scholarly journals HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

2016 ◽  
Vol 10 (1) ◽  
pp. 34-48 ◽  
Author(s):  
Ayesha B.M. Kharsany ◽  
Quarraisha A. Karim
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Young Women ◽  
Sub Saharan Africa ◽  
Current Status ◽  
Global Burden ◽  
Medical Male Circumcision ◽  
Global Trends ◽  
Sub Saharan ◽  
Disproportionate Burden

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

scholarly journals Male circumcision and HIV prevention: Directions for future research

2000 ◽  
Author(s):  
Johannes van Dam ◽  
Marie Christine Anastasi
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Male Circumcision ◽  
Sub Saharan Africa ◽  
Future Research ◽  
Scientific Publications ◽  
Sexually Transmitted ◽  
Cultural Implications ◽  
The World ◽  
Sub Saharan

A growing body of scientific publications suggests that male circumcision is associated with reduced risk of HIV infection in sub-Saharan Africa. Thus, male circumcision is being considered as a potential intervention in the prevention of sexually transmitted HIV infection, even though this procedure has profound cultural implications and carries the risk of complications, and its benefits are realized only many years later. This report presents the findings of a meeting of international researchers, organized by the Horizons Project to explore the programmatic and research implications of the association between male circumcision and HIV prevention. Most studies on male circumcision and HIV infection have been done in Africa, and the discussion focuses largely on this continent. The conclusions and recommendations from the meeting, however, may be relevant for other parts of the world. Based on the discussion, participants determined that there is considerable evidence supporting a protective effect of male circumcision on HIV infection in men in sub-Saharan Africa. Participants also concluded that there are many unknowns.

scholarly journals Exploring the “Blesser and Blessee” Phenomenon: Young Women, Transactional Sex, and HIV in Rural South Africa

SAGE Open ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 215824401880634 ◽  
Author(s):  
Johannes N. Mampane
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
Young Women ◽  
Sexual Behaviors ◽  
Transactional Sex ◽  
Sub Saharan Africa ◽  
Rural South ◽  
Sub Saharan ◽  
African Media ◽  
Rural South Africa

The “blesser and blessee” phenomenon has been prominent in South African media since the year 2016. This is a form of transactional sex in which older rich men (“blessers”) tend to entice young women (“blessees”) with money and expensive gifts in exchange for sexual favors. In most cases, these older men are married men who secretly engage in extramarital affairs with these young women. In this light, there have been many debates on whether transactional sex should be equated to prostitution or sex work. However, many researchers argue that both practices at the end of the day are proven to be equally high-risk sexual behaviors for HIV infection in sub-Saharan Africa. In this regard, the purpose of this study was to explore and describe perceptions and experiences of young women regarding factors that influence their susceptibility to transactional sex and the risk of HIV infection in rural South Africa. Twelve young women aged 18 to 30 years participated in two focus group discussions and 12 individual in-depth interviews. The findings of the study revealed that there are sociobehavioral, sociocultural, and socioeconomic factors that influence the susceptibility of young women to transactional sex and HIV risk. The study concluded that it was imperative for researchers to explore the context and motivation for transactional sex among young women in sub-Saharan Africa to be able to develop and implement appropriate and relevant HIV prevention interventions for this vulnerable population.

scholarly journals Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 513 ◽  
Author(s):  
Megan S. Dunbar ◽  
Katharine Kripke ◽  
Jessica Haberer ◽  
Delivette Castor ◽  
Shona Dalal ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Adolescent Girls ◽  
Young Women ◽  
Sub Saharan Africa ◽  
World Health ◽  
Substantial Risk ◽  
Sub Saharan ◽  
Health Organization ◽  
Exposure Prophylaxis ◽  
Oral Prep

In response to World Health Organization (WHO) guidance recommending oral pre-exposure prophylaxis (PrEP) for all individuals at substantial risk for HIV infection, significant investments are being made to expand access to oral PrEP globally, particularly in sub-Saharan Africa. Some have interpreted early monitoring reports from new programs delivering oral PrEP to adolescent girls and young women (AGYW) as suggestive of low uptake. However, a lack of common definitions complicates interpretation of oral PrEP uptake and coverage measures, because various indicators with different meanings and uses are used interchangeably. Furthermore, operationalising these measures in real-world settings is challenged by the difficulties in defining the denominator for measuring uptake and coverage among AGYW, due to the lack of data and experience required to identify the subset of AGYW at substantial risk of HIV infection. This paper proposes an intervention-centric cascade as a framework for developing a common lexicon of metrics for uptake and coverage of oral PrEP among AGYW. In codifying these indicators, approaches to clearly define metrics for uptake and coverage are outlined, and the discussion on ‘low’ uptake is reframed to focus on achieving the highest possible proportion of AGYW using oral PrEP when they need and want it Recommendations are also provided for making increased investments in implementation research to better quantify the sub-group of AGYW in potential need of oral PrEP.and for improving monitoring systems to more efficiently address bottlenecks in the service delivery of oral PrEP to AGYW so that implementation can be taken to scale.

