BackgroundAdolescent girls and young women (AGYW, ages 15–24) are at high risk of HIV in Swaziland. Understanding more about their male sexual partners can inform HIV prevention efforts for both.MethodsUsing the PLACE methodology across all 19 DREAMS implementation districts, 843 men ages 20–34 were surveyed between December 2016-February 2017. Surveys were conducted at 182 venues identified by community informants as places where AGYW and men meet/socialize. Descriptive and multivariate analyses examined characteristics and risk behaviors of male partners of AGYW.ResultsMen’s average age was 25.7. Sixty-three percent reported female partners ages 15–19, and 70% reported partners ages 20–24 in the last year; of those, 12% and 11% respectively had five or more such partners. Among the 568 male partners of AGYW, 36% reported consistent condom use with their current/last partner. Forty-two percent reported testing for HIV in the last year; 6% were HIV-positive, and of those, 97% were currently on treatment. One-third (37%) reported being circumcised; among uncircumcised, 81% were not considering it. In multivariate analyses, men who reported three or more AGYW partners in the last year were more likely to be HIV-positive (aOR 3.2, 95% CI 1.1,8.8). Men were also less likely to disclose their HIV status to adolescent versus older partners (aOR 0.6, 95% CI 0.4,0.9) and partners more than 5 years younger than themselves (aOR 0.6, 95% CI 0.4,0.9). Results also revealed relatively high unemployment and mobility, substantial financial responsibilities, and periodic homelessness.ConclusionsMost men identified through community venues reported relationships with AGYW, and these relationships demonstrated substantial HIV risk. Challenging life circumstances suggest structural factors may underlie some risk behaviors. Engaging men in HIV prevention and targeted health services is critical, and informant-identified community venues are promising intervention sites to reach high-risk male partners of AGYW.
Objective: To assess men's experiences of adverse events in both child and adulthood and their effects on violence, HIV risk, and well being in three sub-Saharan countries. Design: We conducted cross-sectional surveys from 2017 to 2018 with men (all 18+) recruited via the PLACE methodology at community hotspots and HIV service sites in Eswatini (n = 1091), South Africa (n = 932), and Malawi (n = 611). Methods: Prevalence of men's adverse events in childhood (e.g. beaten at home often) and adulthood (e.g. robbed at gunpoint) was described. We examined associations between cumulative effects of these events on health outcomes, via log binomial regression. Results: About 70% of men in each country experienced adverse events in childhood, while adult experience varied from 47 to 64%. There was a dose–response effect of cumulative exposure. Among men with 0, 1–2, and 3+ traumas, for example, 22, 35, and 52% reported depression/anxiety in Malawi, and 8, 17, and 27% perpetrated intimate partner violence (IPV) in South Africa. In multivariate analyses, experiencing at least one event in both childhood and adulthood (vs. neither) was significantly associated with various health outcomes (e.g. multiple sexual partnerships: adjusted risk ratio or aRR = 2.40 in Malawi; IPV perpetration: aRR = 3.59 in South Africa; depression/anxiety: aRR = 1.37 in Eswatini). Conclusion: Men who experienced adverse events in childhood or adulthood faced increased HIV risk/negative health outcomes. More events were associated with worse outcomes. Interventions for men addressing trauma in both childhood and adulthood are essential for their (and their partners’) health and well being.
Research on transactional sexual relationships has largely focused on women's perspectives. Better understanding the men's views-especially regarding relationships with adolescent girls and young women-can inform HIV prevention efforts. In 2017, 134 in-depth interviews were conducted with the male partners of girls and young women aged 19-47 years, 94 in Uganda and 40 in Eswatini. Respondents were recruited at venues such as bars where men and potential partners meet and through other young women. Most respondents believed that providing money/ gifts was the way to establish relationships with women in their communities, a context that some found undesirable. Young women were mainly perceived as actively pursuing transactional sex for material goods, but respondents also described economically impoverished women who were manipulated into relationships. Men described conflict with longer term partners as a driver to seeking younger partners, who were more compliant. Transaction dominates the male partners of adolescent girls and young women's understanding of sexual relationships, and inequitable power dynamics are reinforced by seeking younger partners. However, some respondents' discontent with this dynamic suggests an opportunity for change. HIV prevention programmes should directly address the underlying drivers of transactional relationships (e.g. gender norms) and work with men who question the practice.
