HIV transmission risk behavior among HIV-infected adults in Uganda: results of a nationally representative survey.
ABSTRACT Evaluate factors associated with HIV transmission risk behavior among HIV-infected adults in Uganda.
Cross-sectional and nationally representative study (2004-2005 Uganda HIV/AIDS Sero-Behavioral Survey) tested 18,525 adults (15-59 years old) for HIV and herpes simplex virus type 2 (HSV-2).
Data were weighted to obtain nationally representative results. Sexual-risk behavior by HIV-infected individuals was defined as unprotected sex at last encounter. Using multivariate analysis, we identified factors associated with being sexually active, knowing HIV status, and using contraception and condoms.
Of 1092 HIV-infected respondents, 64% were female (median age was 33 years), 84% had HSV-2, and 13% reported one lifetime partner (1% of men and 23% of women). Twenty-one percent of adults knew their HIV status and 9% knew their partners'. Seventy-seven percent were sexually active, of whom 27% reported condom use at last sex. Of last unprotected sexual encounters, 84% were with spouses and 13% with steady partners. Of cohabitating persons, 40% had an HIV-negative spouse. Those who knew their HIV status were three times more likely to use a condom at last sex encounter [adjusted odds ratio (AOR), 3.0; 95% confidence intervals (CI), 1.9-4.7] and those who knew their partners' HIV status were 2.3 times more likely to use condoms (AOR, 2.3; 95% CI, 1.2-4.3).
A minority of HIV-infected adults in Uganda knew they had HIV infection; nearly half were in an HIV-discordant relationship, and few used condoms. Knowledge of HIV status, both one's own and one's partner's, was associated with increased condom use. Interventions to support HIV-infected persons and their partners to be tested are urgently needed.
- SourceAvailable from: Margaret Kyakuwa[Show abstract] [Hide abstract]
ABSTRACT: Margaret Kyakuwa onderzocht de rol van hiv-positieve verpleegsters in twee behandelcentra voor hiv/aids in Uganda. Ze bekeek wat er gebeurt met de identiteit van de verpleegsters wanneer hun persoonlijke leven en sociale omgeving verandert als gevolg van de aidsepidemie en behandeling met antiretrovirale therapie (ART). Ook onderzocht Kyakuwa hoe de ziekte de zorgrelaties van de verpleegsters beïnvloedt. Uit haar onderzoek blijkt dat verpleegsters die werkzaam zijn in de publieke kliniek vaak kiezen voor een leven van geheimzinnigheid en verschuiling. Kyakuwa concludeert daarnaast dat hiv-positieve verpleegsters betere zorgverleners zijn, door de toegevoegde waarde van hun persoonlijke ervaring. Zulke verpleegsters blijken pragmatischer en flexibeler te zijn. In plaats van zich strikt te houden aan medisch-ethische codes van objectiviteit en afstandelijkheid, hechten zij meer waarde aan relaties die gebaseerd zijn op vertrouwen, onderlinge afhankelijkheid, creativiteit en samenwerking. Dit moeten de verpleegsters zien te bereiken binnen beperkte kaders, wat een constante herziening van keuzes vereist.
