Sexuality and health: a study of Tanzanian men's experiences of living with HIV/AIDS

The aim of this study was to explore Tanzanian men's experiences regarding their health and sex life after they had been diagnosed with HIV. In-depth interviews were performed with a purposive sample of ten men living in an urban area in Tanzania and who had been HIV positive for more than one year. A phenomenological-hermeneutic approach was used for analyzing the transcribed interviews. Three themes emerged from the texts; "awareness of HIV infection", "perceived and ideal health", and "sex life a source of happiness and caring". Living with HIV meant profound adjustments to daily life activities for the participants. HIV forced them to learn new ways of having sexual intercourse and new ways of acting as a man. The meaning of being a "real man" had changed from being a man with great sexual prowess to being a "caring man" within one relationship. (Afr Reprod Health 2008; 12[1]:35-46)

Expenditure and payment sources for treating acute respiratory infections in rural Vietnam.

This paper highlights important effects of the health sector reform in rural Vietnam, such as the expenditure for treatment, payment sources among patients and provision of private services. Using a cross-sectional design with a structured questionnaire, the occurrence of illnesses and utilization of health care for 4,769 members in randomly selected households were investigated, with a focus on acute respiratory infections (ARI). Three hundred and seventy people were reported to have suffered from an ARI in the four weeks prior to interview. In 96% of the cases some action had been taken, most often self-medication. The average expenditure for the first treatment was high, 25,000 Dong (US$ 1.7), which is appropriately equal to one third of the monthly per capita in the district. The majority of the expenditure was for drug purchasing in the private or public services. Expenditure for treatment of acute respiratory infections was highest in the hospitals, lower in commune health stations and private clinics, and lowest in the case of self-medication. There was no consultation fee at the commune health stations and private clinics. About half of the patients had borrowed money or sold agricultural products to pay for treatment. Only 2% of the patients benefited from health insurance. High burden of ARI, high cost of treatment and poor coverage of health insurance may create severe economic problems in poor families. Our findings indicate a need to develop pre-payment schemes and the appropriate allocation of resources in order to establish an efficient and equitable health care system.

Utilization of reproductive health services in a mountainous area in Vietnam.

This study uses data from two surveys performed in 1991 and 1994 in a mountainous district of northern Vietnam. The aim was to describe the utilization of family planning, antenatal care, delivery and immunization services during a period of rapid structural change in the health services in general and implementation of a primary health care project in the study area. This project was aimed at increasing access to health services and improving the quality of primary health care services. Factors influencing the utilization of reproductive health services were analyzed. The contraceptive prevalence among women aged 15-49 increased significantly from 48% in 1991 to 60% in 1994. The most commonly used contraceptive method was intra-uterine devices. The BCG coverage among children under five years of age increased from 36 to 70%. The proportion of pregnant women receiving three antenatal check-ups, as recommended by the health authorities was low and increased slightly from 15% in 1991 to 20% in 1994. About one third of the pregnant women were delivered in health care institutions during this period. The utilization of family planning, antenatal care and delivery services varied with ethnicity and was positively related to the mother's educational level both in 1991 and 1994. There is a need to strengthen the reproductive health services, especially antenatal care and delivery services, in terms of improving the quality of care and accessibility to women. Efforts should be made to reach women with a low education level as well as those belonging to ethnic minorities.

Predictors of condom use among patients with sexually transmitted disease in Uganda

Background and objective: Patients with sexually transmitted diseases (STDs) are at an increased risk of HIV infection and they must be targeted for increased condom use. goal : to identify predictors of condom use among patients with STDs. Study Design : in a cross-sectional survey; an interview-ad-ministered questionnaire was administered to 138 patients at the STD clinic; Mulago; and the outpatients department; Mbarara Hospital; in Uganda. Data were collected on socio-demographic situations; STD symptoms; type of sexual partners; and use of condoms. Multivariate logistic regression models were used to identify independent predictors of condomuse. Results: of the 138 patients; 87(66) knew how to use condoms; 81(59) every used a condom; 34(25) used a condom at least once in the previous 3 months; 20(15) used a condom at least once in the previous 3 months; 20(15) used a condom during the last sexual intercourse; and 80 (58) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28; 49) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28; 49);partner does not approve (17;30); reduced sexual pleasure (5;9); and no answer (7;12). The independent predictors of condom use were: being a man; not having a regular partner; having had sex with a casual partner; being able to read eng; having at least secondary education; and using electricity for lighting. Conclusion: Providing health promotion measures in local languages may improve condom use in this population. There is a need for complementary HIV prevention strategies for women and for regular sexual partnerships