scholarly journals Contraceptive Use and Associated Factors among Women Enrolling into HIV Care in Southwestern Uganda

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Winnie Muyindike ◽  
Robin Fatch ◽  
Rachel Steinfield ◽  
Lynn T. Matthews ◽  
Nicholas Musinguzi ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Contraceptive Use ◽  
Multivariable Analysis ◽  
Hiv Care ◽  
Hiv Status ◽  
Unintended Pregnancies ◽  
Hiv Status Disclosure ◽  
Few Data ◽  
Status Disclosure ◽  
Southwestern Uganda

Background. Preventing unintended pregnancies among women living with HIV is an important component of prevention of mother-to-child HIV transmission (PMTCT), yet few data exist on contraceptive use among women entering HIV care.Methods. This was a retrospective study of electronic medical records from the initial HIV clinic visits of 826 sexually active, nonpregnant, 18–49-year old women in southwestern Uganda in 2009. We examined whether contraceptive use was associated with HIV status disclosure to one’s spouse.Results. The proportion reporting use of contraception was 27.8%. The most common method used was injectable hormones (51.7%), followed by condoms (29.6%), and oral contraceptives (8.7%). In multivariable analysis, the odds of contraceptive use were significantly higher among women reporting secondary education, higher income, three or more children, and younger age. There were no significant independent associations between contraceptive use and HIV status disclosure to spouse.Discussion. Contraceptive use among HIV-positive females enrolling into HIV care in southwestern Uganda was low. Our results suggest that increased emphasis should be given to increase the contraception uptake for all women especially those with lower education and income. HIV clinics may be prime sites for contraception education and service delivery integration.

scholarly journals The Paradoxes of PrEP: Rejection, Reluctancy, and Novel Gay Identities in Biomedical HIV Prevention in Serbia

2022 ◽  
pp. 34-51
Author(s):  
Zoran Milosavljević
Keyword(s):  
Hiv Prevention ◽  
Gay Men ◽  
Hiv Transmission ◽  
Gay Identity ◽  
Hiv Status ◽  
Social Significance ◽  
Gay Communities ◽  
Hiv Status Disclosure ◽  
Status Disclosure ◽  
Hiv Negative

This article explores the different ways in which gay men in Serbia perceive PrEP as a novel method of HIV prevention. In the article, I draw on data from my research on PrEP use among thirty gay men in Belgrade. The use of PrEP is still very low amongst gay communities in Serbia due to their rejection of PrEP and due to the stigma around PrEP use. In Serbia, the social significance of PrEP relates to HIV status disclosure on gay social/dating media. Paradoxically, on gay dating sites, the signifier "PrEP" blurs the line between HIV positive gay men – who have achieved undetectable HIV status through a potent ARV therapy – and those HIV negative gay men who use PrEP as a preventative tool against HIV transmission. In the article, I will argue that a new form of gay identity has emerged on gay dating apps in Serbia – "undetectable, on PrEP." This new identity emerges from confusion in HIV risk assessment. The use of PrEP has been seen as a marker to denote someone’s HIV negative status and to protect them from HIV transmission. However, some gay men with an undetectable HIV status would like to be regarded as HIV negative even though they are not, and thus they use the signifier "on PrEP" to highlight their desire to claim an HIV negative status. PrEP has many symbolic valences: from HIV status disclosure to assumed promiscuity. As I will argue, while the health paradigm is of utmost importance for Serbian gay men, internalized stigma additionally drives the low uptake of PrEP amongst gay communities in Serbia, thus contributing to the confusion regarding PrEP use and the overall approach to HIV prevention. This article finds that those respondents who accept PrEP without stigma or confusion regarding their HIV status are also more willing and ready to recommend using PrEP to other gay men.

scholarly journals Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project

2021 ◽  
Vol 9 ◽  
Author(s):  
Sokhna Boye ◽  
Seydou Bouaré ◽  
Odette Ky-Zerbo ◽  
Nicolas Rouveau ◽  
Arlette Simo Fotso ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Professionals ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Preliminary Results ◽  
Research Activities ◽  
Medical Consultations ◽  
Hiv Status Disclosure ◽  
Status Disclosure

Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners.Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis.Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status.Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.

scholarly journals The Role of Early HIV Status Disclosure in Retention in HIV Care

2015 ◽  
Vol 29 (12) ◽  
pp. 646-650 ◽  
Author(s):  
Latesha Elopre ◽  
Edward W. Hook ◽  
Andrew O. Westfall ◽  
Anne Zinski ◽  
Michael J. Mugavero ◽  
...  
Keyword(s):  
Hiv Care ◽  
Hiv Status ◽  
Retention In Hiv Care ◽  
Hiv Status Disclosure ◽  
Status Disclosure

scholarly journals Accelerating caregivers’ HIV status disclosure to community-based lay social welfare volunteers in Tanzania

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Amon Exavery ◽  
John Charles ◽  
Asheri Barankena ◽  
Erica Kuhlik ◽  
Godfrey Martin Mubyazi ◽  
...  
Keyword(s):  
Social Welfare ◽  
Multivariable Analysis ◽  
Exposure Period ◽  
Estimating Equation ◽  
Hiv Status ◽  
Community Based Interventions ◽  
Community Based ◽  
Project Staff ◽  
Hiv Status Disclosure ◽  
Status Disclosure

