Mothers' knowledge of mother-to-child transmission of HIV and infant feeding practices in Juba, South Sudan

Introduction: While exclusive breastfeeding for the first six months of life is recommended for HIV-infected mothers, this may not be practiced fully in South Sudan; exclusive formula feeding, which is the best alternative to breastfeeding, may not be practical. Objective: To assess the knowledge of mother-to-child transmission of HIV (MTCT) and practices of feeding infants in the first six months of life among HIV-infected mothers attending Antiretroviral Therapy Centres in Juba Teaching Hospital (JTH) and Juba Military Hospital (JMH). Method: A cross-sectional study in which 304 HIV-infected mothers with children aged 6-18 months were interviewed between October and December 2016 using structured questionnaires. Key informant interviews (KIIs) and focus group discussions (FGDs) were also conducted using interview guides. Quantitative data was analysed using Statistics Package for Social Sciences software. Chi-square test was used to test the presence of significant association between the variables and the association is statistically significant when the p-value is < 0.05. Multiple logistic regression analysis was used to identify which predictor variables have major effect on the dependent variable. Qualitative data was transcribed in English and summarized according to the key themes, and the information obtained was used to supplement and interpret the findings of the quantitative data. Results: Only 120 (40%) of the HIV-infected mothers had a good knowledge of MTCT; 213 mothers (70.1%) practiced mixed feeding, 70 (23.0%) practiced exclusive breastfeeding and 20 (6.6%) practiced exclusive formula feeding. The factors that were found to have a positive effect on choice of infant feeding methods were having more than one child (odds ratio = 0.303, 95% Confidence interval: 0.161-0.571, p = 0.001) and participation in the prevention of motherto-child transmission of HIV programme (PMTCT) (odds ratio = 2.260, 95% Confidence interval: 1.251-4.084, p = 0.007). Stigma (p = 0.248) and mothers' knowledge of MTCT (p = 0.072) were not statistically significantly associated with the mothers' infant feeding practices. Conclusion: Knowledge of MTCT is low. Mixed feeding before six months of age is predominant among the HIV-infected mothers. It is therefore recomm;ended that HIV-infected mothers receive adequate information from counsellors regarding MTCT and exclusive breastfeeding for the first six months of an infant's life

Demographic determinants of risky sexual behaviours among senior high school students in the Hohoe municipality, Ghana

Senior High School (SHS) students fall within the age group (15-24 years) hardest hit by HIV/AIDS. Since about 90% of HIV transmission in sub-Saharan Africa (SSA) is through heterosexual intercourse, it is assumed that these students engage in risky sexual behaviours. Hohoe municipality has one of the highest HIV prevalence in Ghana (3.4%). The current study investigated the demographic determinants of risky sexual behaviours among senior high school students in the Hohoe municipality, Ghana.Methods: a descriptive cross-sectional design was employed in the study. A pretested structured questionnaire was used to collect data from a multistage sample of 270 SHS students who consented to participate in January 2019. Descriptive and inferential statistics were performed using Stata version 14.0 software program at the 0.05 level of significance.Results: of 270 respondents, 112 (41.5%) were engaged in risky sexual behaviours. Single students were 82% less likely to engage in risky sexual behaviours than their married counterparts (p=0.032) and muslims were 89% less likely to engage in risky sexual behaviours than christians (p=0.032).Conclusion: religion and marital status were the two socio-demographic characteristics that were significantly associated with risky sexual behaviour. Health promotion interventions to curb risky sexual behaviours among the SHS students should target the christian and married students