- [Show abstract] [Hide abstract]
ABSTRACT: This study uses data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) in eight high HIV prevalence countries in sub-Saharan Africa (Kenya, Lesotho, Malawi, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe) to assess HIV-related knowledge and behaviors among people living with HIV (PLHIV). HIV/AIDS has become the leading cause of death in sub-Saharan Africa. UNAIDS has recommended that comprehensive HIV-prevention programs should include a focus on PLHIV as a primary source of HIV infection. In order to design effective prevention strategies focusing on PLHIV, it is essential to understand their HIV-related knowledge and behaviors. Knowledge about HIV/AIDS The study results show that among three areas of knowledge of HIV/AIDS—comprehensive knowledge about AIDS, knowledge of preventing mother-to-child transmission (PMTCT) and knowledge of HIV prevention methods—the largest percentage of HIV-positive men and women are aware of HIV prevention methods, particularly “abstinence” and “being faithful.” The lowest percentage by far is for comprehensive knowledge about AIDS. There has been significant improvement, however, in comprehensive knowledge about AIDS and knowledge of PMTCT in countries studied with recent trend data. Prior HIV testing is positively associated with comprehensive knowledge about HIV/AIDS in only half the countries, for both men and women. A positive association between prior HIV testing and knowledge of PMTCT is observed among HIV-positive women in most countries, and among men in a handful of countries, possibly because of widespread government and donor efforts toward universal access to PMTCT services, including HIV testing and counseling during pregnancy. Overall, there is a strong association between educational attainment and comprehensive knowledge about AIDS among HIV-positive men and women. Women’s education is also positively associated with their knowledge of PMTCT in most countries studied, but not so for men. Sexual Risk Behaviors Among HIV-positive men and women a greater percentage of men than women report having multiple sexual partners. Also, a higher percentage of men than women report higher-risk sex (sex with nonspousal or non-cohabiting partners) in the past 12 months, and condom use at last sex. Lesotho and Swaziland, where HIV prevalence rates are particularly high, have the highest levels of condom use, for both women and men. However, in four countries (Malawi, Tanzania, Uganda and Zambia) more than 75 percent of men report that their most recent sex was unprotected. Over time, prevalence of multiple partnership and higher-risk sex has remained about the same in all five countries studied with data from two surveys. While condom use at at last sex has more than doubled in most cases, a large proportion of PLHIV are sexually active and have unprotected sex. The results also show that being married or in a cohabitating relationship is significantly associated with lower levels of condom use for both women and men, as within marriage condom use is more for protection from pregnancy than for protection against sexually transmitted infections. Increasing people’s awareness of their own HIV status as well as their partner’s status could increase condom use within marriage or cohabitation. Prior HIV Testing Experience Prior HIV testing is common in all countries studied with data from the last five years. Testing rates are higher for women than men, probably because of testing during antenatal care. However, not all PLHIV who tested for HIV received results. Rates of testing and receiving results have increased substantially for both women and men, possibly reflecting recent policy and program efforts. In Swaziland, however, only half of HIV-infected women and one-third of HIV-infected men have ever tested for HIV. Contrary to expectations, the study found that engaging in sexual risk behaviors, such as having multiple sexual partners, is not associated with HIV testing uptake. The study found a positive association between receiving STI care and testing for HIV in the last 12 months, although only for women and only in three of the eight countries examined. Integrating HIV testing into STI clinics could be an effective approach for scaling up HIV testing, as many people are reluctant to go for testing to a health facility serving HIV patients. Overall, the findings from this analysis can help inform policies and programs in sub-Saharan Africa to develop comprehensive HIV-prevention strategies that include a stronger focus on HIV prevention among men and women living with HIV.
- [Show abstract] [Hide abstract]
ABSTRACT: Background:With transmission of HIV occurring mainly through heterosexual contact, it is paramount to identify serodiscordant couples and implement preventive strategies that will protect the negative partner. The burden of serodiscordance and its predictors in Ethiopia is not clearly understood due to the dearth of data.Objective: To assess the prevalence and predictors of HIV serodiscordance among couples tested in Jimma University Specialized Hospital (JUSH) Voluntary Counseling and Testing (VCT) center.Methods:The study employed a case-control study design conducted at VCT center of JUSH in all registered serodiscordant couples and seroconcordant couples that were selected from the registered clients in the period from 2003 to 2010. A pretested structured questionnaire was used for data collection using medical chart abstraction. Data were entered, cleaned, and coded using Statistical Package of Social Sciences (SPSS) version 16.Results:The prevalence of serodiscordance in the study population was found to be 8.4%. Male and female discordants accounted for 5.8% (137) and 2.6% (62), respectively. Rare use of condom (adjusted odds ratio [AOR] = 7.2; 95% confidence interval [CI] = 1.59-32.54) and active tuberculosis (TB) at enrollment (AOR= 17.7; 95% CI = 2.3-139.2) were significantly found to be the predictors of serodiscordance. Conclusion:The prevalence of serodiscordance in the study area was found to be low, but it contributes to a clinically significant population that mandates implementation of preventive strategy. Sero-positive individuals who use condoms rarely should be encouraged to have their partners tested, and the association between active TB and serodiscordance underscores the need for further study.05/2013; 14(3). DOI:10.1177/2325957413488177