In Uganda, community-based health programs using volunteers should focus on strengthening support systems to address transportation and stockout issues and on improving links with the health structure while reinforcing effort recognition, status, and acquisition of new skills.

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Summaryobjectives To assess willingness to participate in HIV vaccine trials and possible barriers to participation.methods Questionnaire survey of participants completing a 2-year community-based HIV Vaccine Preparedness Study, followed by cross sectional analysis of data.results 95% of participants were willing to participate in a trial with similar attributes to the Vaccine Preparedness Study. Certain hypothetical trial attributes significantly reduced willingness to participate: The requirement to delay pregnancy (for females) had the largest effect, reducing willingness to participate from 97% to 23% (P < 0.0001). Larger blood draws had the second largest effect: 95-55% (P < 0.0001). The possibility of receiving either candidate vaccine or placebo had the third largest effect: 95-73% (P < 0.0001). Monthly study visits had the fourth largest effect: 95-92% (P < 0.0001). Trial duration longer than 2 years had the least effect: 95-93% (P = 0.0025). Combined attributes reduced willingness to participate from 95% to 43% (McNemar's v 2 = 521.00; P < 0.0001) overall and 97-11% (McNemar's v 2 = 531.00; P < 0.0001) for female participants. Physical harm concerns (adjusted OR = 34.9; 95% CI, 10.4-118) and a low risk behaviour index (adjusted OR = 0.09; 95% CI, 0.01-0.73) were associated with unwillingness to participate.

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BackgroundThe growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs.Methodology and Main FindingsDuring 2010–11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events.ConclusionThis work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches.

Public drinking in this community serves as a marker for men willing to exercise privileges of independence (sexual and otherwise) and women willing to defy gender norms (and risk the sexual consequences). The social and symbolic context of drinking suggests why effective HIV prevention around alcohol should not be limited to drinking environments alone.

The relationship between gendered power relations and sexual behaviours of adolescents has been limitedly explored in Uganda. A 2015 cross‐sectional survey covering 16 purposively selected districts of Uganda assessed perceptions and associations of gender norms measured using the Gender Equitable Men scale and sexual behaviours among adolescents (N = 867). Findings indicate that behavioural intention to use contraception was moderately correlated with a gender equitable norm towards reproductive health and pregnancy and disease prevention among girls, r = .23 (p < .01; 95% CI .14‐.31) and boys, r = .22 (p < .01; 95% CI .12‐.31). A moderate correlation was found between self‐efficacy to use condoms and the norm towards reproductive health and pregnancy and disease prevention among girls, r = .29 (p < .01; 95% CI .20‐.37) and boys, r = .30 (p < .01; 95% CI .21‐.38). This indicates persistent inequitable gender norms that affect health service uptake among adolescents. Addressing inequitable gender norms requires working closely with girls and boys, promoting informed peer and partner discussions, engaging in strategic partnerships with parents, religious, political, and community leaders, and enforcing health information services to address misconceptions.

ObjectiveHigher than expected pregnancy rates have been observed in HIV related clinical trials in Sub-Saharan Africa. We designed a qualitative study to explore the factors contributing to high pregnancy rates among participants in two HIV clinical trials in Sub-Saharan Africa.MethodsFemale and male participants enrolled in one of two clinical HIV trials in south-west Uganda were approached. The trials were a phase III microbicide efficacy trial among HIV negative women using vaginal gel (MDP); and a trial of primary prevention prophylaxis for invasive cryptococcal disease using fluconazole among HIV infected men and women in Uganda (CRYPTOPRO). 14 focus group discussions and 8 in-depth interviews were conducted with HIV positive and negative women and their male partners over a six month period. Areas explored were their experiences about why and when one should get pregnant, factors affecting use of contraceptives, HIV status disclosure and trial product use.ResultsAll respondents acknowledged being advised of the importance of avoiding pregnancy during the trial. Factors reported to contribute to pregnancy included; trust that the investigational product (oral capsules/vaginal gel) would not harm the baby, need for children, side effects that led to inconsistent contraceptive use, low acceptance of condom use among male partners. Attitudes towards getting pregnant are fluid within couples over time and the trials often last for more than a year. Researchers need to account for high pregnancy rates in their sample size calculations, and consider lesser used female initiated contraceptive options e.g. diaphragm or female condoms. In long clinical trials where there is a high fetal or maternal risk due to investigational product, researchers and ethics committees should consider a review of participants contraceptive needs/pregnancy desire review after a fixed period, as need for children, partners and health status of participants may alter over time.