HIV self-testing services for female sex workers, Malawi and Zimbabwe

Objective To present findings from implementation and scale-up of human immunodeficiency virus (HIV) self-testing programmes for female sex workers in Malawi and Zimbabwe, 2013­2018. Methods In Zimbabwe, we carried out formative research to assess the acceptability and accuracy of HIV self-testing. During implementation we evaluated sex workers' preferences for, and feasibility of, distribution of test kits before the programme was scaled-up. In Malawi, we conducted a rapid ethnographic assessment to explore the context and needs of female sex workers and resources available, leading to a workshop to define the distribution approach for test kits. Once distribution was implemented, we conducted a process evaluation and established a system for monitoring social harm. Findings In Zimbabwe, female sex workers were able to accurately self-test. The preference study helped to refine systems for national scale-up through existing services for female sex workers. The qualitative data helped to identify additional distribution strategies and mediate potential social harm to women. In Malawi, peer distribution of test kits was the preferred strategy. We identified some incidents of social harm among peer distributors and female sex workers, as well as supply-side barriers to implementation which hindered uptake of testing. Conclusion Involving female sex workers in planning and ongoing implementation of HIV self-testing is essential, along with strategies to mitigate potential harm. Optimal strategies for distribution and post-test support are context-specific and need to consider existing support for female sex workers and levels of trust and cohesion within their communities

Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013­2016

Objective To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. Methods : We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013­2016. Two survey rounds were conducted (2013­2015 and 2015­2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round.Findings In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds. Conclusion Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals

Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe

Background: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% ­ 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases.Aim: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV.Setting: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe.Methods: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed.Results: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support.Conclusions: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV

HIV fatalism and engagement in transactional sex among Ugandan fisherfolk living with HIV

HIV fatalism, or the belief that HIV acquisition and mortality is out of one's control, is thought to contribute to HIV risk in fishing populations in East Africa. The objective of this cross-sectional study was to investigate the association between fatalism and sexual risk behaviours (unprotected sex, engagement in transactional sex), beyond the influence of other known HIV risk factors (e.g. food insecurity, mobility), and identify demographic, psychosocial, and structural correlates of HIV fatalism. Ninety-one men and women living in fishing villages on two islands in Lake Victoria, Uganda completed an interviewer-administered questionnaire after testing HIV-positive during home or community-based HIV testing between May and July 2015. Multivariate logistic regression was used to test the association between HIV fatalism and transactional sex and multivariate linear regression was used to identify demographic, psychosocial, and structural correlates of HIV fatalism. HIV fatalism was significantly associated with a greater likelihood of transactional sex (AOR = 3.07, 95% CI = 1.02­9.23, p = 0.04), and structural barriers to HIV care (e.g. distance to clinic) were significantly associated with HIV fatalism (ß = 0.26, SE = 0.12, p = 0.04). Our findings highlight HIV fatalism as a contributor to transactional sex in Ugandan fishing communities, and as a product of broader social and contextual factors, suggesting the potential need for structural HIV interventions in this setting

HIV testing at birth: Are we getting it right?

Background: Birth polymerase chain reaction (PCR) testing improves early detection of HIV and allows for early treatment initiation. National guidelines exist, but it is unknown whether these are being implemented correctly.Objectives: To determine whether HIV-exposed infants at the Mangaung University Community Partnership Programme Community Health Centre (MUCPP CHC) received PCR tests at birth, if HIV-positive infants were initiated on treatment, if follow-up dates were scheduled and the percentage of mothers or caregivers who returned to collect the results.Methods: The study was a retrospective descriptive file audit (1304 files) of births from 01 January to 31 December 2016 at MUCPP CHC. The study sample was 428 infants born to HIV-positive mothers. The birth register was used to collect the infants' HIV PCR test barcodes. The birth and 10-week PCR results were retrieved from an electronic database at the Virology Department, University of the Free State.Results: In total, 375 infants received a birth PCR test (87.6%) of which 4 (1.1%) tested HIV positive and 327 (87.2%) negative. Follow-up tests were not scheduled. However, 145 (44.3%) HIV-negative infants returned for a 10-week test. Irrespective of the PCR birth result, 157 (36.7%) infants were brought for a 10-week follow-up test at which time 3 (1.9%) tested positive and 151 (96.2%) negative.Conclusion: The majority of HIV-exposed infants received a PCR test at birth; however, the clinic is below the national target (90%) for HIV testing. A record-keeping system of infants' visits does not exist at MUCPP CHC, making it impossible to determine whether HIV-positive infants were started on antiretroviral treatment

Medical selection effectiveness inassessing the risk of HIV transmission in blood transfusion in Antananarivo Madagascar

