A role for traditional doctors in health promotion: experience from a trial of HIV prevention in Botswana

Traditional doctors have been largely ignored in HIV prevention, particularly primary prevention. As part of a structural intervention programme to reduce HIV risk among young women in Botswana, we trained 147 traditional doctors in four districts as well as government health education assistants (HEAs) and teachers to run discussion groups in the community and schools, using an evidence-based eight-episode audio-drama, covering gender roles, gender violence, and how these are related to HIV risk. One year later, we contacted 43 of the 87 trained traditional doctors in two districts. Most (32) were running discussion groups with men and women, with links to the local HEAs and teachers. They were adept at recruiting men to their groups, often a challenge with community interventions, and reported positive changes in attitudes and behaviour of group participants. Traditional doctors can play an important role in primary prevention of gender violence and HIV.

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Exploring the feasibility and acceptability of integrating screening for gender-based violence into HIV counselling and testing for adolescent girls and young women in Tanzania and South Africa

BMC Public Health ◽

10.1186/s12889-021-10454-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Manuela Colombini ◽

◽

Fiona Scorgie ◽

Anne Stangl ◽

Sheila Harvey ◽

...

Keyword(s):

South Africa ◽

Hiv Prevention ◽

Young Women ◽

Hiv Risk ◽

Clinical Staff ◽

Gender Based Violence ◽

Process Data ◽

Hiv Counselling And Testing ◽

Gender Based ◽

Study Participants

Abstract Background Gender-based violence (GBV) undermines HIV prevention and treatment cascades, particularly among women who report partner violence. Screening for violence during HIV testing, and prior to offering pre-exposure prophylaxis (PrEP) to HIV uninfected women, provides an opportunity to identify those at heightened HIV risk and greater potential for non-adherence or early discontinuation of PrEP. The paper describes our experience with offering integrated GBV screening and referral as part of HIV counselling and testing. This component was implemented within EMPOWER, a demonstration project offering combination HIV prevention, including daily oral PrEP, to young women in South Africa and Tanzania. Methods Between February 2017 and March 2018, a process evaluation was conducted to explore views, experiences and practices of stakeholders (study participants and study clinical staff) during implementation of the GBV screening component. This article assesses the feasibility and acceptability of the approach from multiple stakeholder perspectives, drawing on counselling session observations (n = 10), in-depth interviews with participants aged 16–24 (n = 39) and clinical staff (n = 13), and notes from debriefings with counsellors. Study process data were also collected (e.g. number of women screened and referred). Following a thematic inductive approach, qualitative data were analysed using qualitative software (NVivo 11). Results Findings show that 31% of young women screened positive for GBV and only 10% requested referrals. Overall, study participants accessing PrEP were amenable to being asked about violence during HIV risk assessment, as this offered the opportunity to find emotional relief and seek help, although a few found this traumatic. In both sites, the sensitive and empathetic approach of the staff helped mitigate distress of GBV disclosure. In general, the delivery of GBV screening in HCT proved to be feasible, provided that the basic principles of confidentiality, staff empathy, and absence of judgment were observed. However, uptake of linkage to further care remained low in both sites. Conclusion Most stakeholders found GBV screening acceptable and feasible. Key principles that should be in place for young women to be asked safely about GBV during HIV counselling and testing included respect for confidentiality, a youth-friendly and non-judgmental environment, and a functioning referral network.

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Strategies for Primary and Secondary Prevention of HIV Transmission

Handbook of AIDS Psychiatry ◽

10.1093/oso/9780195372571.003.0009 ◽

2010 ◽

Author(s):

Mary Ann Cohen ◽

Harold W. Goforth

Keyword(s):

Primary Prevention ◽

Hiv Prevention ◽

Secondary Prevention ◽

Risk Reduction ◽

Hiv Risk ◽

Hiv Transmission ◽

Sexual Practices ◽

Prevention Strategies ◽

Primary And Secondary Prevention ◽

Hiv Risk Reduction

Since HIV disease was first recognized three decades ago, numerous efforts have been made to prevent its continued transmission. The Centers for Disease Control and Prevention (CDC) estimates that more than 56,000 Americans become infected each year—one person every 9 1/2 minutes—and that more than one million people in this country are now living with HIV (CDC, 2008, 2009;Hall et al., 2008). The CDC estimates that roughly 1 in 5 people infected with HIV in the United States is unaware of his or her infection and may be unknowingly transmitting the virus to others (CDC, 2008). Over the past 15 years, many behavioral HIV risk reduction interventions have been developed, with prevention efforts targeting mostly HIV-negative individuals and focusing almost exclusively on HIV testing and counseling. More recently, comprehensive HIV prevention has involved both primary and secondary prevention activities to decrease the number of new HIV infections and associated complications, respectively (Marks et al., 2006; O’Leary and Wolitski, 2009). Psychiatric factors both complicate and perpetuate the HIV pandemic as a result of unsafe sexual practices and substance use disorders. In this chapter, we describe some of the psychiatric and psychodynamic factors that lead to HIV transmission and present novel strategies to assist clinicians and health-care policymakers in prevention efforts. Primary prevention is defined as any activity that reduces the burden of morbidity or mortality from disease; it is to be distinguished from secondary prevention, in which activities are designed to prevent the complications of already existing disease. In the case of HIV, primary prevention efforts focus on strategies designed to prevent the transmission of HIV—keeping seronegative people seronegative. In the HIV pandemic, however, many prevention strategies share characteristics of both primary and secondary efforts, so the distinction is somewhat artificial. Multiple prevention strategies have been devised, and these center around HIV counseling, substance abuse programs, and HIV prevention and intervention programs for children. Counseling healthy pregnant women, uninfected children, adolescents, adults, and older persons about HIV risk reduction and providing information about sexual health are important components to primary prevention strategies, but few physicians and other clinicians actually do this unless it is a part of a program specifically designed to prevent HIV transmission.

