1,721,108 research outputs found
Parental control and monitoring of young people's sexual behaviour in rural North-Western Tanzania: implications for sexual and reproductive health interventions
Full text linkBackground: parenting through control and monitoring has been found to have an effect on young people's sexual behaviour. There is a dearth of literature from sub-Saharan Africa on this subject. This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania.Methods: this study employed an ethnographic research design. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. Thematic analysis was conducted with the aid of NVIVO 7 software.Results: parents were motivated to control and monitor their children's behaviour for reasons such as social respectability and protecting them from undesirable sexual and reproductive health (SRH) outcomes. Parental control and monitoring varied by family structure, gender, schooling status, a young person's contribution to the economic running of the family and previous experience of a SRH outcome such as unplanned pregnancy. Children from single parent families reported that they received less control compared to those from both parent families. While a father's presence in the family seemed important in controlling the activities of young people, a mother's did not have a similar effect. Girls especially those still schooling received more supervision compared to boys. Young women who had already had unplanned pregnancy were not supervised as closely as those who hadn't. Parents employed various techniques to control and monitor their children's sexual activities.Conclusions: despite parents making efforts to control and monitor their young people's sexual behaviour, they are faced with several challenges (e.g. little time spent with their children) which make it difficult for them to effectively monitor them. There is a need for interventions such as parenting skills building that might enable parents to improve their relationships with children. This would equip parents with the appropriate skills for positive guidance and monitoring of their children and avoid inappropriate parenting behaviour. As much as parents focus their attention on their school going daughters, there is a need to also remember the out-of-school young people as they are also vulnerable to adverse SRH outcome
"Women's bodies are shops": beliefs about transactional sex and implications for understanding gender power and HIV prevention in Tanzania
No full textAlthough transactional sex has been linked to undesirable sexual health outcomes, there is a lack of clarity as to the meaning of the practice, which appears to extend beyond behaviors related to women's economic circumstances. This article explored the perspectives of parents and unmarried young people on motivations for, and beliefs about, transactional sex in rural Tanzania using an ethnographic research design. Data collection involved 17 focus groups and 46 in-depth interviews with young people aged 14-24 years and parents/caregivers. Transactional sex was widely accepted by both parents and young people. Male parents equated sexual exchange to buying meat from a butcher and interpreted women's demand for exchange before sex with personal power. Young men referred to transactional sex as the easiest way to get a woman to satisfy their sexual desires while also proving their masculinity. Young women perceived themselves as lucky to be created women as they could exploit their sexuality for pleasure and material gain. They felt men were stupid for paying for "goods" (vagina) they could not take away. Mothers were in agreement with their daughters. Although young women saw exploitation of the female body in positive terms, they were also aware of the health risks but ascribed these to bad luck. Interventions aimed at tackling transactional sex in the interests of women's empowerment and as a strategy for HIV prevention need to understand the cultural beliefs associated with the practice that may make it thrive despite the known risks.<br/
Adjusting HIV prevalence for survey non-response using mortality rates: an application of the method using surveillance data from rural South Africa
Full text linkBackground: the main source of HIV prevalence estimates are household and population-based surveys; however, high refusal rates may hinder the interpretation of such estimates. The study objective was to evaluate whether population HIV prevalence estimates can be adjusted for survey non-response using mortality rates.Methodology/principal findings: data come from the longitudinal Africa Centre Demographic Information System (ACDIS), in rural South Africa. Mortality rates for persons tested and not tested in the 2005 HIV surveillance were available from routine household surveillance. Assuming HIV status among individuals contacted but who refused to test (non-response) is missing at random and mortality among non-testers can be related to mortality of those tested a mathematical model was developed. Non-parametric bootstrapping was used to estimate the 95% confidence intervals around the estimates. Mortality rates were higher among untested (16.9 per thousand person-years) than tested population (11.6 per thousand person-years), suggesting higher HIV prevalence in the former. Adjusted HIV prevalence for females (15–49 years) was 31.6% (95% CI 26.1–37.1) compared to observed 25.2% (95% CI 24.0–26.4). For males (15–49 years) adjusted HIV prevalence was 19.8% (95% CI 14.8–24.8), compared to observed 13.2% (95% CI 12.1–14.3). For both sexes (15–49 years) combined, adjusted prevalence was 27.5% (95% CI 23.6–31.3), and observed prevalence was 19.7% (95% CI 19.6–21.3). Overall, observed prevalence underestimates the adjusted prevalence by around 7 percentage points (37% relative difference).Conclusions/significance: we developed a simple approach to adjust HIV prevalence estimates for survey non-response. The approach has three features that make it easy to implement and effective in adjusting for selection bias than other approaches. Further research is needed to assess this approach in populations with widely available HIV treatment (ART