Un défi auquel fait face un centre de transfusion en Afrique consiste à assurer une sécurité transfusionnelle optimale. Il est estimé que 25% des dons de sang collectés en Afrique sub-saharienne francophone sont infectés par des agents viraux (HIV, HBV, HCV), parasitaires (Plasmodium spp., microfilaires) et bactériennes. Méthode : Il s'agit d'une étude rétrospective descriptive effectuée au CRTS Analamanga. L'étude concerne tous les dons enregistrés au CRTS Analamanga durant l'année 2013 et l'année 2014. La prévalence du VIH chez les donneurs de sang durant ces deux périodes a été comparée à celle rapportée dans la population générale. Nous avons comparé la prévalence du VIH au niveau du CRTS en utilisant le test de l'écart-réduit avec les données du SE/CNLS 2013 pour l'année 2013 et les données du SE/CNLS 2014 pour l'année 2014. Résultats: Le nombre de total de dons pour l'année 2013 était de 14316. La prévalence du VIH était de 0,78% (112/14316) (ℇ = 5,46). Pour l'année 2014, le nombre total de dons était de 16551 donnant une prévalence du VIH de 0,28% (472/16551) (ℇ = 0,31) Conclusion : La sélection médicale est le seul moyen le plus efficace pour la réduction des IT par le sang en transfusion en Afrique et à Madagascar. La sélection médicale du donneur avec le questionnaire actuel est inefficace pour diminuer le risque de la transmission du VIH par la transfusion sanguine. Une élaboration d'un nouveau questionnaire est urgente. L'adoption des stratégies adaptées aux réalités locales est bénéfique pour le pays

Knowledge, attitudes and practices regarding the prevention of mother-to-child transmission of HIV among pregnant women in the Bosome Freho district in the Ashanti region of Ghana: a descriptive cross-sectional design

Introduction: the impact of HIV/AIDS on women and children has called for a higher increase in global commitment and response to the prevention of mother-to-child transmission (PMTCT). The study investigated the knowledge, attitudes and practices of pregnant women regarding PMTCT of HIV in Bosome Freho District in the Ashanti region of Ghana. Methods: a facility-based cross-sectional study was conducted in August of 2017, involving 339 pregnant women, selected through a multistage sampling technique. Data were collected through a structured pre-tested and validated questionnaire and analysed by using Stata SE version 12.0. Logistic regression analyses were used to test associations between background factors and the knowledge, attitudes and practices at 0.05 level of significance. Results: the level of knowledge was high (77.0%), attitudes were good (71.1%), and the practice of PMTCT was high (95.9%). However, the knowledge of participants on the importance of exclusive breastfeeding, the moments when HIV transmission occurs, and the merits of elective caesarean sections as an HIV preventive method were grossly insufficient. Knowledge was influenced by the level of education (AOR=19 (95% CI: 1.08-333.82); p=0.04); Attitudes were influenced by the level of knowledge regarding PMTCT (AOR=5.3 (95% CI: 2.76-10.35); p<0.001). Conclusion: interventions to improve the knowledge, attitudes and practices regarding PMTCT should focus more on women with less than Senior High School (SHS) level of education. Exclusive breastfeeding and elective caesarean sections, though effective in reducing transmission of HIV from the mother to the child, could be missed opportunities in reducing the burden of HIV in this community

Prevalence and route of transmission of undiagnosed human immunodeficiency virus infection among children using provider-initiated testing and counselling strategy in Ido-Ekiti, Nigeria: a cross-sectional study