Abstract Background HIV status disclosure facilitates access to HIV-related prevention and treatment services and increases opportunities for social support, HIV risk reduction with partners, and index testing for sexual partners or children. This study assessed the effect of a program model of community-based social welfare volunteers on HIV status disclosure among caregivers of orphans and vulnerable children (OVC). Methods This was a longitudinal study, which was based on OVC caregivers who were beneficiaries of the USAID Kizazi Kipya project in Tanzania. They were enrolled (baseline) by community social welfare volunteers during 2017–2018, received services, and reassessed at midline in 2019. Caregivers who reported having been HIV tested, were asked to voluntarily report the status in order for the volunteers to establish and provide needed services. Those who reported their HIV status as negative or positive were grouped as “disclosed”, and those who knew their status but did not report it were documented as “undisclosed”. McNemar’s tests compared disclosure rates at baseline and midline. Multivariable analysis was conducted using generalized estimating equation (GEE). Results The study analyzed 140,664 caregivers (72% female) from 81 district councils of Tanzania. Their mean age at enrollment was 47.4 years. Overall, 81.3% of the caregivers disclosed their HIV status to the project staff at baseline; this increased significantly to 96.1% at midline (p < 0.001). Disclosure at baseline varied significantly by sociodemographic characteristic (p < 0.05), with higher disclosure in females, among urban residents, and higher educated caregivers. However, the observed disclosure variations by sociodemographic characteristics at baseline disappeared at midline and disclosure reached around 96% across the characteristics (p > 0.05). In the multivariable analysis, caregivers’ likelihood of HIV status disclosure was nearly 6 times higher at midline than at baseline, when baseline characteristics were adjusted for (OR = 5.76, 95% CI 5.59–5.94, p < 0.001). There were 26,329 caregivers who did not disclose their HIV status at baseline (i.e., 0% diclosure rate at baseline), but 94.7% (n = 24,933) had disclosed by midline, and their disclosure trend was rapidly increasing as their duration of exposure to the project increased. Conclusions This study detected an increased caregivers’ HIV status disclosure to the USAID Kizazi Kipya project staff by 14.8%, from 81.3% at baseline to 96.1% at midline within an average project exposure period of 1.4 years. The observed loss of sociodemographic differences in HIV status disclosure rate at midline implies that community-based interventions may be well-positioned to successfully address and eliminate sociodemographic barriers to service uptake and consequently improve services coverage and health outcomes.

Self-disclosure of HIV status, disclosure counseling, and retention in HIV care in Cameroon

AIDS Care ◽  
2016 ◽  
Vol 29 (7) ◽  
pp. 838-845 ◽  
Author(s):  
Tiffany L. Breger ◽  
Jamie E. Newman ◽  
Brigitte Mfangam Molu ◽  
Wilfred Akam ◽  
Ashu Balimba ◽  
...  
Keyword(s):  
Hiv Care ◽  
Hiv Status ◽  
Self Disclosure ◽  
Retention In Hiv Care ◽  
Hiv Status Disclosure ◽  
Status Disclosure

scholarly journals Stigma and discrimination: barriers to the utilisation of a nutritional program in HIV care services in the Tigray region, Ethiopia.

2020 ◽  
Author(s):  
Fisaha Tesfay ◽  
Sara Javanparast ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Family Members ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Services ◽  
Tigray Region ◽  
Stigma And Discrimination ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure

Abstract Background: In Ethiopia, stigmatising attitudes towards people living with HIV have reduced over time due to improved HIV knowledge and the expansion of services. However, HIV stigma and discrimination remain a key challenge and have negative impacts on access to and utilisation of HIV services including nutritional programs. A small number of studies have examined the experience of stigma related to nutritional programs, but this is limited. This study explored HIV status disclosure and experience of stigma related to a nutritional program in HIV care settings in Ethiopia and impacts on nutritional program utilisation. Methods: As part of a larger study, qualitative in-depth interviews were conducted with 20 adults living with HIV, 15 caregivers of children living with HIV and 13 program staff working in the nutritional program in three hospitals in the Tigray region of Ethiopia. Framework thematic analysis using NVivo was employed to analyse the data. Results: The study found varying levels of positive HIV status disclosure, depending on who the target of disclosure was. Disclosing to family members was reported to be less problematic by most participants. Despite reported benefits of the nutritional program in terms of improving weight and overall health status, adults and caregivers of children living with HIV revealed experiences of stigma and discrimination that were amplified by enrolment to the nutritional program. This was due to: a) transporting, consuming and disposing of the nutritional support itself, which is associated with HIV in the broader community; b) required increased frequency of visits to HIV services for those enrolled in the nutritional program and associated. Conclusion: There was evidence of concerns about HIV-related stigma and discrimination among individuals enrolled in this program and their family members, which in turn negatively affected the utilisation of the nutritional program. Stigma and discrimination are a source of health inequity and undermine access to the nutritional program. Nutritional programs in HIV care should include strategies to take these concerns into account by mainstreaming stigma prevention and mitigation activities. Further research should be done to identify innovative ways of facilitating social inclusion to mitigate stigma and improve utilisation.

scholarly journals The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0255945
Author(s):  
Matthew D. Hickey ◽  
Gor B. Ouma ◽  
Brian Mattah ◽  
Ben Pederson ◽  
Nicholas R. DesLauriers ◽  
...  
Keyword(s):  
Social Support ◽  
Social Network ◽  
Pilot Study ◽  
Hiv Care ◽  
Hiv Status ◽  
Point Scale ◽  
Western Kenya ◽  
Retention In Hiv Care ◽  
Hiv Status Disclosure ◽  
Status Disclosure

Background Existing social relationships are a potential source of “social capital” that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based ‘microclinic’ intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness. Methods In nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits (‘time-in-care’). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma. Results Of 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61–1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08–0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2–0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17). Conclusions The data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care. Trial registration Clinical trial number: NCT02474992.

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