Stigma of People with HIV/AIDS in Sub-Saharan Africa: A Literature Review

The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed; Medscape; and Psycinfo up to March 31; 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS; identification of people living with HIV/AIDS (PLWHA); linking HIV/AIDS to immorality and other negative characteristics; and finally behavioural consequences of stigma (distancing; isolation; ination in care). It was found that the cultural construction of HIV/AIDS; based on beliefs about contamination; sexuality; and religion; plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended

Process Evaluation of School-based Peer Education for HIV Prevention Among Yemeni Adolescents

In 2005; a survey was conducted among all the 27 high schools of Aden; which revealed low levels of knowledge on major prevention measures; and a high level of stigma and discrimination towards people living with HIV (PLWH). The results served as a baseline for implementing a school-based peer education intervention for HIV prevention in the 27 schools of Aden. In 2008; and after 3 years of implementation; a quasi-experimental evaluation was conducted; which revealed that the peer education intervention has succeeded in improving HIV knowledge and skills; and in decreasing stigmatization of PLWH. This process evaluation aims to give a deeper understanding of the quasi-experimental evaluation which was conducted in the 27 high schools of Aden; and to highlight the factors that facilitated or inhibited school peer education in such a conservative Muslim setting. Qualitative methodologies were pursued; where 12 focus group discussions and 12 in-depth interviews were conducted with peer educators; targeted students; school principals; social workers; and parents of peer educators. Results revealed that school-peer education was well received. There was an apparent positive effect on the life skills of peer educators; but the intervention had a lesser effect on targeted students. Key enabling factors have been the high quality of training for peer educators; supportive school principals; and acceptance of the intervention by parents. These findings are important for improving the life skills and peer education intervention at the school level; and in better planning and implementation of life skills and peer programmes at a national scale

SISTA South Africa: The Adaptation of an Efficacious HIV Prevention Trial Conducted with African-American Women for isiXhosa-speaking South African Women

Although new HIV treatments continue to offer hope for individuals living with HIV; behavioural interventions shown to reduce HIV risk behaviour remain one of the most powerful tools in curbing the HIV epidemic. Unfortu- nately; the development of evidencebased HIV interventions is a resource-intensive process that has not progressed as quickly as the epidemiology of the disease. As the epidemic continues to evolve; there is a need to expedite the development of evidence-based HIV interventions for populations that are often disproportionately impacted by HIV/AIDS. One mechanism of accelerating the development process is to adapt evidence-based HIV interventions for vulnerable populations. The aim of this paper was to describe the adaptation process of a HIV intervention for African-American women for black South African Xhosa women. For African-American women the intervention was effective in increasing consistent condom use; sexual self-control; sexual communication; sexual assertiveness and partner adoption of norms supporting consistent condom use

Determinants of communication between partners about STD symptoms: implications for partner referral in South Africa

"Background: STDs as preventable diseases are a major public health problem in South Africa; both in terms of their effect on quality of life; their economic costs and the fact that STDs as co-factors drive the HIV epidemic. Their widespread occurrence and high prevalence rates are cause for concern. It is argued that the duration of infection increases the probability of harmful sequelae and STD transmission; including HIV; to others. The promotion of seeking health care for STD symptoms at an early stage and partner referral for STD treatment are important strategies in preventing STD transmission to others and re-infection of partners. The cost implications of contact tracing by healthcare workers has resulted in patients being encouraged to refer their partners for STD treatment. This has not always been effective; despite efforts to improve partner referral rates by improved ""contact cards"" (i.e. a card with a code representing the STD that the patient has been treated for to be given to sexual partners as a way to speed up treatment) and more accessible healthcare services. Other studies have found that the proportion of clients who present with contact cards at STD services ranged from about 2 to 39 ; while the proportion of partners who were referred for treatment range from 16 to 30 . Mathews et al. argue that returning contact cards might not be a sensitive enough proxy indicator for partner referral rates.Partner referrals have been found to be seriously compromised by patients' causal explanations for STDs; as well as by the unequal power of the genders in sexual relationships; which impacts on the patients' ability to communicate about sexual matters. Patients often lack an understanding of the importance of referring their asymptomatic partners for treatment. Women's inability to discuss sexual issues due to their unequal status in sexual relationships might impact on partner referral behaviour. Men have been found to blame the STD on the ""outside women"" (sexual partners outside the primary relationship) and are therefore less likely to refer these partners. The conflict that could arise from informing a partner about an STD was viewed by men as a reason not to communicate about having a STD.While the ability to communicate about STDs with sexual partners is an essential prerequisite for referring them for medical treatment; little attention has been paid to understanding this process. This study is aimed at gaining some understanding of the determinants of communication between partners about STD symptoms. In this study; ""talking with a partner about STD symptoms"" before seeking medical treatment was viewed as an indication of the likelihood of future partner referral behaviour. Methods A randomly selected sample of 1 477 patients with STD symptoms was interviewed using a structured questionnaire. Logistic regression analysis was used to identify the determinants of talking to a partner about the present STD.ResultsIt was found that patients who had talked with their partner about their current STD symptoms were more likely to be female; be employed; have a tertiary level of education; have had only one sexual partner in the preceding six months; have used condoms; albeit inconsistently during the last six months; and to have thought about abstaining from sex while infected. Those who talked were also more likely to have good knowledge about the effects of STDs and the transmission of STDs in the absence of symptoms; had positive attitudes towards condoms and perceived social support for partner referral. Conclusion: Improved partner referral through health education interventions needs to focus specifically on a subgroup of patients; e.g. men and the unemployed; and on the improvement of knowledge regarding the consequences of STDs and asymptomatic transmission. Social and partner support for partner referral and perceived self-efficacy in this regard should be encouraged and maintained. In the absence of skills and counselling services to manage the consequences of STD partner referral; this prevention strategy will remain vulnerable."