Introduction: ninety-one percent of global Human Immunodeficiency Virus (HIV) infection in children occurs in sub-Saharan Africa. Provider Initiated Testing and Counselling (PITC) Strategy is a means of reducing missed opportunities for HIV exposed or infected children. The present study determined the prevalence of HIV infection using PITC Strategy among children seen at the Paediatric Emergency Unit of Federal Medical Centre (FMC), Ido-Ekiti, and the possible route of transmission. Methods: cross-sectional study on prevalence of HIV infection using PITC model. 530 new patients whose HIV serostatus were unknown and aged 15 years or below were recruited consecutively and offered HIV testing. Serial algorithm testing for HIV infection using Determine HIV-1/2 and Uni-Gold rapid test kits was adopted. Seropositive patients younger than eighteen months had HIV Deoxyribonucleic Acid Polymerase Chain Reaction (HIV DNA PCR) test for confirmation.Results: twenty-four (4.5%) of the 530 patients were confirmed to have HIV infection; of whom 19(79.2%) were less than 18 months of old; with age range of five to 156 months. Fifteen (62.5%) of the infected children were females; likewise, the gender specific infection rate was higher (%) among the females compared with (%) among the males. Two of the HIV infected children's mothers were late, while the remaining 22 mothers (%) were HIV seropositive. Mother-To-Child-Transmission was the most likely route of transmission in the children. Conclusion: PITC strategy is vital to the early diagnosis and effective control of HIV infection in children. However, this cannot be totally effective if PMTCT is not optimized

Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy

Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesn and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful

Incursions from the epicentre: Southern theory, social science, and the global HIV research domain

Research about HIV constitutes a global domain of academic knowledge. The patterns that structure this domain reflect inequalities in the production and dissemination of knowledge, as well as broader inequalities in geopolitics. Conventional metrics for assessing the value and impact of academic research reveal that "Northern" research remains dominant, while "Southern" research remains peripheral. Southern theory provides a framework for greater critical engagement with knowledge produced by researchers within the global South. With a focus on HIV social science, we show that investigators working in and from Africa have produced and disseminated knowledge fundamental to the global domain of HIV research, and argue that their epistemological contribution may be understood within the framework of Southern theory. Through repurposing a bibliometrical measure of citation count, we constitute a new archive of highly cited social science research. With a focus on South Africa, we situate this archive within changing historical contexts, connecting research findings to developments in medicine, health sciences and politics. We focus on two key themes in the evolution of HIV knowledge: (1) the significance of context and locality ­ the "setting" of HIV research; and (2) sex, race and risk ­ changing ideas about the social determinants of HIV transmission

The influence of marital status on HIV infection in an HIV hyperendemic area of rural South Africa, 2000­2017

Marital status is one of the factors whose impact on HIV infection has always been studied but contradictory findings have been reported. The drastic changes in marriage patterns in South Africa influences the role of marital status on HIV infection. This study aims to give evidence-based information on the association between marital status and HIV infection in a hyperendemic HIV area in rural South Africa. This study was conducted on longitudinal data collected from the African Health Research Institute (AHRI) based in northern rural KwaZulu-Natal from 2000 to 2017 using multivariable Cox regression. The multivariable Cox regression results found marital status to be a significant factor of HIV infection. Compared to those who were married, the risk of HIV infection was approximately two times in those who were never married while those who were widowed presented as much as twice the risk of HIV infection. In addition, less educated participants were at more risk of HIV infection than those with tertiary education. Furthermore, as expected, the risk of HIV infection increased with age (20­24 HR: 3.05 (2.32­4.02); 25­34 HR: 3.98 (3.12­5.07) and 35­49 HR: 4.36 (3.36­5.67). Women were more susceptible to HIV infection than men were. This study found marital status to be an influential factor of HIV infection together with other socio-economic and demographic factors. This finding will help guide policy makers on empowerment programmes and policies targeting HIV and other health related issues in rural South Africa

Informal transit, socio-spatial exclusion, and changing geographies of HIV/AIDS in urban Malawi

The role played by the transport sector in the regional spread of HIV in sub-Saharan Africa is well known, yet attention has remained confined to entertainment hotspots and stopping places along long-distance highways and cross-border transport corridors. This paper draws attention to informal modes of transit prevalent in sub-Saharan African cities, by linking the rise of two-wheeled, manually operated bicycles, known as "Sacramento", to the potential spread of HIV and AIDS in Malawi. The findings of a qualitative study from Mzuzu city show that Sacramento operators are prone to demanding or accepting sexual favours from female commuters as payment for a ride. We draw on complementary theories of the political ecology of health (PEH) and feminist political ecology to show how a popular belief that Sacramento is an inferior mode of urban transit underpins risky sexual behaviour among men hired to operate this informal mode transport. The findings further show that operators' responses to this perceived inferiority are themselves also driven by gender discourses that seek to validate their identities as powerful go-getters. These scripts also create an environment that fosters multiple sexual partners and venerates unprotected sex. Because Sacramento is both a source of livelihood and an HIV risk milieu, it epitomises the contraction inherent in HIV and AIDS vulnerability in sub-Saharan Africa

