Understanding caregivers' experiences of disclosure to HIV-positive children.

Master of Social Science in Psychology. University of KwaZulu-Natal, Durban 2016.South Africa has the highest burden of the HIV/AIDS epidemic in the world, with a large number of peri-natally infected children. With the advent of antiretroviral treatment, these children are now able to live into adolescence, adulthood and old age. With this longevity comes the responsibility of disclosing the child‟s HIV-positive status to them so that they can begin to take responsibility for their health and well-being, as well as protect others from possible HIV infection. The research aimed to understand caregivers‟ views on the process of disclosure of a child‟s HIV status to the child, to develop an understanding of factors that promote disclosure, as well as the impact of disclosure on the child. This study used a qualitative design. Semi-structured qualitative interviews were held with ten participants who were caregivers to HIV-positive children. The participants were recruited through the Vuka Family Programme: Supporting Health and Behavior of South African HIV+ Youth. Inclusion criteria were that participants had to have disclosed their status to their HIV-positive children. Thematic analysis, specifically the framework approach, was used to analyse the data. Findings from this study show that disclosure is not an easy task to undertake, with caregivers needing help on how to disclose; however, it reportedly had benefits for the child, such as improved levels of adherence. Factors promoting disclosure included children questioning the medication that they were taking and pressure from clinicians to disclose. Factors hindering disclosure included fear of stigma and discrimination against the child, as well as shame, guilt and embarrassment among the biological caregivers. The need for the introduction of HIV disclosure guidelines for clinicians and caregivers of children living with HIV is recommended, to assist in making the process of disclosure easier

Determinants of HIV infection among adolescent girls and young women aged 15–24 years in South Africa: a 2012 population-based national household survey

Abstract Background South Africa is making tremendous progress in the fight against HIV, however, adolescent girls and young women aged 15–24 years (AGYW) remain at higher risk of new HIV infections. This paper investigates socio-demographic and behavioural determinants of HIV infection among AGYW in South Africa. Methods A secondary data analysis was undertaken based on the 2012 population-based nationally representative multi-stage stratified cluster random household sample. Multivariate stepwise backward and forward regression modelling was used to determine factors independently associated with HIV prevalence. Results Out of 3092 interviewed and tested AGYW 11.4% were HIV positive. Overall HIV prevalence was significantly higher among young women (17.4%) compared to adolescent girls (5.6%). In the AGYW model increased risk of HIV infection was associated with being young women aged 20–24 years (OR = 2.30, p = 0.006), and condom use at last sex (OR = 1.91, p = 0.010), and decreased likelihood was associated with other race groups (OR = 0.06, p < 0.001), sexual partner within 5 years of age (OR = 0.53, p = 0.012), tertiary level education (OR = 0.11, p = 0.002), low risk alcohol use (OR = 0.19, p = 0.022) and having one sexual partner (OR = 0.43, p = 0.028). In the adolescent girls model decreased risk of HIV infection was associated with other race groups (OR = 0.01, p < 0.001), being married (OR = 0.07), p = 0.016], and living in less poor household (OR = 0.08, p = 0.002). In the young women’s models increased risk of HIV infection was associated with condom use at last sex (OR = 2.09, p = 0.013), and decreased likelihood was associated with other race groups (OR = 0.17, p < 0.001), one sexual partner (OR = 0.6, p = 0.014), low risk alcohol use (OR = 0.17, p < 0.001), having a sexual partner within 5 years of age (OR = 0.29, p = 0.022), and having tertiary education (OR = 0.29, p = 0.022). Conclusion These findings support the need to design combination prevention interventions which simultaneously address socio-economic drivers of the HIV epidemic, promote education, equity and access to schooling, and target age-disparate partnerships, inconsistent condom use and risky alcohol consumption

Oral pre-exposure prophylaxis uptake, adherence, and adverse events among South African men who have sex with men and transgender women

DATA AVAILABILITY : Data that support the findings may contain identifying or sensitive patient information. To preserve participant confidentiality, these data cannot be shared publicly. The principal investigator of this study, P.S.S. (pssulli@emory. edu), can be contacted with requests to access these data.BACKGROUND : HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented. OBJECTIVES : The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility. METHOD : In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations. RESULTS : Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232–325 days). Across the follow-up time points, 57% – 72% of participants self-reported taking protective levels of PrEP and 59% – 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation. CONCLUSION : Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.The Center for AIDS Research at Emory University and the National Institute for Allergy and Infectious Diseases.http://www.sajhivmed.org.zaam2023School of Health Systems and Public Health (SHSPH

An understanding of the underlying determinants of infant and child mortality in a Johannesburg Metro community health care centre .

MM 201

Prevalence of Self-Reported Diagnosed Cataract and Associated Risk Factors among Elderly South Africans

This paper estimates the prevalence of self-reported cataract and associated risk factors among individuals aged ≥50 years in South Africa. Data from a nationally-representative cross-sectional Study on Global AGEing and Adult Health (SAGE) (N = 3646) conducted in South Africa from 2007–2008 was analyzed. The primary outcome was self-reported cataract, and exposures included socio-demographics, self-reported co-morbidities, and behavioral factors. Linearized multivariate logistic regression models were used. The weighted prevalence of self-reported diagnosed cataract was 4.4% (95%CI: 3.4–5.8). Prevalence was greater among individuals with advancing age (10.2%), higher quality of life (QoL) (5.9%), education (5.2%), and wealth (5.8%) than their counterparts. Prevalence was also higher among individuals with depression (17.5%), diabetes (13.3%), hypertension (9.1%), and stroke (8.4%) compared to those without these conditions, with the exception of obesity (4.2%). In the final multivariate model, the odds of self-reported cataract were: 4.14 times higher among people ≥70 years than 50 to 59 year olds (95%CI: 2.28–7.50); 2.48 times higher in urban than rural residents (95%CI: 1.25–4.92); 5.16, 2.99, and 1.97 times higher for individuals with depression (95%CI: 1.92–13.86), hypertension (95%CI: 1.60–5.59), and diabetes (95%CI: 1.07–3.61), compared to those without these conditions