Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda

Abstract Background: HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children amongpeople living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflictnorthern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describehow stigma affected the desires of PLHIV to have children in the future.Methods: Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews,conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysiswas undertaken using NVivo8 and was underpinned by the ‘‘Conceptual Model of HIV/AIDS Stigma’’.Results: HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influencesPLHIV’s desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internalstigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced byseveral factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensionsof stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion)and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reducedPLHIV’s desire to have more children.Conclusions: The social-cultural context within which PLHIV continue to desire to have children must be better understoodby all health professionals who hope to improve the quality of PLHIV’s lives. By delineating the stigma process, the paperproposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and healthoutcomes for PLHIV and their children

The World Starts With Me: A multilevel evaluation of a comprehensive sex education programme targeting adolescents in Uganda

<p>Abstract</p> <p>Background</p> <p>This paper evaluates the effect of the World Starts With Me (WSWM), a comprehensive sex education programme in secondary schools in Uganda. The aim of the present study was to assess the effects of WSWM on socio-cognitive determinants of safe sex behaviour (delay; condom use and non-coercive sex).</p> <p>Methods</p> <p>A survey was conducted both before and immediately after the intervention among students in intervention (<it>N </it>= 853) and comparison (<it>N </it>= 1011) groups. A mixed model repeated measures analysis was performed to assess the effectiveness of the WSWM programme on the main socio-cognitive determinants of safe sex behaviour at post-test. A similar post-hoc comparison was made between schools based on completeness and fidelity of implementation of WSWM.</p> <p>Results</p> <p>Significant positive effects of WSMW were found on beliefs regarding what could or could not prevent pregnancy, the perceived social norm towards delaying sexual intercourse, and the intention to delay sexual intercourse. Furthermore, significant positive effects of WSWM were found on attitudes, self-efficacy and intention towards condom use and on self-efficacy in dealing with sexual violence (pressure and force for unwanted sex). A reversed effect of intervention was found on knowledge scores relating to non-causes of HIV (petting, fondling and deep kissing). A follow-up comparison between intervention schools based on completeness of the programme implementation revealed that almost all significant positive effects disappeared for those schools that only implemented up to 7 out of 14 lessons. Another follow-up analysis on the basis of implementation fidelity showed that schools with a "partial" fidelity score yielded more significant positive effects than schools with a "full" fidelity of implementation score.</p> <p>Conclusions</p> <p>The study showed an intervention effect on a number of socio-cognitive determinants. However, the effectiveness of WSWM could be improved by giving more systematic attention to the context in which such a programme is to be implemented. Implications for the systematic development and implementation of school-based safe sex interventions in Uganda will be discussed.</p

Evaluation of a Peer Network-Based Sexual Risk Reduction Intervention for Men in Beer Halls in Zimbabwe: Results from a Randomized Controlled Trial

While much emphasis has been placed on involving men in AIDS prevention in sub-Saharan Africa, there remain few rigorously evaluated interventions in this area. A particularly appealing point of intervention is the sexual risk behavior associated with men’s alcohol consumption. This article reports the outcomes of The Sahwira HIV Prevention Program, a male-focused, peer-based intervention promoting the idea that men can assist their friends in avoiding high-risk sexual encounters associated with alcohol drinking. The intervention was evaluated in a randomized, controlled trial (RCT) implemented in 24 beer halls in Harare, Zimbabwe. A cadre of 413 male beer hall patrons (~20% of the patronage) was trained to assist their male peers within their friendship networks. Activities included one-on-one interactions, small group discussions, and educational events centering on the theme of men helping their male friends avoid risk. Venues were randomized into 12 control versus 12 intervention beer halls with little cross-contamination between study arms. The penetration and impact of the intervention were assessed by pre- and post-intervention cross-sectional surveys of the beer hall patronage. The intervention was implemented with a high degree of fidelity to the protocol, with exposure to the intervention activities significantly higher among intervention patrons compared to control. While we found generally declining levels of risk behavior in both study arms from baseline to post-intervention, we found no evidence of an impact of the intervention on our primary outcome measure: episodes of unprotected sex with non-wife partners in the preceding 6 months (median 5.4 episodes for men at intervention beer halls vs. 5.1 among controls, P = 0.98). There was also no evidence that the intervention reduced other risks for HIV. It remains an imperative to find ways to productively engage men in AIDS prevention, especially in those venues where male bonding, alcohol consumption, and sexual risk behavior are intertwined

Evidence, politics and Uganda's HIV success: moving forward with ABC and HIV prevention

Uganda's HIV success story has become increasingly focused around the idea of 'ABC' (Abstain, Be faithful or use Condoms). During the George W. Bush administration, the US Government has promoted one specific ABC model for its development agencies, with a particular emphasis on abstinence. Yet other actors have contested this view. To understand Uganda's success, it is imperative to look at what ABC was in Uganda when critical changes in behaviour were occurring. This paper investigates Uganda's HIV success, the politicised meanings of 'ABC', and the implications this may have for future HIV prevention in Uganda and beyond. Copyright (C) 2010 John Wiley & Sons, Ltd