Near-real-time tracking of gaps in prevention of mother-to-child transmission of HIV in three districts of KwaZulu-Natal Province, South Africa

Background. Identifying and addressing gaps in the prevention of mother-to-child transmission of HIV (PMTCT) is required if South Africa (SA) is to achieve targets for eliminating MTCT (eMTCT). Potential PMTCT gaps that increase MTCT risk include late maternal HIV diagnosis, lack of or delayed antiretroviral therapy (ART) during pregnancy and breastfeeding, and lack of effective prophylaxis for HIV-exposed infants.Objectives. To investigate, in near real time, PMTCT gaps among HIV-infected infants in three districts of KwaZulu-Natal Province, SA.Methods. Between May and September 2016, PMTCT co-ordinators from eThekwini, uMgungundlovu and uMkhanyakude districts received daily email notification of all HIV polymerase chain reaction (PCR)-positive results. Co-ordinators reviewed facility records for each infant to identify gaps in PMTCT care, including maternal age, timing of maternal HIV diagnosis, maternal treatment history and maternal viral load (VL) monitoring. Data were submitted via the mobile phone SMS (text message) service using Rapid Pro technology and analysed in Stata 14.Results. Data on PMTCT gaps were received for 367 (91.8%) of 400 infants with HIV PCR-positive results, within a median time of 12.5 days (interquartile range (IQR) 6 - 23). The median maternal age was 25 years (IQR 22 - 30), with 48 teenage mothers (15 - 19 years). The sample size was too small to determine whether there were significant differences in PMTCT gaps between the 48 teenage mothers and 293 older (20 - 34 years) mothers. Of the mothers, 220 (60.0%) were first diagnosed prior to conception or at their first antenatal care (ANC) visit, and 127 (34.6%) at or after delivery; 137 (37.3%) transmitted HIV to their infants despite receiving >12 weeks of ART. VL results were unavailable for 70.0% of women. Only 41 (17.5%) of women known to be HIV-positive during ANC had confirmed virological suppression. No statistically significant differences in PMTCT gaps were observed between districts, owing to small sample sizes in uMgungundlovu and uMkhanyakude.Conclusions. The findings highlight the need to improve services during ANC, in particular prioritising maternal VL monitoring. We intend to use improved technology to streamline data collection and reporting towards eMTCT

Evaluation du devenir des enfants infectés par le VIH suivis au Togo

L'objectif de l'étude était de décrire les caractéristiques cliniques, immunologiques, thérapeutiques et évolutives des enfants sous traitement antirétroviral (TArv) au Togo. Il s'agit d'une étude transversale descriptive portant sur 870 dossiers du 1er janvier 2001 au 31 décembre 2010 dans 40 sites de prise en charge médicales au Togo. L'étude a porté sur les données sociodémographiques, cliniques, biologiques et évolutives. L'âge médian était de 5 ans avec un intervalle compris entre 7 semaines et 15 ans. Les stades cliniques 3 et 4 de l'OMS étaient retrouvés respectivement chez 47,60 % (870/414) et 12,30 % (870/107) en début de traitement. Les affections opportunistes observées au moment de l'initiation du traitement antirétroviral chez les enfants étaient essentiellement : les affections pulmonaires (436 cas), cutanées (260 cas), buccales (151 cas) et les diarrhées (140 cas). La moyenne du taux de CD4 était de 485,165 cel/µl avec un écart type de 548, 248. Le Taux de survie à 5 ans de l'enfant sous TArv au Togo a été de 93,81 %. L'état clinique reste un critère important pour le dépistage et la mise sous traitement antirétrovirale dans le contexte pédiatrique africain

Determinants of adherence to antiretroviral therapy among HIV-Positive women accessing prevention of mother to child transmission services in Ebonyi State, Nigeria