Objective: To assess trends in men's HIV risk factors and service use, and their experiences with prevention programming, during an intensive HIV response for adolescent girls and young women and their male partners. Design: Independent cross-sectional surveys in 2016–2017 and 2018 with men in Eswatini (20–34 years-old, n = 1391) and Durban, South Africa (20–40 years-old; n = 1665), complemented by 74 in-depth interviews (IDIs) with men exposed to HIV services/prevention programming. Methods: Survey recruitment was primarily at hot-spot venues. We assessed Round 1–2 trends in HIV risk factors and service use, overall and by HIV risk profiles. IDI respondents were identified via survey responses or program partners. Results: HIV risk factors were prevalent in both countries at each survey round, although there were reductions over time among the highest risk profiles in South Africa. Most men were engaged in HIV services (e.g. nearly two-thirds tested for HIV in the last year at round 2, with large increases in Eswatini). Qualitative data suggest HIV service uptake was facilitated by increased convenience and supportive information/messaging about HIV treatment efficacy. Men described eagerly receiving the information and support offered in HIV prevention programming, and effects on HIV risk reduction and newly engaging in HIV services. However, less than 15% of survey respondents reported being reached by such programming. Conclusion: Important inroads have been made to engage men in HIV services and prevention programming in the two countries, including among the high-risk profiles. Still, improving coverage of comprehensive HIV prevention programming is critical, particularly for men most at risk.
Volume 5 -Issue 2 Study populationSite selection: Data were collected from all five MOHCC facilities in Chitungwiza; namely Chitungwiza Central Hospital, Seke North Clinic, Seke South Clinic, St Mary's Clinic and Zengeza Clinic. Data was abstracted for the period April 2013 to March 2017. Patient inclusion criteria:All HIV positive clients 15 years and older, who were initiated on ART between the October 2012 and March 2013, at the five ART sites in Chitungwiza, regardless of treatment outcome, were included in the study. This is because clients would be put on MMS only if they have been on ART for at least 6 months and are stable. Patient exclusion criteria:Patients initiated on ART after March 2013 was excluded from the study. Patients without a documented ART initiation date were excluded from the study.
Volume 5 -Issue 2 patients with working functional status. As expected, TB co-infected clients also had higher odds of experiencing treatment failure [AHR=3.06; 95% CI: (1.72 ± 5.44)]. The study further showed that patients who developed TB after ART initiation had higher odds to experience treatment failure as compared to their counter parts [AHR=4.35; 95% CI: (1.99 ± 9.54]. Having other opportunistic infections during ART initiation was also found to be associated with higher odds of experiencing treatment failure [AHR=7.0, 95% CI: (3.19 ± 15.37)]. Having fair [AHR=4.99 95% CI: (1.90 ± 13.13)] and poor drug adherence [AHR=2.56; 95% CI: (1.12 ± 5.86)] were significantly associated with higher odds of treatment failure as compared to clients with good adherence.Overall, the study by Haile, et al. [5] shows two sets of variables: one with narrower confidence intervals (implying less variability) e.g., having a lower CD4 count, ambulatory status, TB co-infection and poor drug adherence. The other set of variables have wider confidence intervals (implying higher variability) e.g., bed ridden, developing TB after initiation, other OIs and fair drug resistance. This study explores some of the major factors being investigated in this study and provides critical insights into what to potentially expect. That it is a recent study adds value to what is being investigated in this study. However, the study report does not show whether these findings are reflective of a post multi-month scripting era or not. Nonetheless, other reviews done by this researcher show that Ethiopia has adopted the differentiated models of care. Factors associated with survival:A retrospective study conducted by Ram Bajpai, et al. [6] assessed the survival rates and factors associated with survival among adult PLHIV in Andhra Pradesh, India. This research piece used data from 139 679 PLHIV aged ≥ 15 years on ART, registered between 2007 and 2011. These were followed up through December 2013. The outcome of interest was death of the client. The Kaplan-Meier was used to estimate survival, while the Cox-regression models were used to explore the factors associated with survival.
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