Changes in HIV prevalence among differently educated groups in Tanzania 2003–2007
London School of Hygiene and Tropical Medicine, London, AIDS (London, England)
(Impact Factor: 5.55).
03/2010; 24(5):755-61. DOI: 10.1097/QAD.0b013e328336672e
HIV prevalence trends suggest that the epidemic is stable or declining in many sub-Saharan African countries. However, trends might differ between socioeconomic groups. Educational attainment is a common measure of socioeconomic position in HIV datasets from Africa. Several studies have shown higher HIV prevalence among more educated groups, but this may change over time. We describe changes in HIV prevalence by educational attainment in Tanzania from 2003 to 2007.
Analysis of data from two large, nationally representative HIV prevalence surveys conducted among adults aged 15-49 years in Tanzania in 2003-2004 (10 934 participants) and 2007-2008 (15 542 participants). We explored whether changes in HIV prevalence differed between groups with different levels of educational attainment after adjustment for potential confounding factors (sex, age, urban/rural residence and household wealth).
Changes in HIV prevalence differed by educational attainment level (interaction test P value = 0.07). HIV prevalence was stable among those with no education (adjusted odds ratio 2007-2008 vs. 2003-2004 1.03, 95% confidence interval 0.72-1.47), whereas showing a small but borderline significant decline among those with primary education (adjusted odds ratio 0.85, 95% confidence interval 0.69-1.03) and a larger statistically significant decline among those with secondary education (adjusted odds ratio 0.53, 95% confidence interval 0.34-0.84).
Prevalent HIV infections are now concentrating among those with the lowest levels of education in Tanzania. Although HIV-related mortality, migration and cohort effects might contribute to this, different HIV incidence by educational level between the surveys provides the most likely explanation. Urgent measures to improve HIV prevention among those with limited education and of low socioeconomic position are necessary in Tanzania.
Available from: Justin Parkhurst
- "Numerous descriptions of how being poor can lead to risky sex (for example when food insecurity leads to transactional sex ) does not change the fact that poverty can also be extremely socially isolating, making it hard to have broad sexual networks. The relationship between wealth, poverty and HIV does appear to be changing over time in some parts of Africa, with falling prevalence among those of higher socio-economic status seen in Tanzania, for instance [88,91]. But the point, again, should not be to look for any evidence that poverty is more important for HIV spread, but rather to accept that other social values must be utilized in guiding policy decisions. "
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ABSTRACT: The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals.
This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses.
HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values.
While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well.
Journal of the International AIDS Society 06/2012; 15 Suppl 1(Suppl 1):1-10. DOI:10.7448/IAS.15.3.17367 · 5.09 Impact Factor
Available from: Christine Danel
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ABSTRACT: To investigate the relationship between unsafe sexual behaviours and poor self-perceived health among people living with HIV and AIDS (PLWHA) in western Africa.
In March 2006, a survey was conducted among patients continuing their participation in the TRIVACAN trial (ANRS 1269) in Côte d'Ivoire, in which patients had been randomized to either continuous or interrupted antiretroviral therapy (ART) (2-months-off/4-months-on cycles [2/4-ART]) after 6-18 months of continuous ART (C-ART). Socio-demographic and psychosocial information, including data on sexual behaviours during the previous 6 months, was collected using face-to-face interviews. Sexually active patients with either a steady partner (serodiscordant or of unknown HIV status) or casual partners were considered to have unsafe sexual behaviours if they reported inconsistent condom use (ICU).
Seventy-seven of the 192 patients reported ICU. In multivariate logistic regression, men were significantly less likely to report ICU than women (OR [95% CI] = 0.45 [0.20-0.98]). After adjustment for educational level and reduced sexual activity since ART initiation, concealment of HIV status (2.08 [1.02-4.25]) and poor self-perceived health (2.32 [0.97-5.52]) were independently associated with ICU.
HIV prevention strategies in resource-limited settings should take into account self-perceived health and difficulties to disclose HIV status. Counselling interventions need to be developed to help PLWHA to adopt or negotiate safe behaviours respecting their individual cultures.
Tropical Medicine & International Health 03/2010; 15(6):706-12. DOI:10.1111/j.1365-3156.2010.02524.x · 2.33 Impact Factor
Available from: Handan Wand
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ABSTRACT: Objectives To investigate the impact of early sexual debut on HIV seroprevalence and incidence rates among a cohort of women.
Design Prospective study.
Setting KwaZulu-Natal, South Africa.
Participants A total of 3492 sexually active women who consented to screen a HIV prevention trial during September 2002 to September 2005; a total of 1485 of them were followed for approximately 24 months.
Primary and secondary outcome measures HIV seroprevalence among those who were screened for the trial and HIV seroconversion among those who seroconverted during the study.
Results Lowest quintiles of age at sexual debut, less than high school education, a higher number of lifetime sexual partners and lack of cohabitation, being diagnosed as having herpes simplex virus 2 and other sexually transmitted infections were all significantly associated with prevalent HIV infection in multivariate analysis. During follow-up, 148 (6.8 per 100 person-years, 95% CI 5.8 to 8.0) women seroconverted. Highest seroconversion rate was observed among women who had reported to have had sex 15 years or younger (12.0 per 100 person-years, 95% CI 8.0 to 18.0). Overall, impact of risk factors considered in this study was associated with considerable potential reductions in HIV prevalence and incidence rates (population attributable risk: 85%, 95% CI 84% to 87% and population attributable risk: 77%, 95% CI 72% to 82%, respectively).
Conclusions The association of HIV status with younger age at sexual debut may likely due to an increased number of lifetime partners. This increase could result from longer duration of sexual life. Prevention of HIV infection should include efforts to delay age at first sex in young women.
Trial registration number NCT00121459.
BMJ Open 01/2012; 2(1):e000285. DOI:10.1136/bmjopen-2011-000285 · 2.27 Impact Factor
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