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HIV Prevention Among Youth: Designing Effective Evidence-Based HIV Risk-Reduction Programs for Adolescents

A Clinical Guide to Pediatric HIV ◽

10.1007/978-3-319-49704-4_11 ◽

2016 ◽

pp. 273-295

Author(s):

Ralph J. DiClemente ◽

Nihari Patel

Keyword(s):

Hiv Prevention ◽

Risk Reduction ◽

Hiv Risk ◽

Evidence Based ◽

Hiv Risk Reduction

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Dynamic Perceived HIV Risk and Sexual Behaviors Among Young Women Enrolled in a PrEP Trial in Kenya: A Qualitative Study

Frontiers in Reproductive Health ◽

10.3389/frph.2021.637869 ◽

2021 ◽

Vol 3 ◽

Author(s):

Kenneth Ngure ◽

Nicholas Thuo ◽

Vallery Ogello ◽

Catherine Kiptinness ◽

Kevin Kamolloh ◽

...

Keyword(s):

Risk Perception ◽

High Risk ◽

Hiv Prevention ◽

Qualitative Study ◽

Young Women ◽

Hiv Risk ◽

Sexual Behaviors ◽

Hiv Acquisition ◽

Risk Of Hiv Acquisition ◽

Over Time

Background: In Kenya and elsewhere in sub-Saharan Africa, young women are disproportionately affected by the HIV epidemic compared to young men. The extent to which young women's self-perceptions about risk of HIV acquisition influence their sexual behaviors and use of HIV prevention methods remains unclear. We therefore conducted a qualitative study to explore these issues among young women enrolled in a pre-exposure prophylaxis (PrEP) trial.Methods: From January 2017 to January 2020, we conducted serial semi-structured in-depth interviews 50 purposively selected young women (18–24 years old) who were participating in the MPYA (Monitoring PrEP for Young Adult women) study—a randomized controlled trial in Thika and Kisumu, Kenya, assessing the impact of SMS reminders on PrEP adherence. Interviews were conducted at three time points (~1 week, 3, and 12 months after initiating PrEP). We used an inductive, content analytic approach to identify key themes related to risk perceptions, sexual behavior, and use of HIV prevention tools.Results: Around the time of enrollment, most of the 50 women interviewed reported being at high risk of HIV because of their own sexual behaviors, such as inconsistent condom use, multiple sexual partners, and transactional sex. Additionally, high risk perception was based on the behavior of their partners, such as refusing to use condoms and being unsure of their partner's HIV status. Young women's perceived risk of HIV acquisition was a key motivator for PrEP initiation and continuation. During PrEP use, participants reported feeling protected and at less risk compared to peers who were not taking PrEP. Some reported no longer using condoms because they were confident that PrEP provided enough protection. Over time, many young women reported reducing risky sexual behaviors because of the regular counseling and HIV testing they received as part of their PrEP services. This lowered risk perception was in most cases accompanied by discontinuation of PrEP.Conclusions: HIV risk perception among young women in Kenya was dynamic and influenced their use of PrEP and condoms over time, suggesting an often-deliberate approach to HIV prevention and sexual health.

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Characterizing the unmet HIV prevention needs and HIV risk vulnerabilities of adolescent girls and young women in Ethiopia

10.31899/hiv5.1006 ◽

2018 ◽

Author(s):

Keyword(s):

Hiv Prevention ◽

Adolescent Girls ◽

Young Women ◽

Hiv Risk

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Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention

Frontiers in Reproductive Health ◽

10.3389/frph.2021.667413 ◽

2021 ◽

Vol 3 ◽

Author(s):

Edward Nyaboe ◽

Anna Larsen ◽

Joseph Sila ◽

John Kinuthia ◽

George Owiti ◽

...

Keyword(s):

Family Planning ◽

Hiv Prevention ◽

Risk Behaviors ◽

Adolescent Girls ◽

Young Women ◽

Hiv Risk ◽

Prevalence Ratio ◽

Hiv Risk Behaviors ◽

Risk Scores ◽

Oral Contraceptive Pills

Background: Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics.Methods: From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15–24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5–15% HIV incidence) defined “high” HIV risk.Results: Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20–23], median completed education was 12 years (IQR 10–12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09–1.29, p < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09–2.10, p = 0.012); injectable use was not associated with HIV risk scores ≥5.Conclusions: Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.

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