Getting to zero HIV/AIDS in sub‐Saharan Africa: Understanding perceptions of locals using the social determinants of health framework

McMahan, Lyndsey D; Lombe, Margaret; Evans, Caroline B. R.; Enelamah, Ngozi; Chu, Yoosun; Simms, Stewart; Verkamp-Ruthven, Jennifer; Martinez, Javier Reyes; Mweemba, Odericky; LaForest, Lubenji; Weiss, Deborah Jones; Wideman, Laura

doi:10.1111/hsc.13444

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…The findings in this study show the coexistence of different perceptions and meanings of HIV amongst the population of Equatorial Guinea. In this respect, as with other studies undertaken in the African context [ 28 ], our research demonstrates that age, place of residence and level of education all influence the way HIV is perceived. Nevertheless, it is important to mention that some meanings ascribed to HIV were shared by the majority of the population.…”

Section: Discussionsupporting

confidence: 86%

“It doesn’t exist, only other people have it, or it’s bad luck”: perceptions of HIV as barriers to its prevention in Bata

Rodríguez-Reinado,

Blasco-Hernández,

Abeso

et al. 2023

BMC Public Health

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Background Currently, Africa is the region of the world where the highest number of new cases of HIV infection are registered. In 2022, Equatorial Guinea was the Central African country with the highest HIV prevalence (6.9%) and incidence (3.80 per 1,000 amongst the population of all ages). The main objective of this study was to determine the perceptions of HIV and the meanings given to it among the population of Equatorial Guinea in order to assess to what extent they represent a barrier to the prevention strategies implemented hitherto. Methods A total of 30 semi-structured interviews and nine focal groups were carried out. Findings The interviewees’ testimonies revealed a combination of differing perceptions and meanings around HIV. In some cases, HIV was perceived as “a non-existent illness”, and in others as “a disease of others”, or as “a disease of bad luck”. Other majority perceptions of HIV classed it as “a deadly disease” or “a sexual illness”. Conclusions All these perceptions of HIV and the social representations constructed around it can represent a barrier to adopting preventive practices. Hence, in order to improve efficacy, efficiency, and effectiveness, it is recommended that HIV prevention policies take into account the heterogeneity of meanings linked to the different social groups that have contracted the virus.

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Section: Discussionsupporting

confidence: 86%

“It doesn’t exist, only other people have it, or it’s bad luck”: perceptions of HIV as barriers to its prevention in Bata

Rodríguez-Reinado,

Blasco-Hernández,

Abeso

et al. 2023

BMC Public Health

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“…While, after 40 years form its appearance, the large number of effective treatments and prevention interventions have implemented, causing a considerable reduction in new cases in the world, this reduction did not occur equally among populations, subpopulations and geographic regions [ 2 ]. In order to reduce these inequalities, and achieve the AIDS-related Sustainable Development Goal (“end the epidemic of AIDS by 2030”), structural interventions should aim to reduce poverty, social vulnerabilities, and decrease geographic and economic barriers to healthcare [ 3 ]. Recent studies suggest that Conditional Cash Transfers (CCTs) can be effective for the reduction of maternal transmission of HIV, may reduce HIV/AIDS incidence among some populations, and can increase adherence to ARV treatment [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the impact of social determinants, conditional cash transfers and primary health care on HIV/AIDS: Study protocol of a retrospective and forecasting approach based on the data integration with a cohort of 100 million Brazilians

et al. 2022

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Background Despite the great progress made over the last decades, stronger structural interventions are needed to end the HIV/AIDS pandemic in Low and Middle-Income Countries (LMIC). Brazil is one of the largest and data-richest LMIC, with rapidly changing socioeconomic characteristics and an important HIV/AIDS burden. Over the last two decades Brazil has also implemented the world’s largest Conditional Cash Transfer programs, the Bolsa Familia Program (BFP), and one of the most consolidated Primary Health Care (PHC) interventions, the Family Health Strategy (FHS). Objective We will evaluate the effects of socioeconomic determinants, BFP exposure and FHS coverage on HIV/AIDS incidence, treatment adherence, hospitalizations, case fatality, and mortality using unprecedently large aggregate and individual-level longitudinal data. Moreover, we will integrate the retrospective datasets and estimated parameters with comprehensive forecasting models to project HIV/AIDS incidence, prevalence and mortality scenarios up to 2030 according to future socioeconomic conditions and alternative policy implementations. Methods and analysis We will combine individual-level data from all national HIV/AIDS registries with large-scale databases, including the “100 Million Brazilian Cohort”, over a 19-year period (2000–2018). Several approaches will be used for the retrospective quasi-experimental impact evaluations, such as Regression Discontinuity Design (RDD), Random Administrative Delays (RAD) and Propensity Score Matching (PSM), combined with multivariable Poisson regressions for cohort analyses. Moreover, we will explore in depth lagged and long-term effects of changes in living conditions and in exposures to BFP and FHS. We will also investigate the effects of the interventions in a wide range of subpopulations. Finally, we will integrate such retrospective analyses with microsimulation, compartmental and agent-based models to forecast future HIV/AIDS scenarios. Conclusion The unprecedented datasets, analyzed through state-of-the-art quasi-experimental methods and innovative mathematical models will provide essential evidences to the understanding and control of HIV/AIDS epidemic in LMICs such as Brazil.

