Ajar-African Journal of Aids Research最新文献

Aim: Women and girls living with and at high risk of HIV (WGL&RHIV) had an increased risk for gender-based violence (GBV) during COVID-19. The study aimed to assess the associations between vaccine hesitancy and GBV, HIV status and psychological distress among these vulnerable women and girls in Nigeria.Methods: This cross-sectional study collected data from WGL&RHIV in 10 states in Nigeria between June and October 2021. The dependent variable was vaccine hesitancy. The independent variables were the experience of physical, sexual, economic and emotional GBV, HIV status and psychological distress during the COVID-19 pandemic. We conducted a multivariable logistics regression analysis to test the associations between vaccine hesitancy and the independent variables and covariates.Results: Among the 3 431 participants, 1 015 (22.8%) were not willing to be vaccinated against COVID-19. Not knowing or willing to disclose HIV status (aOR 1.40) and having mild (aOR 1.36) and moderate (aOR 1.38) symptoms of anxiety and depression were significantly associated with higher odds of vaccine hesitancy. Being a survivor of intimate partner physical violence (aOR 5.76), non-intimate partner sexual violence (aOR 3.41), as well as emotional abuse (aOR 1.55) were significantly associated with respectively more than five, three and one and half times higher odds of vaccine hesitancy. One positive outcome is that HIV-positive women and girls appeared to be more likely to get the COVID-19 vaccine when available.Conclusions: Sexual and gender-based violence, low socio-economic status, psychological distress and an unknown HIV status are essential determinants of COVID-19 vaccine hesitancy among vulnerable women and girls in Nigeria. National authorities and civil society organisations need to better integrate COVID-19 mitigation activities with HIV and gender-based violence interventions through a more feminist approach that promotes gender equality and the empowerment of women and girls in all their diversity for better access to health services.

This study determined the measurement properties of the HIV Disability Questionnaire (HDQ) on a sample of people living with HIV (PLWHIV) to validate this assessment in a resource-limited environment. A quantitative, descriptive, cross-sectional research design was used with PLWHIV on antiretroviral therapy (ART) for six months or more. Participants completed the HDQ, World Health Organisation Disability Assessment Scale (WHODAS 2.0) and the Medical Outcomes Study - Social Support Survey (MOS-SSS). Disability presence, severity and episodic scores on the HDQ were tested against the WHODAS 2.0 and MOS-SSS to determine convergent and divergent construct validity and internal consistency. Results for the HDQ were compared to four other populations from high-income countries. Of the sample of 498 participants, 68% were female, the median age was 41 years and 19% had a median of one concurrent health condition. Median HDQ scores were 24.63 for disability presence, 10.14 for disability severity and 15.94 for the episodic scale. Moderate correlations confirmed 92.8% of convergent a priori hypotheses, while 85.7% of divergent a priori hypotheses were accepted. Cronbach's alpha for the HDQ scales ranged from 0.89 to 0.84. Results from the HDQ differed from those determined in Canada, Ireland, the United States and the United Kingdom, with presence and severity scores for the South African sample being lower. Episodic scores were higher, which may be related to the socio-economic context. The HDQ is reliable and valid for disability determination and may be used as a rehabilitation outcome measure for PLWHIV in South Africa.

Aim: Women and girls living with or at high risk of acquiring HIV (WGL&RHIV) in Africa are economically vulnerable. This study aims to advance understanding of the economic impact of COVID-19 on WGL&RHIV and to identify the factors associated with this insecurity.Methods: Data were collected from a cross-sectional survey conducted among a convenience sample of WGL&RHIV in Nigeria between May and September 2021. Logistic regressions enabled the study of the role of HIV status, mental health and macrosocial characteristics (people with disability, transgender women, sex workers, persons engaged in transactional sex, substance users, and people on the move) on economic vulnerability, measured by food, financial and housing insecurity, since the COVID-19 pandemic began. The model accounted for the possible interactions between the macrosocial characteristics and controlled for confounders.Results: There were 3 313 (76.1%) of 4 355 respondents facing food insecurity, 3 664 (83.6%) of 4 385 with financial vulnerability and 1 282 (36.2%) of 3 544 with housing insecurity. Being a member of the key and vulnerable groups was strongly associated with food insecurity, financial vulnerability and housing insecurity, regardless of HIV serostatus. For example, WGL&RHIV engaging in transactional sex were more than four times more likely (aOR 4.42; 95% CI 2.57-7.59) to face housing insecurity and more than twice more likely to face food insecurity (aOR 2.47, 95% CI 1.35-4.52) and financial vulnerability (aOR 2.87, 95% CI 1.39-5.93). This economic vulnerability may reduce their negotiating power for safer sex or the use of HIV prevention methods, exposing them to increased risks of HIV infection. Poor mental health was also associated with the three forms of economic vulnerability.Conclusions: As the long-term impact of the COVID-19 crisis on African economies unfolds, HIV programmes at the country level must include economic vulnerability and mental unwellness mitigation activities for WGL&RHIV.

