Posted: Oct 31, 2016
‘‘Violence. Enough already’’: findings from a global participatory survey among women living with HIV
Introduction: Women living with HIV are vulnerable to gender-based violence (GBV) before and after diagnosis, in multiple settings. This study’s aim was to explore how GBV is experienced by women living with HIV, how this affects women’s sexual and reproductive health (SRH) and human rights (HR), and the implications for policymakers.
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Methods: A community-based, participatory, user-led, mixed-methods study was conducted, with women living with HIV from key affected populations. Simple descriptive frequencies were used for quantitative data. Thematic coding of open qualitative responses was performed and validated with key respondents.
Results: In total, 945 women living with HIV from 94 countries participated in the study. Eighty-nine percent of 480 respondents to an optional section on GBV reported having experienced or feared violence, either before, since and/or because of their HIV diagnosis. GBV reporting was higher after HIV diagnosis (intimate partner, family/neighbours, community and health settings). Women described a complex and iterative relationship between GBV and HIV occurring throughout their lives, including breaches of confidentiality and lack of SRH choice in healthcare settings, forced/coerced treatments, HR abuses, moralistic and judgemental attitudes (including towards women from key populations), and fear of losing child custody. Respondents recommended healthcare practitioners and policymakers address stigma and discrimination, training, awareness-raising, and HR abuses in healthcare settings.
Conclusions: Respondents reported increased GBV with partners and in families, communities and healthcare settings after their HIV diagnosis and across the life-cycle. Measures of GBV must be sought and monitored, particularly within healthcare settings that should be safe. Respondents offered policymakers a comprehensive range of recommendations to achieve their SRH and HR goals. Global guidance documents and policies are more likely to succeed for the end-users if lived experiences are used.
Orza L, Bewley S, Chung C, et al. “Violence. Enough already”: findings from a global participatory survey among women living with HIV. Journal of the International AIDS Society. 2015;18(6Suppl 5):20285. doi:10.7448/IAS.18.6.20285.
Posted: Oct 20, 2016
Advancing sexual and reproductive health and rights of young women at risk of HIV
Current approaches to HIV prevention typically target people who are identiﬁed as, or self-identify, with being at risk. In Africa, 74% of new HIV infections are among adolescent girls aged 15–19 years, and AIDS-related illnesses are the leading cause of death among adolescent girls and women of reproductive age.1 Hundreds of millions of dollars spent on developing and testing biomedical interventions to prevent HIV in women have not succeeded in reducing HIV incidence.
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Posted: Oct 20, 2016
Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa
Background: Increased sexual risk behaviour and HIV prevalence have been reported in migrants compared with non-migrants in sub-Saharan Africa. We investigated the association of residential and migration patterns with sexual HIV risk behaviours and HIV prevalence in an open, general population cohort in rural KwaZulu-Natal, South Africa.
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Methods: In a mainly rural demographic surveillance area in northern KwaZulu-Natal, South Africa, we collected longitudinal demographic, migration, sexual behaviour, and HIV status data through household surveillance twice per year and individual surveillance once per year. All resident household members and a sample of non-resident household members (stratiﬁed by sex and migration patterns) were eligible for participation. Participants reported sexual risk behaviours, including data for multiple, concurrent, and casual sexual partners and condom use, and gave a dried blood spot sample via ﬁngerprick for HIV testing. We investigated population-level diﬀerences in sexual HIV risk behaviours and HIV prevalence with respect to migration indicators using logistic regression models.
Findings: Between Jan 1, 2005, and Dec 31, 2011, the total eligible population at each surveillance round ranged between 21 129 and 22 726 women (aged 17–49 years) and between 20 399 and 22 100 men (aged 17–54 years). The number of eligible residents in any round ranged from 24 395 to 26 664 and the number of eligible non-residents ranged from 17 002 to 18 891 between rounds. The stratiﬁed sample of non-residents included between 2350 and 3366 individuals each year. Sexual risk behaviours were signiﬁcantly more common in non-residents than in residents for both men and women. Estimated diﬀerences in sexual risk behaviours, but not HIV prevalence, varied between the migration indicators: recent migration, mobility, and migration type. HIV prevalence was signiﬁcantly increased in current residents with a recent history of migration compared with other residents in the study area in men (adjusted odds ratio 1·19, 95% CI 1·07–1·33) and in women (1·18, 1·10–1·26).
Interpretation: Local information about migrants and highly mobile individuals could help to target intervention strategies that are based on the identiﬁcation of transmission hotspots.
Posted: Oct 20, 2016
Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population
Background: Combination antiretroviral therapy has substantially increased life-expectancy in people living with HIV, but the eﬀ ects of chronic infection on health-related quality of life (HRQoL) are unclear. We aimed to compare HRQoL in people with HIV and the general population.
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Methods: We merged two UK cross-sectional surveys: the ASTRA study, which recruited participants aged 18 years or older with HIV from eight outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012; and the Health Survey for England (HSE) 2011, which measures health and health-related behaviours in individuals living in a random sample of private households in England. The ASTRA study has data for 3258 people (response rate 64%) and HSE for 8503 people aged 18 years or older (response rate 66%). HRQoL was assessed with the Euroqol 5D questionnaire 3 level (EQ-5D-3L) instrument that measures health on ﬁ ve domains, each with three levels. The responses are scored on a scale where a value of 1 represents perfect health and a value of 0 represents death, known as the utility score. We used multivariable models to compare utility scores between the HIV and general population samples with adjustment for several sociodemographic factors.
Findings: 3151 (97%) of 3258 of participants in ASTRA and 7424 (87%) of 8503 participants in HSE had complete EQ-5D-3L data. The EQ-5D-3L utility score was lower for people with HIV compared with that in the general population (marginal eﬀ ect in utility score adjusted for age, and sex/sexuality –0·11; 95% CI –0·13 to –0·10; p<0·0001). HRQoL was lower for people with HIV for all EQ-5D-3L domains, particularly for anxiety/depression. The diﬀ erence in utility score was signiﬁ cant after adjustment for several additional sociodemographic variables (ethnic origin, education, having children, and smoking status) and was apparent across all CD4 cell count, antiretroviral therapy, and viral load strata, but was greatest for those people diagnosed with HIV in earlier calendar periods. Reduction in HRQoL with age was not greater in people with HIV than in the general population (pinteraction>0·05).
Interpretation: People living with HIV have signiﬁ cantly lower HRQoL than do the general population, despite most HIV positive individuals in this study being virologically and immunologically stable. Although this diﬀ erence could in part be due to factors other than HIV, this study provides additional evidence of the loss of health that can be avoided through prevention of further HIV infections.
MINERS, A., PHILLIPS, A., KREIF, N., RODGER, A., SPEAKMAN, A., FISHER, M., ANDERSON, J., COLLINS, S., HART, G., SHERR, L. & LAMPE, F. C. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. The Lancet HIV, 1, e32-e40.
Posted: Oct 20, 2016
How to deal with HIV after rape
This booklet guides you on what to do, and explains other medical things that you need to attend to after the rape. This booklet also tells you what to do if you want to know the HIV status of your rapist. And it ex-plains how to report rape. Read and share the information in this booklet.
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