2,641 research outputs found
Gender differentials in the impact of parental death: adolescent's sexual behaviour and risk of HIV infection in rural South Africa
No full textUsing data from a longitudinal surveillance study from rural South Africa, we investigated the odds of sexual debut, pregnancy and HIV infection of 15- to 19-year-old adolescents by parental survival. Using descriptive statistics and logistic regressions, we examine the relative risk of orphans compared with non-orphans to have ever had sex, being pregnant and being HIV infected, adjusting for age, sex, socio-economic status, education, being employed and residency. Of 8274 adolescents, 42% were orphaned (one or both parents died). Over 80% of adolescents remained in school, but orphans were significantly more likely to lag behind in grade for age. Female adolescent maternal (aOR 1.32, 95% CI 1.071.62), paternal (aOR 1.26, 95% CI 1.061.49) and dual (aOR 1.37, 95% CI 1.051.78) orphans were significantly more likely than non-orphaned females to have ever had sex; among males it was only paternal (aOR 1.27, 95% CI 1.051.53) orphans. Maternal (aOR 1.49, 95% CI 1.032.15) and dual (aOR 1.74, 95% CI 1.112.73) female orphans relative to non-orphaned females were significantly more likely to be HIV infected; male paternal (aOR 3.41, 95% CI 1.378.46) and dual (aOR 3.54, 95% CI 1.0611.86) orphans had over three-fold the odds of being infected. There was strong evidence that death of mother for girls was associated with increased vulnerability to earlier sexual debut and HIV infection, while fathers appeared to play a significant role in both their son's and daughter's lives
Mortality risk in older people on antiretroviral therapy
No full textThe report by Morna Cornell and colleagues1 in The Lancet HIV on the effect of age on mortality in a large South African antiretroviral treatment (ART) programme emphasises three issues for health-care delivery: ageing of the population of people with HIV who are receiving therapy, possibly poor immunological response to ART in older people, and delayed HIV diagnosis and treatment initiation in older peopl
The effect of orphanhood on marriage among young adults in rural South Africa? International meeting on changing transitions to marriage: gender implications for the next generation in developing countries
No full textSix month partnership change and sexual activity by ART-eligibility in an ART programme in rural KwaZulu-Natal, South Africa
No full textBackground: Studies have raised concerns that ART initiation may result in increases in sexual risk behavior and partnership instability. In Africa, an important, increasing group are HIV-infected people in contact with ART programs but not yet eligible to start ART (monitoring group). Individuals with CD4 >500 may be earlier in their HIV disease, expected to be partnered, and more sexually active. They also provide a comparison group to investigate the impact of ART on sexual risk behavior.Methods: A prospective cohort study of ART-eligible and monitored (CD4 >500) participants at 3 rural HIV treatment and care program clinics. Enrollment started 1 January 2009. Data are collected about partnerships and sexual activity every 6 months.Results: By 10 October 2010, 484 individuals had been interviewed at baseline and 6 months; 72% female; median age 34 years, IQR (28 to 42); 318 (66%) ART-eligible and 166 (34%) monitored. At baseline, 238 (74%) ART-eligible and 137 (83%) monitored individuals had at least 1 partner. By 6 months, the rate of new partner acquisition among ART-eligible was 13.0/100 patient-years vs 14.7/100 patient-years among monitored individuals (p = 0.7). In these new partnerships, 49% had disclosed to their partner, 63% of partners had not tested, 29% were HIV concordant, 89% had sex in the last month (median number of acts = 4, IQR [2 to 6]); with no significant difference between groups. By 6 months, the rate of partnership dissolution was 24.3/100 patient-years in ART-eligible vs 27.4/100 patient-years in monitored group (p = 0.6). Among those with the same partner at 6 months, the proportion sexually active in the previous 6 months was 88% and 94% at baseline, 83% and 90% at 6 months, and at 6 months the median number of sexual acts in the last month was 2, IQR (1 to 4) vs 3, IQR (1 to 6.5), p = 0.03, in ART-eligible and monitored groups, respectively. At baseline, 11 (3%) ART-eligible people had concurrent partners vs 0 in the monitored group (?2p = 0.02). By 6 months, 2 ART-eligible and 3 monitored individuals had acquired a concurrent partner, and 3 ART-eligible individuals were no longer in concurrent relationships.Conclusions: The majority of individuals accessing the ART program are in partnerships. ART initiation is not associated with different rates of partner acquisition or partnership dissolution in the first 6 months. Individuals not yet on ART and in stable partnerships appear to have sex more frequently. These findings highlight the need for ongoing safe sex messages and promotion of couples testing before and after ART initiation
