Stigma interdependence among pregnant HIV-infected couples in a cluster randomized controlled trial from rural South Africa.

BACKGROUND: Stigma can exacerbate negative health outcomes in people living with HIV (PLWH). This longitudinal, cluster randomized controlled trial in rural Mpumalanga, South Africa, examined the interdependence of HIV-related stigma among pregnant couples living with HIV, and the potential impact of a lay health worker delivered intervention, Protect Your Family, on changes in stigma over time across couples, controlling for physical intimate partner violence (IPV), verbal IPV, gender, HIV knowledge, and months since HIV diagnosis. Using a form of the Actor-Partner Interdependence model, changes in stigma over time were also examined within each dyad of seroconcordant participants with HIV. METHOD: Antenatal clinics were randomized to experimental or control conditions, and participants completed baseline antenatal and 12-month postpartum assessments. Both women and male partners participated in intervention sessions in gender concordant groups and couple or individual sessions. RESULTS: Multilevel models (N = 1475) revealed stigma was related to condition and verbal intimate partner violence, but not time. Using an Actor-Partner Interdependence cross-lagged path model to examine within dyad changes in stigma for seroconcordant couples (n = 201), intervention condition participants' stigma levels were not interdependent over time. Women's 12-month stigma was related to their partners' stigma at baseline in the control condition, but not in the intervention condition. DISCUSSION: Compared to women in the control condition, postpartum stigma among women in the intervention condition was not related to their male partners' stigma, suggesting that women's perception of stigma became uncoupled from that of their partners. The intervention may have promoted female empowerment to shape their own beliefs and attitudes towards what it means to be infected with HIV, and express their own agency in responding to how others treat them and they treat themselves.

A community-based study to examine the effect of a youth HIV prevention programme in South Africa.

The aim of this study was to examine the relationships among changes in self-reported HIV and sexually transmitted infection (STI) and exposure to the loveLife youth HIV prevention programmes. A cross-sectional population-based household survey was conducted using a multistage stratified cluster sampling approach. The total sample included 3123 participants, aged 18-24, 54.6% men and 45.4% women, from four provinces (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Results indicate a self-reported STI past-year prevalence of 2.6%, experienced genital sores or ulcers in the past year prevalence of 3.9% and an HIV self-reported prevalence of 7.4%. In multivariable analyses it was found that knowing a person living with HIV and a person who has died from AIDS, lower education, having had two or more sexual partners in the past year, not having talked with a partner about condom use, difficulty of getting condoms and not having been male circumcised were associated with having been diagnosed with an STI in the past 12 months and/or HIV. Face-to-face and multimedia youth HIV prevention programmes had limited effect.

The Social and Clinical Characteristics of Patients on Antiretroviral Therapy who are 'Lost to Follow-up' in KwaZulu-Natal; South Africa: a Prospective Study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms; quality of life; depression; herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naive patients recruited from three (one urban; one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months' follow-up. At 12-months follow-up 557 (75.9) individuals continued active ART; 177 (24.1) were all cause attrition; there were 82 deaths (13.8); 58 (7.9) transfers; 7 (1.0) refused participation; 8 (1.1) were not yet on ART and 22 (3.0) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio; RR=2.05; confidence intervals; CI=1.20 - 3.49) and higher depression levels (RR=1.05; CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme; such as delays in health care access (delayed health care seeking); health system delays; or inappropriate treatment criteria; need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome

Drug prescription habits in public and private health facilities in 2 provinces in South Africa.

The aim of this study was to explore drug prescription habits using WHO standard indicators in public hospitals and 36 private surgeries in 2 provinces in South Africa. A high mean number of drugs were prescribed per patient (3.2 versus 2.8) in public hospitals and by general practitioners (GPs) respectively andc generic prescribing rates were low (45.2% versus 24.5%). The rates of prescribing in public hospitals and by GPsa were 8.3% versus 23.3% for injections, 68.1% versus 31.9% for antibiotics and 92.6% versus 68.5% for drugs from the essential drugs list. Drug prescribing in both sectors needs to be regulated, especially the use of antibiotics, essential drugs and generic prescribing.

Drug prescription habits in public and private health facilities in 2 provinces in South Africa

The aim of this study was to explore drug prescription habits using WHO standard indicators in 15 public hospitals and 36 private surgeries in 2 provinces in South Africa. A high mean number of drugs were prescribed per patient [3.2 versus 2.8] in public hospitals and by general practitioners [GPs] respectively and generic prescribing rates were low [45.2% versus 24.5%]. The rates of prescribing in public hospitals and by GPs were 8.3% versus 23.3% for injections, 68.1% versus 31.9% for antibiotics and 92.6% versus 68.5% for drugs from the essential drugs list. Drug prescribing in both sectors needs to be regulated, especially the use of antibiotics, essential drugs and generic prescribing