The Effects of Enhanced Access to Antiretroviral Therapy : a Qualitative Study of Community Perceptions in Kampala city; Uganda

Introduction: Since 2001; Antiretroviral Therapy (ART) has been integrated as part of the Uganda National Program for Comprehensive HIV/AIDS Care and Support. If patients take Antiretroviral drugs (ARVs) as prescribed; quality of life is expected to improve and patients become healthier. It is; however; postulated that scale up of ARVs could erode the previous achievement in behaviour change interventions. This study examined community perceptions and beliefs on whether enhanced access to ARVs increases risk beha-viour. It also examined people's fears regarding HIV/AIDS infection and the use of ARVs. Methods: This was a qualitative study that utilized Focus Group Discussions (FGDs) and Key Informant (KI) interviews. Participants were purposefully sampled. Twenty FGDs comprising of 190 participants and 12 KI interviews were conducted. FGDs were conducted with adult men and women (above 25 years); and youth (male and female) while KI interviews were held with Kampala City Council officials; Kawempe Division Local Council officials; health workers and religious leaders. All data was tape recorded with consent from participants and transcribed thereafter. Typed data was analyzed manually using qualitative latent content analysis technique. Results: Most participants felt that enhanced access to ART would increase risky sexual behaviour; namely promiscuity; lack of faithfulness among couples; multiple partners; prostitution; unprotected sexual practices; rape and lack of abstinence as the risky sexual behaviours. A few FGDs; however; indicated that increased ART access and counselling that HIV-positive people receive promoted positive health behaviour. Some of the participants expressed fears that the increased use of ARVs would promote HIV transmission because it would be difficult to differentiate between HIV-positive and HIV-negative persons since they all looked healthy. Furthermore; respondents expressed uncertainty about ARVs with regard to adherence; sustainable supply; and capacity to ensure quality of ARVs on the market Con- clusions: There are fears and misconceptions that enhanced access to ART will increase risky sexual behaviour and HIV transmission. Information Education and Communi-cation (IEC) on ART use and availability should be enhanced among all people. Prevention programs which are modified and specific to the needs of the people living with HIV should be developed and implemented; and should include information on the ability of individuals to transmit HIV even when they are on ART

Trends in Cancer Incidence in Kyadondo County; Uganda; 1960-1997

Incidence rates of different cancers have been calculated for the population of Kyadondo county (Kampala; Uganda) for four time periods (1960-1966; 1967-1971; 1991-1994; 1995-1997); spanning 38 years in total. The period coincides with marked social and lifestyle changes and with the emergence of the AIDS epidemic. Most cancers have increased in incidence over time; the only exceptions being cancers of the bladder and penis. Apart from these; the most common cancers in the early years were cervix; oesophagus and liver; all three have remained common; with the first two showing quite marked increases in incidence; as have cancers of the breast and prostate. These changes have been overshadowed by the dramatic effects of the AIDS epidemic; with Kaposi's sarcoma emerging as the most common cancer in both sexes in the 1990s; and a large increase in incidence of squamous cell cancers of the conjunctiva. In the most recent period; there also seems to have been an increase in the incidence of non-Hodgkin lymphomas. So far; lung cancer remains rare. Cancer control challenge. With little improvement in the incidence of cancers associated with infection and poverty (liver; cervix; oesophagus); it must face the burden of AIDS-associated cancers; while coping with the emergence of cancers associated with Weternization of lifestyles (large bowel; breast and prostate)

Knowledge of HIV by Health Professionals in Kampala; Uganda

Deficiencies in HIV knowledge among health care professionals is of concern because they play an instrumental role in counseling patients to reduce risk behaviors. We report here on the results of a pretest questionnaire which we administered to assess baseline levels of HIV knowledge among a group of health care providers in Kampala; Uganda; our educational intervention; and the results of the post-test questionnaire which we administered to detect changes in the level of HIV knowledge following intervention. Pre-test results indicated that the greater deficiencies in knowledge related to transmission and prevention and clinical manifes nottations of disease. Scores on the post-test; administered following a 15-hour course; indicated a significant improvement in knowledge of clinical manifestations and overall knowledge. Our findings underscore the need for ongoing HIV educational programs for health care workers

Psycho-social determinants for sexual partner referral in Uganda : quantitative Results

The purpose of this study was to investigate the factors influencing sexual partner referral using the attitude-social influence - self efficacy model as a guiding theoretical. The data was collected in an interview survey with 236 women and 190 men attending a sexually transmitted disease clinic in Kampala; Uganda. Intention; attitude; subjective norm; self-efficacy; and past behaviour predicted partner referral for women whereas intention; self efficacy; and previous behaviour predicted partner referral for men. For the women the strongest predictors for intention were self-efficacy followed by partner type and self efficacy. Social influence was a better predictor of intention for women than for men. An analysis of underlying cognitive beliefs discriminating those who referred and those who did not refer the sexual partner showed that attitudinal beliefs were the most important for men whereas self-efficacy beliefs were the most important for women. The targeting of the gender based descriminatory beleifs in intervention may improve compliance with sexual partner referral