Demographic Determinants of Paediatric HIV in Generalised HIV Epidemics
Full text linkBackground: Estimates of Paediatric HIV are essential for planning national HIV programs. Although there is a large amount of empirical data on the prevalence of adult HIV from antenatal clinics and national surveys there is very little HIV data for children, necessitating estimates based on knowledge of: HIV infection in pregnant women; transmission rates among pregnant and breastfeeding women according to their treatment status; and survival of infants infected in different ways. It is essential that these inputs into estimating paediatric HIV are as accurate as possible as there is little empirical data to calibrate the final estimates of prevalence of paediatric HIV. Currently there are gaps in the understanding of some of the inputs needed to estimate paediatric HIV and a potential to improve estimates as new data become available, particularly as more widespread availability of antiretroviral treatment changes the circumstances in which children become infected. Aims and Objectives: The aim of the research is to improve and fill gaps in knowledge about the HIV epidemic and thereby improve estimates of paediatric HIV. Objectives include improving estimates of survival of infected children, exploring the acquisition of HIV by women in relation to incidence during pregnancy, furthering understanding of the impact of HIV on fertility and understanding the biases inherent in different data sources. Implications: The new empirical evidence and rigorous methods developed to evaluate the inputs needed to estimate the number of children born to HIV positive women and the prevalence of paediatric HIV will produce more reliable HIV epidemic projections, and will improve information available to policy makers and programme planners
Starting, Stopping and Switching: Contraceptive Dynamics and Fertility in Rural Northern Malawi
Full text linkBackground: This thesis examines the complex relationship between fertility intentions, contraception, and fertility in northern Malawi. Malawi has one of the highest contraceptive prevalence rates (CPR) in sub-Saharan Africa (42%), puzzlingly coupled with one of the highest fertility rates (5.7)[1]. Conventional assessments of contraception do not furnish a clear understanding of contraceptive dynamics. The Karonga Prevention Study (KPS) provides a unique opportunity to unpack these issues.
Methods: A secondary data analysis was conducted to explore whether rates of conception varied by fertility intentions and contraceptive use in Karonga. A new one-year prospective longitudinal study collected provider-recorded data on contraceptive services, using patient-held records for 4,678 women aged 15-49, allowing an exploration of postpartum uptake, contraceptive switching and discontinuation. In-depth interviews explored women’s reasons for contraceptive choices and changes.
Findings: Women who wanted a child within two years had a 45.5% chance of conceiving within two years, as compared to an 11.7% chance for women who wanted no more children. A novel construct of the CPR was used (the “actual CPR”) and estimated at 35.1%. There was high discontinuation of injectables and oral contraception pills (OCP) (only 51.2% of injection-users and 27.9% of OCP-users had their next injection/pill-cycle on time), and just 15.1% managed to adhere to the injection schedule consistently over 12 months. Amongst postpartum women, 28.4% initiated contraception within six months. Women viewed themselves as contraception users even if they were not using the methods consistently.
Implications: The actual CPR was lower than conventional estimates, demonstrating that conventional estimates of contraceptive use must be corrected to account for periods of non-use. The reliance on short-term methods, and high discontinuation rates contribute to persistently high fertility in Malawi. In a context of relatively good provision of contraceptive services, quality of care must be improved, and strategies to motivate women to adhere to their method of choice must be employed. Promotion of long-acting methods is also key
Health, health care and death among older adults in England and Wales: a hundred years' perspective
No full textUnderstanding the role of HIV testing and counselling services in HIV prevention in rural Tanzania
Full text linkThis thesis aims to describe the uptake and coverage of HIV testing and counselling
(HTC) services in a community cohort study in rural Tanzania between 2003 and
2010, and to investigate the impact of HTC on changes in sexual risk behaviour and
HIV incidence.
