educational system; psychosocial impact on children and youth; human rights of children affected by HIV/AIDS; and religion and responses to OVC. It does this with the help of many contributors with expert knowledge on issues affecting children, particularly those who are orphaned and made vulnerable by HIV/AIDS.SAHARA-J Vol. 5 (3) 2008: pp. 158-15

Age at sexual debut: A determinant of multiple partnership among South African youth

Age at sexual debut is an important determinant of HIV infection. The paper investigates the effects of age at sexual debut on sexual behaviour among South African youth. Among 2 875 respondents who ever had sexual intercourse, 39% had early sexual debut (sexual debut at age 16 years and below). Males (44.6%) were significantly more likely than females (35.1%) to report early sexual debut (odds ratio (OR)=1.45, p-value <0.001). Multiple sexual partners are significantly more common among those that had early sexual debut (10.4% vs. 4.8%) than those who had late sexual debut, (OR=2.29, p-value<0.001). Those aged 15 to 19 years were 1.4 times more likely to report multiple partners compared to those aged 20 to 24 years. Delaying sexual debut is a strategy many national programmes are promoting. The results of this study provide additional arguments to support such initiatives and show the need to strengthen intervention targeting youth (Afr. J. Reprod. Health 2010; 14[2]:47-54)

Predictors of unplanned pregnancies among female students at South African Technical and Vocational Education and Training colleges: Findings from the 2014 Higher Education and Training HIV and AIDS survey

Background. Unplanned pregnancies among college/tertiary female students pose a serious public health concern in South Africa (SA) and are associated with adverse health and social outcomes that impact negatively on educational progress and future career prospects.Objectives. To examine the potential predictors of unplanned pregnancy among female students at Technical and Vocational Education and Training (TVET) colleges in SA.Methods. This analysis used data drawn from the 2014 Higher Education and Training HIV and AIDS survey, which was a nationally representative survey of TVET college students in SA. Associations between unplanned pregnancy and the explanatory variables were assessed using bivariate analysis. Multivariate logistic regression analysis was used to identify the effect of several independent predictors of unplanned pregnancy.Results. Of 1 002 female students who responded to the question on unplanned pregnancy, 74.6% reported having had an unplanned pregnancy. Predictors significantly associated with a reduced likelihood of unplanned pregnancy among female TVET students included living with a husband (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.13 - 0.62; p=0.002), having two (OR 0.45, 95% CI 0.23 - 0.88; p=0.003) or three (OR 0.07, 95% CI 0.01 - 0.39; p=0.003) previous pregnancies, and not having had an abortion (OR 0.16, 95% CI 0.04 - 0.62; p=0.008).Conclusions. The high level of unplanned pregnancies is indicative of the state of women’s reproductive health services at SA TVET colleges. The findings suggest that certain groups of female students are at increased risk of unplanned pregnancy and would benefit from targeted family planning interventions tailored to their needs.

'They are inconveniencing us' - exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: perspectives from patients and clinicians in the Free State Province, South Africa

Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and inadequate health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. Thematic analysis using a mixed deductive/inductive thematic approach was used. Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient's TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients not following their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. Conclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care

Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/AIDS Research: Innovations in access to prevention, treatment and care in HIV/AIDS, Kisumu, Kenya, 29 April - 3 May 2007

About 520 delegates from all over Africa and 21 countries attended the conference. This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from the three countries were classified as best practice interventions. Of the 83 abstracts that were accepted at the conference, only 7 (8.4%) were dealing with antiretroviral therapy (ART).There has been tremendous effort by various organisations to provide information about prevention of HIV/AIDS. Information received by adolescents has been effective in increasing their knowledge, but without positive sexual behaviour change.The conference noted the contribution of gender discrimination and violence to the HIV epidemic and the different risks that men and women face in relation to the epidemic. Social scientists need to study the deep cultural meanings attached to male circumcision among different ethnic groups to be able to guide the debate on the latest biomedical findings on the protective effect of circumcision against HIV. Palliative care and support is crucial for coping among people living with HIV/AIDS (PLWHA) in order to deal with medical and psychological issues. Results from several countries have helped researchers to explore alternative ways of examining poverty in the context of HIV and AIDS. Policy frameworks which are likely to succeed in combating HIV/AIDS need to be updated to cover issues of access, testing, disclosure and stigma. In general, the conference was successful in identifying innovations in access to prevention, treatment and care in HIV/AIDS. SAHARA J Vol. 4 (2) 2007: pp. 640-65

A Qualitative Exploration of the Meaning and Understanding of Male Partner Involvement in Pregnancy-Related Care Among Men in Rural South Africa

Male partner involvement (MPI) during antenatal care has been promoted as an effective intervention to improve maternal and newborn health outcomes. Although MPI is commonly defined as men attending antenatal clinic visits with their female partner, few men attend antenatal clinic visits in rural communities in the province of Mpumalanga, South Africa. The study aimed to qualitatively explore the meaning and understanding of MPI as perceived by men visiting primary health care clinics in rural communities in Mpumalanga. Six focus groups discussions (n = 53) were conducted, digitally recorded, simultaneously transcribed, and translated verbatim into English. Data were analyzed using thematic content analysis. Perceptions of male roles during and after pregnancy differed among men. Male involvement was understood as giving instrumental support to female partners through financial help, helping out with physical tasks, and providing emotional support. Accompanying female partners to the clinic was also viewed as partner support, including behaviors such as holding a spot for her in the clinic queues. Community attitudes, traditional beliefs, and negative experiences in health facilities were barriers for MPI. This study provides support for concerted efforts to work with both men and women within the cultural context to explore the important roles of all members of the family in working together to provide the best possible health outcomes for mother and infant. In particular, future interventions should focus on making antenatal care services more responsive to male partners, and improving male partner accessibility in health care facilities

Evaluation of population health programmes at Atlantic Philanthropies

Paper presented at the Meeting with directors: the Atlantic Philanthropies. 24 Marc