Sex differentials in the uptake of antiretroviral treatment in Zambia.

This study explores socio-structural factors that influence uptake of antiretroviral treatment (ART) in Zambia and assess differences between men and women. We conducted a case-control study nested in a community- and health facility-based survey, between September 2010 and February 2011. Cases were defined as HIV-positive individuals who, while eligible, never started ART and controls were HIV-positive individuals who were on ART. Cases and controls were matched by place of residence. We performed a conditional logistic regression analysis using a discrete logistic model stratified by sex. Overall, a significantly larger proportion of men (32.7%) than women (25.6%) did not uptake ART (Pearson χ(2) = 5.9135; p = 0.015). In the crude analysis, poor health status and low self-efficacy were common factors associated with non-uptake in both sexes. After adjusting for covariates, men were more likely than women to refuse ART even though men's self-rated health was lower than women's. In general, the adjusted analysis suggests that HIV status disclosure affects uptake in both sexes but women's uptake of ART is largely hampered by poverty-related factors while for men, side effects and social pressure, probably associated with masculinity, are more important barriers. Alarmingly men's health seems to deteriorate until they start treatment, in contrast to women. Understanding gender differences in uptake and attitudes to ART is a crucial component to providing effective and appropriate health care to both men and women living with HIV/AIDS in Zambia.

University Students' Perspective of Sexual Harassment: a Case Study of the University of Zambia

Objectives: To determine if sexual harassment was a problem at the University of Zambia (UNZA); to explore UNZA student's perception on the nature of sexual harassment; and determine student's knowledge and understanding about sexual harassment. Design: A cross-sectional study across UNZA. Main outcomes: Occurrence of sexual harassment at UNZA; knowledge; perception and understanding of sexual harassment. Measure: A self-administered questionnaire was developed for the purpose of the study and piloted. The questionnaire included items on perceptions and understanding of sexual harassment; the nature of the environment at UNZA; frequency of the occurrence of sexual harassment; direct experiences and observations of sexual harassment; and formal and informal reporting of sexual harassment. Results: This study found that sexual harassment was a problem at the University of Zambia (UNZA) and female students were more likely to be affected. There was no gender difference on the knowledge about sexual harassment (p=0.27) but there was a significant gender difference in the perception of sexual harassment occurring at UNZA (?2 = 86.51; df= 1; p0.001); there were significantly more female students who perceived a lot of sexual harassment to be occurring at UNZA. More female students also perceived that students were likely to harass other students (p0.01) and students were likely to harass lecturers (p0.001). Conclusion: The problem of sexual harassment at UNZA should not be underestimated; among our recommendation is to formulate a policy on sexual harassment at UNZA

Sexual cleansing (Kusalazya) and levirate marriage (Kunjilila mung'anda) in the era of AIDS: changes in perceptions and practices in Zambia.

Since sexual cleansing (kusalazya) and the intertwined ritual of levirate marriage or widow and widower inheritance (kunjilila mung'anda) have come to be implicated in the transmission of HIV/AIDS, alternative rituals to sexual cleansing have emerged. Using both quantitative and qualitative data obtained from Zambia in the second half of 1998, this study reveals that the alternative rituals to sexual cleansing include sliding over a half-naked person (kucuta) or over an animal (kucuta ng'ombe or cow-jumping); use of herbs and roots (misamu); cleansing by a married couple. Concoctions or other rituals that were otherwise considered 'alien' in Southern Province, such as cutting of hair (kugela masusu) and application of some powder (kunanika busu), have also been adopted. The study, therefore, discusses various aspects of these alternative practices: who performs them and how; whether the processes are connected to polygyny (maali), levirate marriage (kunjilila mung'anda), and grabbing or inheriting property (kukona); and whether these practices are also risk factors in the spread of HIV/AIDS.

The socioeconomic implications of HIV / AIDS in sub-Saharan Africa.

PIP: This paper presents the socioeconomic implications of HIV/AIDS in sub-Saharan Africa. Statistics show that more than two-thirds of the global 34 million HIV/AIDS infected are living in sub-Saharan Africa. Moreover, the region has also experienced more AIDS related deaths than any other region in the world, with an adult prevalence rate of 8%. This situation generates several policy concerns since the socioeconomic development at household, community, national and global levels are affected. The increase in AIDS-related illness and deaths also puts an additional burden on constrained social services. HIV/AIDS is expected to affect various institutions in several ways: increased sick leave and absenteeism, high medical expenses, low productivity, higher worker turnover, loss of skilled labor force, increased training costs, and increased expenditure on health and death benefits. Coordinated HIV/AIDS programs by the government, nongovernmental and community-based organizations, and religious institutions could bring about positive socioeconomic developments. The regional bodies should facilitate the establishment of a well-equipped clinic to provide screening, treatment and counseling in border areas. To effectively implement these measures, health programs and personnel should be reoriented.^ieng