Paper A uses data from three HTC services (community outreach HTC (CO-HTC),
walk-in HTC (WI-HTC) and antenatal HTC) linked to the community cohort data to
compare the characteristics of services users, and found that while WI-HTC was
most likely attract HIV-positive individuals, the overall proportion of infected persons
diagnosed was greatest at CO-HTC.
Rates of repeat testing are important to understand given potential HIV treatment as
prevention approaches. Paper B found that small proportions of cohort participants
repeat tested between 2003 and 2010, although this improved over time.
Paper C presents a quantitative analysis of the impact of CO-HTC on changes in
sexual behaviour and HIV incidence, and found moderate associations between
HTC use and reductions in some risk behaviours among HIV-negative participants,
but no impacts among HIV-positive individuals or reductions in HIV incidence,
possibly as a result of small sample sizes and a declining background incidence in
the study area.
Paper D presents findings from a qualitative study exploring the effectiveness of HIV
prevention counselling messages, which showed that relationship dynamics
constrained the extent to which HIV-negative women felt able to control their HIVrelated
risk, and imbalanced client-counsellor interactions limited communication
during counselling sessions.
Overall, the findings from the thesis reveal that provision of different HTC models
increased the uptake of services, but the proportions of individuals repeat testing
were low and there was limited evidence for an impact of HTC on sexual risk
reduction. Future research should explore the effectiveness of different HTC
modalities in encouraging repeat testing among high risk HIV-negative individuals,
influencing sexual behaviour change and linking HIV-positive people to care and
treatment
Measuring the Impact of Antiretroviral Therapy Roll-Out on Population Level Fertility in Three African Countries.
Full text linkBACKGROUND: UNAIDS official estimates of national HIV prevalence are based on trends observed in antenatal clinic surveillance, after adjustment for the reduced fertility of HIV positive women. Uptake of ART may impact on the fertility of HIV positive women, implying a need to re-estimate the adjustment factors used in these calculations. We analyse the effect of antiretroviral therapy (ART) provision on population-level fertility in Southern and East Africa, comparing trends in HIV infected women against the secular trends observed in uninfected women. METHODS: We used fertility data from four community-based demographic and HIV surveillance sites: Kisesa (Tanzania), Masaka and Rakai (Uganda) and uMkhanyakude (South Africa). All births to women aged 15-44 years old were included in the analysis, classified by mother's age and HIV status at time of birth, and ART availability in the community. Calendar time period of data availability relative to ART Introduction varied across the sites, from 5 years prior to ART roll-out, to 9 years after. Calendar time was classified according to ART availability, grouped into pre ART, ART introduction (available in at least one health facility serving study site) and ART available (available in all designated health facilities serving study site). We used Poisson regression to calculate age adjusted fertility rate ratios over time by HIV status, and investigated the interaction between ART period and HIV status to ascertain whether trends over time were different for HIV positive and negative women. RESULTS: Age-adjusted fertility rates declined significantly over time for HIV negative women in all four studies. However HIV positives either had no change in fertility (Masaka, Rakai) or experienced a significant increase over the same period (Kisesa, uMkhanyakude). HIV positive fertility was significantly lower than negative in both the pre ART period (age adjusted fertility rate ratio (FRR) range 0.51 95%CI 0.42-0.61 to 0.73 95%CI 0.64-0.83) and when ART was widely available (FRR range 0.57 95%CI 0.52-0.62 to 0.83 95%CI 0.78-0.87), but the difference has narrowed. The interaction terms describing the difference in trends between HIV positives and negatives are generally significant. CONCLUSIONS: Differences in fertility between HIV positive and HIV negative women are narrowing over time as ART becomes more widely available in these communities. Routine adjustment of ANC data for estimating national HIV prevalence will need to allow for the impact of treatment
Estimation of levels and trends in age at first sex from surveys using survival analysis
No full text
- …