Understanding the economic implications of COVID-19 for the HIV epidemic and response is critical for designing policies and strategies to effectively sustain past gains and accelerate progress to end these colliding pandemics. While considerable cross-national empirical evidence exists at the global level, there is a paucity of such deep-dive evidence at national level. This article addresses this gap. While Zimbabwe experienced fewer COVID-19 cases and deaths than most countries, the pandemic has had profound economic effects, reducing gross domestic product by nearly 7% in 2020. This exacerbates the long-term economic crisis that began in 1998. This has left many households vulnerable to the economic fallout from COVID-19, with the number of the extreme poor having increased to 49% of the population in 2020 (up from 38% in 2019). The national HIV response, largely financed externally, has been one of the few bright spots. Overall, macro-economic and social conditions heavily affected the capacity of Zimbabwe to respond to COVID-19. Few options were available for borrowing the needed sums of money. National outlays for COVID-19 mitigation and vaccination amounted to 2% of GDP, with one-third funded by external donors. Service delivery innovations helped sustain access to HIV treatment during national lockdowns. As a result of reduced access to HIV testing, the number of people initiating HIV treatment declined. In the short term, there are likely to be few immediate health care consequences of the slowdown in treatment initiation due to the country's already high level of HIV treatment coverage. However, a longer-lasting slowdown could impede national progress towards ending HIV and AIDS. The findings suggest a need to finance the global commons, specifically recognising that investing in health care is investing in economic recovery.

The HIV infection rate is higher among adolescent girls and young women (AGYW) in Africa than men in the same age range. Pre-exposure prophylaxis (PrEP) can be used by women discreetly; however, for most AGYW, male partner approval is desired. We explored PrEP use in the context of relationship violence and power dynamics through focus group discussions and support club sessions with AGYW, in-depth interviews and male sensitisation sessions with male partners of AGYW, and joint sessions with AGYW and their male partners. Many male partners reported hesitancy in supporting partner's PrEP use without sufficient information; most of these became supportive following their engagement in study activities; and most preferred participation in decisions around PrEP use. For AGYW, male involvement minimised partner violence around their PrEP use. The findings support the need for correct PrEP information to be provided to male partners of AGYW and to involve them early on, in decision-making about PrEP use. This is likely to improve uptake of and adherence to PrEP.

Background: Uganda adopted the test and treat strategy in 2016 where all people living with HIV are initiated on antiretroviral drugs irrespective of CD4 count and WHO clinical stage, as one of the major strategies to end the HIV epidemic by 2030. Despite these measures, there are still more than 2 000 HIV-related death annually. The study aim was to determine the mortality rate and factors predictive of mortality in the test and treat era among people living with HIV in rural Uganda.Methods: We conducted a retrospective cohort study among people living with HIV enrolled into care between January 2016 and December 2020 at Kabwohe Clinical Research Centre in south-western Uganda. Kaplan-Meier curves were used for survival analysis and Cox regression analysis at bivariate and multivariable levels was used to determine the adjusted hazard ratios (AHR) and identify predictors of death during the study period.Results: Of the 976 participants included in the study, 57.1% (557) were females while 42.9% (419) were males. The median age of the participants was 35 years. The average follow-up period was 2.9 years with an overall mortality rate of 0.99 per 100 person-years at risk. In multivariate analysis, the independent predictors for mortality were: CD4 < 200cells/mm³ (AHR 3.68; 95% CI 1.7-8.1), viral load ≥ 1 000 copies/ml (AHR 5.22; 95% CI 2.4-11.4) and a non-optimised antiretroviral regimen (AHR 4.08; 95% CI 1.5-0.8).Conclusion: There was a low mortality rate observed in this study with a higher risk of death associated with advanced HIV disease and unsuppressed initial viral load. The findings of the study therefore support efforts in early antiretroviral therapy initiation as it increases the likelihood of people living with HIV surviving and can accelerate efforts in ending the HIV epidemic by 2030.