Ajar-African Journal of Aids Research最新文献

Background: People living with HIV/AIDS (PLWHA) may experience HIV-related stigma, which could negatively impact health-related quality of life (HRQoL) and increase symptoms of depression. Self-compassion is a positive personality attribute that may protect PLWHA against stigmatisation. Previous studies have not examined the influence of self-compassion on the association between HIV-related stigma, HRQoL, and depression.Aim: The present study aimed to examine whether self-companion can moderate the relationship between (i) HIV-related stigma and HRQoL, and (ii) HIV-related stigma and depression among PLWHA.Methodology: Participants included 371 PLWHA (mean age = 31.44 years; SD = 9.75 years) recruited from a healthcare institution in Nigeria. Participants completed relevant self-report measures.Results: Regression analysis results showed that self-compassion positively and significantly moderated the relationship between HIV-related stigma and all the HRQoL domains (physical health symptoms, β = 0.01, p < 0. 05; relationship to others, β = 0.02, p < 0. 05; cognitive symptoms, β = 0.02, p < 0. 05; and treatment impacts, β = 0.02, p < 0. 05). Also, the positive relationship between HIV-related stigma and depression was significantly moderated by self-compassion (β = - 0.02, p < 0. 05).Conclusion: We concluded that clinical efforts geared towards improving the well-being of PLWHA should consider integrating self-compassion-based therapy since it has the potential to decrease the detrimental effects of stigma on the patients' health and recovery.

The HIV and AIDS epidemic remains a critical global health challenge. Malawi accounts for 2.5% of global HIV cases and is a focus country in the UNAIDS 95-95-95 fast-track initiative. Despite reaching 92-95-94 in 2020, there is a need to evaluate Malawi's progress as of 2023 to identify gaps and ensure success before the target period ends. This quantitative descriptive study used secondary data from Malawi's Department of HIV and AIDS Management Information System (DHAMIS) database over a 12-year period (2012-2023) and HIV spectrum estimates. It contains aggregate data from HIV service delivery points. Data included key HIV indicators disaggregated by age and gender. Numerators for the 95-95-95 are: people living with HIV (PLHIV) who know their status, PLHIV on treatment, PLHIV on treatment and virally suppressed. Denominators are: the estimated total PLHIV, PLHIV who know their status and PLHIV on treatment. Statistical analysis was performed using Excel, SPSS and Stata to assess differences between groups. Ethical approval and data access permissions were granted by the Ministry of Health. Between 2012 and 2023, the total number of PLHIV increased from 962 043 to 991 600. The percentage of PLHIV aware of their HIV status increased from 73% to 95%, and those on treatment increased from 58% to 95%. By 2023, 87% of children (under 15 years old) knew their HIV status, compared to 96% of adults. Lower percentages of ART initiation and viral load suppression were also noted among children. While both males and females improved across all indicators, men consistently lagged women in all three indicators. The viral suppression gap narrowed after 2019. Malawi has improved in the HIV treatment cascade between 2012 and 2023. Challenges remain in children ART initiation and access to care for men, requiring targeted efforts to achieve equitable treatment for all and meet the UNAIDS 95-95-95 targets.

Adolescents and young people in sub-Saharan Africa account for about a third of persons newly diagnosed with HIV. Health communication, through mobile health (mHealth) can improve access to sexual and reproductive health information, health services and reduce risky sexual behaviours among adolescents and young people. We assessed the impact of a health promotion messaging intervention on the reduction of risky sexual behaviours among HIV-negative high risk adolescent girls and young women (AGYW). Newly diagnosed and sexually active AGYW of 15-24 years old were enrolled between May 2017 and April 2018 in the HIV positive and negative cohorts of the study. We utilised SMS (short message service) and unstructured supplementary service data (USSD) technology to deliver health promotion messages quarterly to the HIV-positive cohort and six-monthly to the HIV-negative cohort over 12 months. Both cohorts completed a SMS survey at the end of their scheduled study follow-up period. We enrolled 184 AGYW in the HIV-negative cohort with a mean age of 20.8 years, 28.6% began sexual activity before 15 years old, and 8.5% tested HIV-positive. Over 12 months, reported multiple sexual partnership reduced from 33% to 12% (p < 0.001) among AGYW who had multiple partners. HIV re-testing increased from 74.2% to 81.6% (p = 0.099). Those who knew their partner's HIV status increased from 70.9% to 85.7% (p <0.001). Our findings demonstrate that mobile phone text messaging is an effective and feasible method for sexual health promotion among young people. Specifically, SMS, which is simple, cost-effective and widely accepted, could be adopted by health intervention programmes as a strategy to effectively promote safer sex behaviours and retesting among high-risk HIV-negative AGYW.