scholarly journals HIV incidence in a multinational cohort of men and transgender women who have sex with men in sub-Saharan Africa: Findings from HPTN 075

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247195
Author(s):  
Theodorus G. M. Sandfort ◽  
Yamikani Mbilizi ◽  
Eduard J. Sanders ◽  
Xu Guo ◽  
Vanessa Cummings ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Cape Town ◽  
Anal Intercourse ◽  
The United States ◽  
Transgender Women ◽  
Sub Saharan Africa ◽  
Hiv Incidence ◽  
Sub Saharan ◽  
Sex With Men

Few studies have assessed HIV incidence in men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA). We assessed HIV incidence and its correlates among MSM and TGW in SSA enrolled in the prospective, multi-country HIV Prevention Trials Network (HPTN) 075 study, conducted from 2015 to 2017. Participants were enrolled at four sites in SSA (Kisumu, Kenya; Blantyre, Malawi; Cape Town and Soweto, South Africa). Eligible participants reported male sex assignment at birth, were 18 to 44 years of age, and had engaged in anal intercourse with a man in the preceding three months. Participation involved five study visits over 12 months. Visits included behavioral assessments and testing for HIV and sexually transmitted infections. Twenty-one of 329 persons acquired HIV during the study [incidence rate: 6.96/100 person-years (PY) (95% CI: 4.3, 10.6)]. Among TGW, HIV incidence was estimated to be 8.4/100 PY (95% CI: 2.3, 21.5). Four participants were found to have acute HIV infection at their first HIV-positive visit. HIV incidence varied among the four study sites, ranging from 1.3/100 PY to 14.4/100 PY. In multivariate longitudinal analysis, factors significantly associated with HIV acquisition were engagement in unprotected receptive anal intercourse [adjusted hazard ratio (AHR) 5.8, 95% confidence interval (CI): 2.4, 14.4] and incident rectal gonorrhea and/or chlamydia (AHR: 2.7, 95% CI: 1.1, 6.8). The higher HIV incidence in Cape Town compared to Blantyre could be explained by the higher prevalence of several risk factors for HIV infection among participants in Cape Town. Annual HIV incidence observed in this study is substantially higher than reported HIV incidence in the general populations in the respective countries and among MSM in the United States. Intensification of HIV prevention efforts for MSM and TGW in SSA is urgently needed.

Risk of HIV infection among adolescent girls and young women in age-disparate relationships in sub-Saharan Africa

AIDS ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Francis Bajunirwe ◽  
Daniel Semakula ◽  
Jonathan Izudi
Keyword(s):  
Hiv Infection ◽  
Adolescent Girls ◽  
Young Women ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Monitoring socioeconomic inequalities across HIV knowledge, attitudes, behaviours and prevention: results from cross-sectional surveys in 18 sub-Saharan African countries

2021 ◽  
Author(s):  
Mohamed Hamidouche ◽  
Pearl Anne Ante-Testard ◽  
Rachel Baggaley ◽  
Laura Temime ◽  
Kévin Jean
Keyword(s):  
Hiv Prevention ◽  
Socioeconomic Inequalities ◽  
Sub Saharan Africa ◽  
Absolute Difference ◽  
People Living With Hiv ◽  
African Countries ◽  
Medical Male Circumcision ◽  
Prevention Services ◽  
Sub Saharan ◽  
Ssa Countries

ObjectivesSocioeconomic inequalities in the access to and uptake of HIV prevention services constitute important barriers to global prevention targets, especially in sub-Saharan Africa (SSA). We aimed at monitoring these inequalities based on data from population-based surveys conducted in 18 SSA countries between 2010 and 2018.MethodsWe defined eight HIV indicators aimed at capturing access to and uptake of HIV prevention services among adult participants. Country-specific wealth-related inequalities were measured using the Relative and Slope Index of Inequalities (RII and SII, respectively) and were then pooled using random-effects meta-analyses. We compared inequalities between African regions using the Wilcoxon rank-sum test.ResultsThe sample consisted of 358,591 participants (66% women). Despite the variability in inequalities between countries and indicators, the meta-analysis revealed significant levels of relative and absolute inequalities in 6 out of 8 HIV indicators. For instance, the richest participants were five times more likely than the poorest to report condom use at last sexual intercourse (RII=5.02; 95% confidence interval, CI: 2.79-9.05), corresponding to an absolute difference of 16 percentage-points (SII=0.16; 95% CI: 0.12-0.20). Similar significant inequalities were observed in HIV-related knowledge, positive attitudes toward people living with HIV, recent HIV testing, participation to prevention of mother-to-child transmission programs and medical male circumcision. Overall, inequalities tended to be larger in West and Central vs. East and Southern African countries.ConclusionsDespite efforts to scale-up HIV-prevention programs, socioeconomic inequalities remain substantial over the continuum of HIV primary and secondary prevention in several SSA countries.

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