Sexual risk after HIV diagnosis: a comparison of early- and late-presenters in an HIV treatment and care programme in rural KwaZulu-Natal, South Africa
No full textTrends in contraceptive use and choice of contraceptive method in a rural South African population-based cohort during the ART era, 2005–2011
No full textReproductive intentions among HIV-infected men and women accessing a public HIV treatment and care programme in rural KwaZulu-Natal, South Africa
No full textBackground: Improved health and wellbeing following ART initiation may encourage favourable attitudes towards childbearing by PLHIV themselves, partners, family and health providers. Furthermore, increases in life-expectancy will extend the period during which partnering and childbearing may occur. In sub-Saharan Africa treatment programmes, support and counselling around fertility for PLHIV varies. We report baseline results from a prospective study of the impact of ART on partnering, fertility intentions and behavior in HIV-infected individuals accessing a public treatment programme in 3 rural clinics in South Africa.Methods: Enrollment started January 2009. Data were collected about partnerships, sexual activity, fertility intentions, and pregnancies. Logistic regression was used to explore factors associated with discussing childbearing with their partner at baseline.Results: Data are available on fertility intentions for 453/607 participants in a partnership at baseline (29% male). Median parity was 2 for women, IQR(1,4), and 3 for men IQR(1,5). Median CD4 was 181 IQR(51,571). Median length of relationship was 5 years IQR(2,11). 30% of women and 43% of men reported they wanted to have more children with their current partner. However, no women and only 7% of men intended to conceive in the next 12 months. Among 36% who discussed childbearing, partners' expectations motivated 49% of women, and 20% in both sexes thought ART enabled them to have an uninfected baby. Among those who did not discuss childbearing, 51% of both sexes had reached their desired family size. In logistic regression, older age of participant and the number of children with current partner were significantly associated with decreasing odds of discussing childbearing. A significant linear trend was found with odds of discussion decreasing with each additional child, 0.69, 95% CI (0.57, 0.83).Conclusion: Results show that there is a desire, albeit postponed, for more children among PLHIV, especially in the context of effective PMTCT
More equitable gender norms are associated with higher levels of condom use at last: sex among HIV+ men and women in rural KwaZulu-Natal, South Africa
No full textTime to eligibility for antiretroviral therapy in adults with CD4+ count >500 cells/µl in rural KwaZulu-Natal, South Africa
No full textThe impact of gender norms on condom use among HIV-positive adults in KwaZulu-Natal, South Africa.
No full textCritical to preventing the spread of HIV is promoting condom use among HIV-positive individuals. Previous studies suggest that gender norms (social and cultural constructions of the ways that women and men are expected to behave) may be an important determinant of condom use. However, the relationship has not been evaluated among HIV-positive women and men in South Africa. We examined gender norms and condom use at last sex among 550 partnerships reported by 530 sexually-active HIV-positive women (372) and men (158) who had sought care, but not yet initiated antiretroviral therapy in a high HIV-prevalence rural setting in KwaZulu-Natal, South Africa between January 2009 and March 2011. Participants enrolled in the cohort study completed a baseline questionnaire that detailed their socio-demographic characteristics, socio-economic circumstances, religion, HIV testing history and disclosure of HIV status, stigma, social capital, gender norms and self-efficacy. Gender norms did not statistically differ between women and men (p = 0.18). Overall, condoms were used at last sex in 58% of partnerships. Although participants disclosed their HIV status in 66% of the partnerships, 60% did not have knowledge of their partner's HIV status. In multivariable logistic regression, run separately for each sex, women younger than 26 years with more equitable gender norms were significantly more likely to have used a condom at last sex than those of the same age group with inequitable gender norms (OR = 8.88, 95% CI 2.95-26.75); the association between condom use and gender norms among women aged 26+ years and men of all ages was not statistically significant. Strategies to address gender inequity should be integrated into positive prevention interventions, particularly for younger women, and supported by efforts at a societal level to decrease gender inequality
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