Financial insecurity pushes female sex workers into risky sexual transactions. We piloted an economic empowerment intervention among female sex workers in Kenya to test if they could save part of their income from which to make withdrawals to avoid risky sexual encounters. We enrolled female sex workers and randomised half to the intervention arm, who were given instructions on how to save and withdraw money through a mobile platform, and half to the control arm (usual saving). Chi-square test was used to establish the association between condom use, saving and making withdrawals. We enrolled 207 female sex workers (101 in the intervention arm) aged between 18 and 24 years. Of these sex workers, 157 (75.8%) had children and 83 (40.1%) were the primary breadwinners. Of those in the intervention arm, 41 (40.6%, n=101) saved and 19 (46.3%, n=41) withdrew their savings. Withdrawing savings was significantly associated with higher condom use (X²=7.52; p≤0.006). Female sex workers are able to save from their income, and withdraw the savings to avoid unprotected sex.

Background: The role of religion and faith in the context of HIV stigma is complex. It is important to recognise the diversity of religious beliefs and practices and to work with faith communities to promote a compassionate, non-stigmatising response to HIV. This aimed to explore HIV stigma within faith communities.Methods: The study used a quantitative approach with a cross-sectional design, recruiting 141 participants from faith communities in South Africa, mainly from the Western Cape province. Communities that were gathering together with a specific faith, religion, or spirituality were deemed "faith communities". Participants were recruited through the Desmond and Leah Tutu Legacy Foundation network and snowballing. HIV stigma awareness was measured using the People Living with HIV Stigma Index. Data were analysed using independent t-tests, One-Way Analysis of Variance (ANOVA), and Simple correlation analysis.Results: Faith leaders who were involved in HIV ministry gave participants a better understanding of HIV stigma in their communities compared with faith leaders who were not involved in HIV ministry. Younger participants (age < 30 years) thought fewer people believed HIV stigma misinformation compared to the oldest participant group (age >51 years). Participants who witnessed HIV stigma in a community were more involved in healthcare activities (r = 0.262) but were also more likely to believe HIV is the result of immoral behaviour (r = 0.323). Communities that believed HIV was the result of immoral behaviour were more likely to believe misinformation about HIV (r = 0.244). Lastly, when the community believed facts about HIV and medicine, they were less likely to believe that HIV was the result of immoral behaviour (r = -0.246).Conclusion: Faith communities have a role in diminishing HIV stigma. Active involvement of faith communities in HIV services and programs is more effective than solely educating faith communities about HIV. Given faith communities' notable role in shaping morality and stigma within their communities, activities showing the inclusion of people with HIV are vital.

Background: Retention in care of people living with HIV (PLHIV) is a crucial public health issue in Mali. Several barriers to retention have been highlighted, including socioeconomic status, gender, sexual orientation, HIV-related stigma, as well as organisational and structural barriers, such as public insecurity and sub-optimal public services. We explored the role of community health workers (CHWs) in PLHIV retention in care in Mali.

Methods: As part of the Cascades Communautaires project, eight focus groups (FG) and 20 individual interviews were conducted in 2021 among PLHIV at ARCAD Santé PLUS, a Malian community-based organisation (CBO). Participants included PLHIV who self-identified with key populations (KP) (men who have sex with men, female sex workers, people who inject drugs, and transgender women).

Results: Among the 60 PLHIV interviewed, 50% self-identified with KP. The median age and interquartile range were 35 years [28.5; 43.0] and 25% had a tertiary education. Four main themes emerged concerning CHWs' role in fostering retention in care: (i) Good patient-physician relationships in ARCAD Santé PLUS's structures; (ii) Social support between peers in the CBO; (iii) Peer educators (a sub-category of CHWs) as facilitators of continuous antiretroviral treatment distribution, and care and (iv) Free healthcare access in the CBO and financial support for transportation.

Conclusion: Peer educators play an essential role in PLHIV (general public and KP) retention in care in Mali in terms of psychosocial and logistical support. The non-judgmental approach of physicians working in CBO is also a major factor in retention.