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“…Despite the effective interventions implemented for the prevention and treatment of HIV/AIDS, with a considerable reduction in new cases in the world, this reduction did not occur equally among populations, subpopulations and geographic regions 8 . This fact triggered the complexity of the challenge of controlling the disease, whose dynamics are closely related to behavioral factors, but also to social determinants to which populations are subjected [9][10][11] . It became clear that responding to HIV is not just a biomedical issue, but is also a social challenge.…”

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confidence: 99%

Incorporating social determinants of health into the mathematical modeling of HIV/AIDS

Oliveira

Rubio

Anderle

et al. 2022

Sci Rep

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Currently, it is estimated that 37.6 million people are living with the HIV/AIDS virus worldwide, placing HIV/AIDS among the ten leading causes of death, mostly among low- and lower-middle-income countries. Despite the effective intervention in the prevention and treatment, this reduction did not occur equally among populations, subpopulations and geographic regions. This difference in the occurrence of the disease is associated with the social determinants of health (SDH), which could affect the transmission and maintenance of HIV. With the recognition of the importance of SDH in HIV transmission, the development of mathematical models that incorporate these determinants could increase the accuracy and robustness of the modeling. This article aims to propose a theoretical and conceptual way of including SDH in the mathematical modeling of HIV/AIDS. The theoretical mathematical model with the Social Determinants of Health has been developed in stages. For the selection of SDH that were incorporated into the model, a narrative literature review was conducted. Secondly, we proposed an extended model in which the population (N) is divided into Susceptible (S), HIV-positive (I), Individual with AIDS (A) and individual under treatment (T). Each SDH had a different approach to embedding in the model. We performed a calibration and validation of the model. A total of 31 SDH were obtained in the review, divided into four groups: Individual Factors, Socioeconomic Factors, Social Participation, and Health Services. In the end, four determinants were selected for incorporation into the model: Education, Poverty, Use of Drugs and Alcohol abuse, and Condoms Use. the section “Numerical simulation” to simulate the influence of the poverty rate on the AIDS incidence and mortality rates. We used a Brazilian dataset of new AIDS cases and deaths, which is publicly available. We calibrated the model using a multiobjective genetic algorithm for the years 2003 to 2019. To forecast from 2020 to 2035, we assumed two lines of poverty rate representing (i) a scenario of increasing and (ii) a scenario of decreasing. To avoid overfitting, we fixed some parameters and estimated the remaining. The equations presented with the chosen SDH exemplify some approaches that we can adopt when thinking about modeling social effects on the occurrence of HIV. The model was able to capture the influence of the employment/poverty on the HIV/AIDS incidence and mortality rates, evidencing the importance of SDOH in the occurrence of diseases. The recognition of the importance of including the SDH in the modeling and studies on HIV/AIDS is evident, due to its complexity and multicausality. Models that do not take into account in their structure, will probably miss a great part of the real trends, especially in periods, as the current on, of economic crisis and strong socioeconomic changes.

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Getting to zero HIV/AIDS in sub‐Saharan Africa: Understanding perceptions of locals using the social determinants of health framework

Cited by 4 publications

References 27 publications

“It doesn’t exist, only other people have it, or it’s bad luck”: perceptions of HIV as barriers to its prevention in Bata

“It doesn’t exist, only other people have it, or it’s bad luck”: perceptions of HIV as barriers to its prevention in Bata

Evaluating the impact of social determinants, conditional cash transfers and primary health care on HIV/AIDS: Study protocol of a retrospective and forecasting approach based on the data integration with a cohort of 100 million Brazilians

Incorporating social determinants of health into the mathematical modeling of HIV/AIDS

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