Background: Mother-to-child transmission (MTCT) of HIV accounts for over 90% of all pediatrics infection globally. Strict adherence to antiretroviral drugs is needed to achieve maximal reduction of HIV transmission in pregnancy. Objective: To determine the level of adherence among HIV infected pregnant women on Prevention of Mother to Child Transmission. (PMTCT) antiretroviral therapy and to establish the factors that contribute to poor adherence. Methods: A cross sectional study was conducted in which 268 HIV positive pregnant women were recruited by systematic sampling method from PMTCT clinic of Federal Teaching Hospital Abakaliki. Pre tested interviewer administered questionnaire was used for data collection. Information on socio-demographic characteristics, knowledge of PMTCT, barriers to PMTCT and obstetric characteristics were obtained. Knowledge on PMTCT was accessed and a score of <4 out of 5 indicated poor knowledge. Adherence Level was calculated using the respondent self-report using (3 day recall) and a value < 95% indicated poor adherence. Data were analyzed using descriptive statistics, Chi square and logistic regression (p ≤ 0.05). Results: The mean age was 30.7 ± 4.2 years. Two hundred and nineteen (81.7%) of the respondents were married, 124 (46.3%) were traders and 141 (52.6%) had secondary education. The prevalence of good adherence was 89.2% and 227 (89.0%) had good knowledge of PMTCT. Fear of being identified as HIV positive (21%) pregnancy related illness (13.7%) and forgetfulness (12.5%) were the most common reasons for non-adherence. Partner's support (OR=.03, 95% CI=0.01-0.09, p=0.001), and duration of ART (OR=4.39, 95% CI=1.3- 14.5, p=0.019) at bivariate analysis were found to be significantly associated with good adherence. Partners support (OR=0.027, 95%CI=0.01-0.09) retained the association with good adherence after controlling for cofounders. Conclusion: The study identified that stigmatization and pregnancy related illnesses were related to poor adherence while having Partners support improve adherence to HAART

Ecological correlates of multiple sexual partnerships among adolescents and young adults in urban Cape Town: a cumulative risk factor approach

Studies in South Africa have reported unsafe levels of risky sexual behaviors among adolescents and young adults, with the country reporting the highest burden of HIV/AIDS globally, as well as a high rate of teenage pregnancy. While determinants of risky sexual behaviours have been investigated for factors occurring at the individual and household levels, not fully explored in the literature is the effect of community level factors. Furthermore, it is unclear whether risk factors occurring within the ecology of adolescents and young adults act cumulatively to influence their sexual practices. This article aims to address this knowledge gap using a case study of the Cape Area Panel Study of adolescents and young adults in urban Cape Town, South Africa. The ecological framework was adopted to guide the selection of risk factors at the individual, household, and community levels. Multivariate linear discriminant function analyses were used to select significant risk factors for multiple sexual partnerships and used to produce risk indices for the respondents. The cumulative risk approach was applied to test whether significant risk factors acted cumulatively. Findings point to the importance of ecological factors in influencing outcomes of multiple sexual partnerships among respondents and further demonstrate that ecological risk factors may act cumulatively. These findings are important for South Africa that is grappling with teenage pregnancy and disproportionate HIV epidemic among the youth

Constrained relationship agency as the risk factor for intimate partner violence in different models of transactional sex

Women who engage in transactional sex are more likely to experience intimate partner violence (IPV) and are at higher risk of HIV. However, women engage in transactional sex for a variety of reasons and the precise mechanism linking transactional sex and IPV is not fully understood. We conducted a behavioural survey with a cross-sectional sample of 401 women attending 1 rural and 1 urban public antenatal clinic in Swaziland between February and June 2014. We used structural equation modelling to identify and measure constrained relationship agency (CRA) as a latent variable, and then tested the hypothesis that CRA plays a significant role in the pathway between IPV and transactional sex. After controlling for CRA, receiving more material goods from a sexual partner was not associated with higher levels of physical or sexual IPV and was protective against emotional IPV. CRA was the single largest predictor of IPV, and more education was associated with decreased levels of constrained relationship agency. Policies and interventions that target transactional sex as a driver of IPV and HIV may be more successful if they instead target the broader social landscape that constrains women's agency and drives the harmful aspects of transactional sex