Background: HIV-related stigma remains a significant barrier to well-being and access to healthcare for adolescents and young adults living with HIV in Sub-Saharan Africa. Stigma reduction interventions have been developed to address this challenge, but the effectiveness of these interventions in this population is not well-documented.Objectives: This narrative review synthesises the available evidence on the effectiveness of stigma reduction interventions for adolescents and young adults (aged 10-24 years) living with HIV in Sub-Saharan African countries.Methods: A comprehensive literature search was conducted using multiple electronic databases to identify relevant studies evaluating stigma reduction interventions targeting internalised stigma, perceived stigma, HIV disclosure, mental health, antiretroviral therapy (ART) adherence, and viral suppression among the population of interest.Results: Studies were conducted in Uganda, Zimbabwe, Kenya, Malawi, South Africa, Ethiopia, Zambia, and Nigeria. Various types of stigma reduction interventions were identified, including education and awareness campaigns, peer support and mentoring, counselling and psychosocial support, and community-based approaches. The evidence demonstrates the effectiveness of these interventions in reducing internalised, perceived and enacted stigma, improving HIV disclosure, enhancing mental health and well-being, increasing ART adherence, and potentially contributing to viral suppression. Factors influencing intervention effectiveness, such as intervention design, participant characteristics, and the sociocultural context, are discussed.Conclusion: Stigma reduction interventions have shown promise in improving a range of outcomes for adolescents and young adults living with HIV in Sub-Saharan Africa. However, more research is needed to identify the most effective intervention strategies and to explore the long-term impact on health outcomes.

Introduction: Globally, mother-to-child transmission (MTCT) of HIV significantly contributes to paediatric HIV infections. Effective prevention of mother-to-child transmission (PMTCT) programs aim to achieve the World Health Organization's target of less than 5% transmission rates. This study evaluated the implementation of PMTCT services in Mwanza district, Malawi, focusing on antiretroviral therapy (ART) adherence and key implementation challenges.Methodology: This was a retrospective study which analysed data from HIV-positive pregnant women and exposed infants enrolled in the PMTCT program (June 2020-June 2022). Logistic regression and bivariate analyses assessed factors influencing MTCT rates. Further, qualitative data from structured interviews with health workers identified implementation barriers.Results: The MTCT rate in Mwanza was 1.7%, below Malawi's national average of 6%. ART defaulting significantly raised MTCT risk (5.56%) versus consistent adherence (0.6%; χ² = 9.6521, p = 0.002). Logistic regression indicated mothers defaulting ART had nine-fold greater odds of MTCT (OR = 9.134, 95% CI: 1.72-48.43). Key challenges included loss to follow-up, shortage of resources, insufficient healthcare worker training, and other socioeconomic factors affecting adherence.Conclusion: Improving ART adherence and addressing socioeconomic and systemic barriers are crucial to reducing MTCT. Enhanced training, adequate resource allocation, and most importantly, targeted adherence interventions are recommended to strengthen PMTCT program effectiveness in Malawi.

Introduction: Understanding how HIV epidemics are likely to behave in the future is key to informing HIV response strategies in low-income countries. Up-to-date HIV epidemiological estimates are important for policy decision- making, but surveillance data can be out of date. This study compared forecasts from HIV epidemiological models.Methods: Five independent modelling groups (EMOD-HIV, Goals, HIV Synthesis, Optima and PopART-IBM) calibrated their mathematical models to datapoints provided by the Ministry of Health and produced several indicators of the HIV epidemic in Zimbabwe for the period 1990 to 2040, under a status quo scenario in which it was assumed continuation of interventions at the current level.Results: All models predicted a continuous decline in HIV incidence and prevalence. However, there was variability in the estimated 2023 incidence rate (range: 2.0-3.3 per 1 000 person-years) and prevalence (range: 12.1%-14.3%). Variance was even larger in 2040 for incidence (range: 1.0-3.0 per 1 000 person-years), while this was not the case for prevalence (range: 3.9%-6.0%). All the models predicted that the country would reach a target of less than 7 800 new HIV infections per year by 2025.Conclusion: Five independent mathematical models fitted to the Zimbabwe Ministry of Health and Child Care's HIV surveillance data provided consistent predictions of continued decline in HIV incidence and prevalence in Zimbabwe if interventions continue to be implemented at the current levels, with prevalence predicted to be around a third of its level in 2000 by 2040.

This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff (n = 72) and economic strengthening beneficiaries (n = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain.