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Peer Reviewed

Title: A new agenda for children affected by HIV/AIDS [editorial]
Source: Lancet. 2009 Feb 14;373(9663):517.
Abstract: As is so often the case in the provision of health care and deciding research agendas, children have been sidelined in the fight against HIV/AIDS. According to the latest UNAIDS figures, nearly 2 million children live with HIV worldwide, two-thirds in sub-Saharan Africa. In addition, 12 million children in sub-Saharan Africa have lost one or two parents due to HIV/AIDS. Many more live with a parent or carer with HIV. A very small proportion of infected children receive antiretroviral treatment, and prevention of mother-to-child transmission is only given to a third of women. Diagnosis in infancy is difficult and therefore often delayed. Child-friendly medication is lacking. 60% of children in southern Africa live in poverty. Now that HIV/AIDS is evolving from an acute emergency into a chronic epidemic, the way to deliver treatment and achieve prevention needs to change radically from an individualistic approach to a broader strategic one. Children and families need to take centre stage. In an excellent report, based on 2 years of research and analyses, the Joint Learning Initiative on Children and HIV/AIDS-an independent alliance of researchers, implementers, activists, policy makers, and people living with HIV-has presented recommendations for such a change in direction. Home Truths: Facing the Facts on Children, AIDS, and Poverty, released on Feb 10, points out three broad policies that will make an immediate and long lasting difference to children: support children through immediate or extended families and deliver integrated family-centred services; strengthen community action to support families; and address family poverty through national social protection. Such policies are AIDS-sensitive but not AIDS-directed. The family is the most important support structure for children. The report argues that the way orphans have been defined (as having lost one or both parents) and have become the centre of attention for many HIV/AIDS policies has been unhelpful, if not damaging. 88% of children labelled as orphans have a surviving parent and overall 95% continue to live with extended families. Additionally, children who live with HIV-positive parents have needs long before their parents die. Children need to stay within a family or kinship structure. Infected children usually live with others who are infected with the virus. The whole family, not the individual, needs to become the unit for support and treatment. The report advocates home health visiting and early childhood development interventions together with strategies to encourage children's education. The use of schools as intervention platforms misses the opportunity to reach children early and to reach those who are not in education-the majority in some countries. Economic strengthening of families has to be the basis to allow many of these programmes to fully succeed. The best immediate support for families is given by com munity groups. International donors need to work with these groups in partnership to avoid duplication, confusion, and waste of time and money. The authors suggest that coordination could be strengthened with a district committee that maintains an active register of community activities and devises a system of accountability that is understood by all and serves the com munity. All activities should be delivered within a framework that is based on best practice. Communities also have a crucial role to act as a backstop when families break down or when children live in an abusive environment. Family poverty and undernutrition can be addressed through income-transfer programmes, such as Mexico's Oportunidades programme or South Africa's child support grants. These projects are efficient and simple, empower women, and can act as a springboard for other more complex schemes, such as microfinance loans. Such economic support increases school attendance, reduces illnesses, improves growth, and encourages uptake of health services. The largest portion of money is usually used to purchase food. Extreme poverty, rather than HIV infection, should be used as a criterion to avoid stigma and resentment. The report argues that "any developing country, no matter how poor, can afford social protection packages for children". The positive effect of this policy is now established beyond doubt and no further pilot studies are needed. To integrate all these strategies, governments need to take the lead with national plans and frameworks to scale-up programmes for children and families. With this approach, society as a whole will be strengthened with intergenerational effects that will go a long way towards, but also go well beyond, tackling the effects of HIV/AIDS. Putting children and families at the centre will show long-term vision with guaranteed future benefits. (fulll-text)
Language: English
Keywords:
AFRICA, SUB SAHARAN | SUMMARY REPORT | CHILDREN | HIV INFECTIONS | AIDS | POVERTY | MALNUTRITION | CHILD HEALTH | HEALTH SERVICES | DELIVERY OF HEALTH CARE | TREATMENT | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Socioeconomic Factors | Economic Factors | Nutrition Disorders | Health | Medical Procedures | Medicine
Document Number: 341049

Title: Advice columns in South African print publications.
Author: Soul City Institute for Health and Development Communication
Source: [Houghton, South Africa], Soul City Institute for Health and Development Communication, [2009]. 17 p.
Abstract: This paper reports on a study about letters to and responses from advice columnists in 13 South African publications over a three-month period. Approximately 40 percent of letters to the columnists asked for advice about multiple concurrent partnerships, but less than half of the answers included information related to HIV and the increased risk of infection that accompanies such relationships. Instead, the columnists chose to focus on emotional or moral issues of concurrent partnerships. The paper highlights this missed opportunity to address HIV-prevention issues.
Language: English
Keywords:
SOUTH AFRICA | SUMMARY REPORT | RESPONDENTS | PRINTED MEDIA | HIV INFECTIONS | AIDS | KNOWLEDGE | COUNSELING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Mass Media | Communication | Viral Diseases | Diseases | Sociocultural Factors | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 331820

Title: A strategic approach: HIV & AIDS and education.
Author: UNAIDS. Inter-Agency Task Team on Education
Source: Paris, France, UNESCO, 2009 May. 53 p. Also available: http://unesdoc.unesco.org/images/0016/001627/162723f.pdf (French) and http://unesdoc.unesco.org/images/0016/001627/162723s.pdf (Spanish).
Abstract: This publication provides a strategic vision of the role that education must play in addressing HIV and AIDS. It targets decision-makers and practitioners in the education sector, as well as colleagues who work on HIV and AIDS responses in other sectors. It can be used as an advocacy tool to build commitment to the role of education in the HIV and AIDS response and to generate multisectoral partnerships for implementation.
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | PERSONS LIVING WITH HIV/AIDS | EDUCATION | AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | SCHOOLS | HIV PREVENTION | AIDS PREVENTION | TREATMENT | HIV TESTING | HEALTH EDUCATION | HEALTH SERVICES | PROGRAM ACCESSIBILITY | PROGRAM ACTIVITIES | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Delivery of Health Care | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Program Evaluation | Programs | Organization and Administration
Document Number: 342035

Title: Expert Group Meeting to Assess the Progress in the Implementation of the Plan of Action on Population and Poverty Adopted at the Fifth Asian and Pacific Population Conference, 3-5 February 2009, Bangkok. Report.
Author: United Nations. Economic and Social Commission for Asia and the Pacific [ESCAP]; United Nations Population Fund [UNFPA]
Source: Bangkok, Thailand, ESCAP, 2009. 38 p.
Abstract: The Expert Group Meeting to Assess the Progress in the implementation of the Plan of Action on Population and Poverty adopted at the Fifth Asian and Pacific Population Conference was held at the United Nations Conference Centre, Bangkok from 3 to 5 February 2009. The Expert Group Meeting was organized by the Social Policy and Population Section, Social Development Division, ESCAP in collaboration with the UNFPA Asia and the Pacific Regional Office. The meeting benefited from background papers and country reports prepared by resource persons and representatives of governments.
Language: English
Keywords:
ASIA | OCEANIA | CONFERENCES AND CONGRESSES | ESCAP | POPULATION | SUSTAINABLE DEVELOPMENT | POVERTY | REPRODUCTIVE HEALTH | MATERNAL-CHILD HEALTH SERVICES | GENDER ISSUES | MIGRATION | HIV INFECTIONS | AIDS | IMPLEMENTATION | Developing Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Economic Development | Economic Factors | Socioeconomic Factors | Health | Primary Health Care | Health Services | Delivery of Health Care | Population Dynamics | Demographic Factors | Viral Diseases | Diseases | Programs | Organization and Administration
Document Number: 331854

10.

Title: The economic burden of HIV and AIDS on households in Nigeria.
Author: Adedigba MA; Naidoo S; Abegunde A; Olagundoye O; Adejuyigbe E; Fakande I
Source: African Journal of AIDS Research. 2009 Apr;8(1):107-114.
Abstract: The study estimates the economic burden of HIV and AIDS on households in a Nigerian population. The data derive from a cross-sectional survey of households affected by HIV or AIDS in Ife-Ijesa Zone, Osun State, Nigeria. The sample consisted of 117 purposively selected, consenting adult HIV patients attending a general and teaching hospital. Participants were asked to self-report monetary expenses for HIV-related care, loss of savings, and funeral costs. The data show a significantly sharp drop in the participants' household income as a result of care for HIV-related illnesses, from the time of knowing one's HIV status to the time of illness, among three occupational categories (artisans, civil servants and unemployed; p = 0.02). Mean income among those in the unemployed category fell by 84.1%, income among artisans dropped by 72.6%, and income among civil servants decreased by 44.4%. The monetary loss during the course of HIV-related illnesses was heaviest for the artisan group, followed by the unemployed and the civil servants. Those who had lost a substantial part of their savings to HIV-related care were most numerous among the unemployed, followed by artisans and civil servants. Out of 16 households, 11 (42.3%) had received support from relatives during a funeral ceremony. There was a significant association between the occupational group and working for more hours after illness ( 2 = 9.28, df = 4; p = 0.05). Nearly all orphaned children were distributed to the extended family following the AIDS death of a parent. Among all the occupational groups, borrowing from a cooperative society during the course of HIV-related sickness was the commonest form. The findings add to data showing that despite the extended family support system, adult deaths due to AIDS continue to undermine the viability of sub-Saharan African households.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | SAMPLING STUDIES | HOUSEHOLDS | AIDS | HIV INFECTIONS | ECONOMIC FACTORS | EXPENDITURES | INCOME | POVERTY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Financial Activities | Socioeconomic Factors
Document Number: 341292

11.

Title: The conceptions of care among family caregivers of persons living with HIV/AIDS in Addis Ababa, Ethiopia.
Author: Aga F; Kylma J; Nikkonen M
Source: Journal of Transcultural Nursing. 2009 Jan;20(1):37-50.
Abstract: This focused ethnographic study explores and describes the conceptions of care among family caregivers of people living with HIV/AIDS (PLWAs) in Addis Ababa, Ethiopia. Leininger's theory of culture care diversity and universality is the conceptual anchor of this ethnographic study. Using semistructured interviews and participant observation, 6 key informants and 12 general informants were interviewed in their home in Amharic language. Data were analyzed in Amharic using Leininger's phases of ethnonursing analysis for qualitative data and then translated to English. Four major themes representing family caregivers' conceptions of care were identified: nourishing the PLWA while struggling with poverty, maintenance of cleanliness and hygiene of the person and surroundings, comforting the PLWA, and sacrificing self to sustain the PLWA. Valuable data were gathered about the family caregivers' conceptions of care. Nurses can use this knowledge to design and provide culturally congruent care to family caregivers and PLWAs in the community.
Language: English
Keywords:
ETHIOPIA | RESEARCH REPORT | QUALITATIVE RESEARCH | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | AIDS | PERCEPTION | CARE AND SUPPORT | TREATMENT | HYGIENE | POVERTY | SANITATION | FAMILY AND HOUSEHOLD | HOME CARE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Viral Diseases | Diseases | Psychological Factors | Behavior | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine | Public Health | Socioeconomic Factors | Economic Factors | Sociocultural Factors
Document Number: 330218

12.

Peer Reviewed

Title: Presentation and survival of patients with AIDS-related Kaposi's sarcoma in Jos, Nigeria.
Author: Agaba PA; Sule HM; Ojoh RO; Hassan Z; Apena L; Mu'azu MA; Badung B; Agbaji OO; Idoko JA; Kanki P
Source: International Journal of STD and AIDS. 2009 Jun;20(6):410-3.
Abstract: AIDS-related Kaposi's sarcoma (AIDS-KS) remains a significant cause of morbidity and mortality. We describe the pattern of presentation and survival in Jos, Nigeria. We identified 48 HIV-positive patients with AIDS-KS and matched them for age and sex with an equal number of HIV-positive patients without AIDS-KS. We compared their clinical, immunological, virological characteristics and survival. They were similar in age and body mass index profile but patients with AIDS-KS had more tuberculosis co-infection (P, 0.02), lower median CD4 count (P, 0.003) and higher mortality (P, 0.002). Surprisingly, patients with AIDS-KS had lower levels of median viral load (29,347 copies/mL) compared with controls (80,533 copies/mL). We recommend specific AIDS-KS therapy in addition to highly active antiretroviral therapy in order to improve survival.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | AIDS | SIGNS AND SYMPTOMS | ANTIRETROVIRAL THERAPY | LIFE EXPECTANCY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | HIV | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 342440

13.
Title: Attitudes of healthcare providers towards patients with HIV/AIDS in Bandar Abbas.
Author: Aghamolaei T; Tavafian SS; Hasani L; Zare S
Source: Archives of Iranian Medicine. 2009 May;12(3):298-301.
Abstract: We aimed to investigate the attitudes of healthcare providers towards patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Bandar Abbas, south of Iran. In this cross-sectional study, a random sample of 250 healthcare providers completed a 20-item questionnaire from January first through February 30th, 2007. There were five domains of attitudes towards patients with HIV. The items measured as a five-point Likert scale ranging from strongly disagree to strongly agree. The mean age of the healthcare providers was 31.3 (SD=7.3) years. Of them 24.4% were males, 42.4% had received Bachelor of Science degree, 19.2% were physicians, 63.2% were nurses, and 17.6% were laboratory technicians. The respondents had fairly positive attitudes towards patients with HIV. Men, older age, more educated participants, and laboratory technicians had more favorable attitude towards HIV (P<0.05).
Language: English
Keywords:
IRAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | HEALTH PERSONNEL | CLIENTS | PERSONS LIVING WITH HIV/AIDS | STAFF ATTITUDE | HIV INFECTIONS | AIDS | LABORATORY PROCEDURES | Middle East | Developing Countries | Research Methodology | Delivery of Health Care | Health | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Attitudes | Psychological Factors | Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services
Document Number: 342660

14.
Title: An assessment of the knowledge, attitudes, and risk perceptions of pharmacy students regarding HIV/AIDS.
Author: Ahmed SI; Hassali MA; Aziz NA
Source: American Journal of Pharmaceutical Education. 2009 Feb 19;73(1):15.
Abstract: OBJECTIVE: To evaluate the level of knowledge, attitudes, and risk perceptions of University Sains Malaysia final-year pharmacy students regarding human immunodeficiency virus (HIV) and acquired immunity deficiency syndrome (AIDS). METHOD: A cross-sectional study among pharmacy students. Data were analyzed with Chi-square to find difference at p value < 0.05. RESULTS: The majority of students (83.07%) responded showing a difference in gender and race. Students showed low willingness (9.2%) to assist patients and low confidence (36.1%) in their education about HIV/AIDS patients. Students recommended HIV testing for health care professionals (69.4%) and patients (75.9%) before surgical procedures. Students knew little about Post Exposure Prophylaxis (18.5%) or about the time for HIV to develop into AIDS (57.4%). About 40% of students were unaware of the inability of antivirals to treat HIV/AIDS. Students had low awareness for opportunistic infections (18.5%), and low agreement on competency to treat and counsel HIV patients (12.9%). CONCLUSION: The study highlighted students' misconceptions, negative attitudes, and risk perceptions towards HIV/AIDS.
Language: English
Keywords:
MALAYSIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | STUDENTS | PHARMACISTS | UNIVERSITIES | KNOWLEDGE | ATTITUDES | RISK FACTORS | PERCEPTION | HIV INFECTIONS | AIDS | TREATMENT | EXPOSURE | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Education | Health Personnel | Delivery of Health Care | Health | Schools | Sociocultural Factors | Psychological Factors | Behavior | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services
Document Number: 342691

15.

Peer Reviewed

Title: Effects of school health nursing education interventions on HIV/AIDS-related attitudes of students in Akwa Ibom State, Nigeria.
Author: Akpabio II; Asuzu MC; Fajemilehin BR; Ofi AB
Source: Journal of Adolescent Health. 2009 Feb;44(2):118-123.
Abstract: Purpose: One of the greatest challenges facing school nurses is that of identifying and using appropriate strategies to meet the health education needs of adolescents in regard to prevention of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). This study examined the effects of HIV/AIDS preventive health education with parental involvement on students' attitude toward HIV/AIDS prevention in Akwa Ibom State, Nigeria. Methods: The study population comprised students from three of nine secondary schools in the study area. The three schools were randomly assigned as Intervention Group 1 (IG1), involving nurses only; Intervention Group 2 (IG2), involving both nurses and parents (IG2); and a control group. A pretest/ post-test intervention design was used. A 29-item, validated questionnaire was the instrument for data collection. Sampling involved multistage and stratified random technique to select 120 subjects from each of the three selected schools, with a total of 360 subjects representing 8.3% of the study population. From this number, 339 (94.2%) provided sufficient data for analysis. Data analysis involved analysis of covariance and the Scheff� post hoc test determined at the .05 significance level. Results: Results show significant effect of intervention on students attitudes toward preventive measures (F<234.27, p .001*). The intervention that involved nurses only was found to be a more potent strategy in providing favorable attitudes toward HIV/AIDS prevention (IG1 mean, 20.59; IG2 mean, 19.20; control mean, 12.34). Attitudes were influenced by older age but not by gender. Conclusion: Health education efforts aimed at improving HIV/AIDS-related attitudes should not only focus on children but also on parents so that they in turn could assist to improve on health workers' efforts in educating the children.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | INTERVENTIONS | STUDENTS | NURSES AND NURSING | HEALTH EDUCATION | ATTITUDES | HIV INFECTIONS | AIDS | PARENTAL INVOLVEMENT | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Programs | Organization and Administration | Education | Health Personnel | Delivery of Health Care | Health | Psychological Factors | Behavior | Viral Diseases | Diseases | Child Rearing
Document Number: 330164

16.

Peer Reviewed

Title: Seroreversion in children born to HIV-positive and AIDS mothers from Central West Brazil.
Author: Alcantara KC; Pereira GA; Albuquerque M; Stefani MM
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):620-6.
Abstract: The spread of HIV-1 infection among women of childbearing age has led to increasing numbers of children at risk of vertical transmission. This study aimed to assess child outcomes among HIV-positive (n=19) and AIDS (n=22) mothers from Central West Brazil. CD4(+) T-cell counts (FACScount, BD) and viral loads (HIV-1 RT-PCR, Amplicor HIV-1 Monitor Roche) were assessed at delivery and during the first 6 months of life. Heteroduplex mobility assay identified env and gag HIV-1 subtypes. Frequencies and medians were calculated. HIV-positive and AIDS mothers did not differ with regard to age, antiretroviral prophylaxis, parity and viral load. AIDS mothers had lower CD4(+) T-cell counts. One vertical transmission and a neonatal death were observed. Gestational age, gender and oral zidovudine prophylaxis were similar regardless of maternal clinical status. Infants born to AIDS mothers had lower birthweight and shorter time to seroreversion. Eight infants were lost to follow-up, and two were breastfed due to delayed maternal diagnosis. HIV-1 B(env)/B(gag) subtype were 75.6%; discordant B(env)/F(gag) were 12.2%. Exposed uninfected infants born to AIDS mothers with lower CD4(+) T-cell counts seroreverted earlier than infants born to asymptomatic HIV-positive mothers. It is possible that maternal immunological status may impact on the time to seroreversion.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | MOTHERS | PERSONS LIVING WITH HIV/AIDS | MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | LABORATORY PROCEDURES | AIDS | HIV INFECTIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Transmission | Infections | Infant Nutrition | Nutrition | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 342742

17.

Peer Reviewed

Title: High-risk behaviours among juvenile prison inmates in Pakistan.
Author: Altaf A; Janjua NZ; Kristensen S; Zaidi NA; Memon A; Hook EW 3rd; Vermund SH; Shah SA
Source: Public Health. 2009 Jul 15;
Abstract: OBJECTIVES: To assess the sexual- and drug-use-related risk behaviours of male juvenile detainees in Karachi, Pakistan. DESIGN: Cross-sectional study. METHODS: A cross-sectional study was conducted of prison inmates aged 15-21 years in Karachi Juvenile Prison in 2002. In total, 321 inmates were interviewed about sexual orientation and behaviours, and knowledge about human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Urine specimens were collected and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction. RESULTS: A substantial proportion (n=111, 34.6%) of the participants were sexually active. Sixty-two (19%) and 67 (21%) had had sex with a male or female before incarceration, respectively. Twenty-seven (8.4%) participants had an STI, and 50% of the 109 sexually active participants had had multiple sexual partners. Use of addictive substances was associated with sexual activity. The mean knowledge score computed from the sum of 16 items was 4.7, with a median of 2.9. A large proportion (40%) of participants knew about condoms, but very few (3.4%) had ever used one. The mean+/-standard deviation risk score from nine items was 2.4+/-1.7. On the basis of behavioural and biological markers, 117 (36.4%) participants had high-risk behaviour. In multivariate logistic regression analysis, knowledge, risk perception and age were predictive of higher risk. CONCLUSIONS: HIV risk behaviours are common among adolescent inmates. Although inmates do have knowledge about modes of transmission and condom use, the use of condoms is significantly low. Interventions are needed for behavioural change among this group.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | YOUTH | PRISONERS | SEX BEHAVIOR | DRUG USE AND ABUSE | ALCOHOL USE AND ABUSE | KNOWLEDGE | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | AIDS | Developing Countries | Asia, Southern | Asia | Age Factors | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Behavior | Reproductive Tract Infections | Infections | Diseases | Viral Diseases
Document Number: 342285

18.

19.

20.

Peer Reviewed

Title: Media saturation, communication exposure and HIV stigma in Nigeria.
Author: Babalola S; Fatusi A; Anyanti J
Source: Social Science and Medicine. 2009 Apr;68(8):1513-20.
Abstract: HIV-related stigma constitutes an impediment to public health as it hampers HIV/AIDS control efforts in many ways. To address the complex problems of increasing HIV infection rate, widespread misinformation about the infection and the rising level of HIV-related stigma, the various tiers of government in Nigeria are working with local and international non-governmental organizations to develop and implement strategic communication programs. This paper assesses the link between these communication efforts and HIV-related stigma using data from a nationally representative household survey. The results show that accepting attitudes towards people living with HIV are more prevalent among men than among women. Exposure to HIV-related communication on the media is associated with increased knowledge about HIV, which is in turn a strong predictor of accepting attitudes. Communication exposure also has a significant and positive association with accepting attitudes towards people living with HIV. In contrast, community media saturation is not strongly linked with accepting attitudes for either sex. The findings strongly suggest that media-based HIV programs constitute an effective strategy to combat HIV/AIDS-related stigma and should therefore be intensified in Nigeria.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | SURVEYS | HOUSEHOLDS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | AIDS | STIGMA | MASS MEDIA | COMMUNICATION PROGRAMS | ATTITUDES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Sampling Studies | Studies | Research Methodology | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Social Problems | Communication | Psychological Factors | Behavior
Document Number: 341694

21.

Peer Reviewed

Title: Sensitivity of paediatric AIDS score vs. WHO case classification in Indian children--a retrospective study.
Author: Banerjee T; Pensi T; Banerjee D
Source: Journal of Tropical Pediatrics. 2009 Apr;55(2):91-6.
Abstract: This study was conducted at the Department of Paediatrics, Dr Ram Manohar Lohia Hospital, to test the statistical significance of existing World Health Organization (WHO) clinical case definition (CCD) for diagnosis of AIDS in areas where diagnostic resources are limited. A total of 360 cases between 18 months and 12 years of age satisfying WHO case definitions of AIDS were included in study group. Our study detected 16.66% (60) of HIV incidence in children visiting the paediatrics outpatient clinic. Twenty percent of cases manifested three major and two minor signs, which had sensitivity of 73.33%; specificity, 90.66% and positive predictive value (PPV), 61.11%. Stepwise logistic analysis identified weight loss, chronic fever >1 month and total lymphocyte count <1500 cells mm(-3) as important predictors. Eighty-six cases (23.89%) showed two major and two minor signs with sensitivity and specificity of 86.66 and 88.66%, respectively. Thus a CCD based on 13 clinical signs/symptoms was proposed for paediatric AIDS with better sensitivity and PPV than the WHO case definition but with almost similar specificity.
Language: English
Keywords:
INDIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HIV TESTING | AIDS | LABORATORY PROCEDURES | EXAMINATIONS AND DIAGNOSES | SIGNS AND SYMPTOMS | STANDARDS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 331192

22.

Title: Minimally invasive surgery for children with HIV/AIDS.
Author: Banieghbal B
Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):97-101.
Abstract: AIM: Human deficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have resulted in millions of deaths in Sub-Saharan Africa from opportunist infections. Children are not spared and are similarly affected. Minimally invasive surgery (MIS) can be used, in a selected number of children, as a mean to establish diagnosis or render a treatment. MATERIALS AND METHODS: This study was comprised of a 7-year retrospective analysis of a single pediatric surgeon's experience in South Africa. Forty-eight children, with ages 3 months to 14 years, with HIV/AIDS underwent laparoscopic/thoracoscopic exploration and treatment. RESULTS: Diagnostic laparoscopy and biopsy were the most common procedures (29 cases) indicated for nonspecific abdominal pain or rectal bleeding. The second most common procedure was laparoscopic antireflux fundoplication (10 cases) for damaged lower esophageal sphincter secondary to chronic candidal infection. The remaining procedures were for other rare surgical conditions, seen often in AIDS patients. No significant procedure-related complications occurred, but there were 2 mortalities from the underlying pathology in this cohort. CONCLUSIONS: This is the largest report on MIS for children with HIV/AIDS in the medical literature. It is shown that laparoscopic/thoracoscopic exploration and treatment in children with HIV/AIDS is safe and indicated for establishing the diagnosis and treatment of these unfortunate children.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | SURGERY | LAPAROSCOPY | PHYSICAL EXAMINATIONS AND DIAGNOSES | PAIN | BLEEDING | CANDIDIASIS | GASTROINTESTINAL EFFECTS | COMPLICATIONS | AIDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Examinations and Diagnoses | Signs and Symptoms | Bacterial and Fungal Diseases | Infections | Physiology | Biology
Document Number: 330998

23.

Peer Reviewed

Title: "Conditional scholarships" for HIV/AIDS health workers: educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa.
Author: Barnighausen T; Bloom DE
Source: Social Science and Medicine. 2009 Feb;68(3):544-51.
Abstract: Without large increases in the number of health workers to treat HIV/AIDS (HAHW) many countries in sub-Saharan Africa will be unable to achieve universal coverage with antiretroviral treatment (ART), leading to large numbers of avoidable deaths among people living with HIV/AIDS. We conduct a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of "conditional scholarships" in sub-Saharan Africa. The scholarships are highly eNPV-positive under a wide range of assumptions. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an eNPV of 1.24 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing "conditional scholarships" for HAHW, especially in countries where health worker education capacity is currently underutilized or can be rapidly expanded.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | MARKOV CHAIN | LABOR FORCE | HEALTH PERSONNEL | HUMAN RESOURCES | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | AIDS | COST BENEFIT ANALYSIS | MANAGEMENT | Africa | Developing Countries | Probability | Statistical Studies | Studies | Research Methodology | Economic Factors | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Organization and Administration
Document Number: 330870

24.

Peer Reviewed

Title: Effects of a rapid peer-based HIV/AIDS educational intervention on knowledge and attitudes of high school students in a high-income Arab country.
Author: Barss P; Grivna M; Ganczak M; Bernsen R; Al-Maskari F
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):86-98.
Abstract: INTRODUCTION: In response to low knowledge about HIV and intolerant attitudes toward persons living with HIV among Arab university students, a peer-based educational intervention was developed and impact evaluated on knowledge and attitudes of high school students in 2 of 4 main cities of United Arab Emirates. METHODS: Four small teams of final year medical students, 3 female and 1 male, were trained. Multistage random sampling selected 14 female and 5 male Arab schools, then 56 female and 14 male grade 12 classes in Al Ain and Abu Dhabi. The 90-minute intervention included a factual presentation and 3 attitude workshops. Baseline and postintervention knowledge and attitudes were assessed. Significance was tested by McNemar, Wilcoxon signed rank, and multilevel regression tests. RESULTS: Response was 99.6%, 1398 females and 505 males. Misconceptions about modes of transmission and intolerant attitudes were evident. Mean knowledge score improved from 65% to 82% and attitude 51% to 64%, that is, relative increase 26% (P < 0.0005). Females had slightly lower baseline knowledge than males but showed greater improvement in knowledge and attitudes (P < 0.0005) CONCLUSIONS: Grade 12 students' knowledge about HIV/AIDS was inadequate and attitudes stigmatizing. Peer-based knowledge workshops were effective, especially among females. Concise integrated teaching and workshops designed to address key knowledge and attitudinal deficiencies can be highly effective.
Language: English
Keywords:
MIDDLE EAST | RESEARCH REPORT | STUDENTS | SECONDARY SCHOOLS | HIGH INCOME POPULATION | KNOWLEDGE | ATTITUDES | SEX BEHAVIOR | SEX EDUCATION | HIV INFECTIONS | AIDS | INTERVENTIONS | STIGMA | ADOLESCENT HEALTH | PROMOTION | AIDS PREVENTION | HIV PREVENTION | EPIDEMIOLOGY | Education | Schools | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Sociocultural Factors | Psychological Factors | Behavior | Viral Diseases | Diseases | Programs | Organization and Administration | Social Problems | Health | Marketing | Public Health
Document Number: 342885

25.

Peer Reviewed

Title: Reflecting and shaping the discourse: the role of music in AIDS communication in Tanzania.
Author: Bastien S
Source: Social Science and Medicine. 2009 Apr;68(7):1357-60.
Abstract: Failure to recognize the importance of oral traditions in Africa and the potential of music and song for stimulating social and behavior change would represent a missed opportunity in HIV prevention strategies. Local narratives concerning AIDS are often utilized in popular songs and constitute rich sources of contextual information about the epidemic that have thus far been un- or underutilized in HIV prevention strategies. Endogenously conceived messages delivered via a channel such as music increase the likelihood of messages being contextually appropriate and culturally engaging. This form of media also presents the greatest opportunity for wide dissemination. Drawing on field work conducted in the Kilimanjaro region, this paper presents examples of how music and musicians in Tanzania reflect and potentially shape AIDS discourse. Three broad recurrent themes addressed in songs are discussed: AIDS metaphors, stigma and broader HIV prevention messages. By tapping into the wealth of information about AIDS discourse contained within popular songs, and by recognizing musicians as potential opinion leaders and agents of social change, the effectiveness of prevention strategies may be increased.
Language: English
Keywords:
TANZANIA | RESEARCH REPORT | BEHAVIOR CHANGE | MUSIC | HIV PREVENTION | HIV INFECTIONS | AIDS | COMMUNICATION STRATEGY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Behavior | Culture | Sociocultural Factors | Viral Diseases | Diseases | Communication
Document Number: 341617

26.

Peer Reviewed

Title: The intergenerational impact of the African orphans crisis: a cohort study from an HIV/AIDS affected area.
Author: Beegle K; De Weerdt J; Dercon S
Source: International Journal of Epidemiology. 2009 Apr;38(2):561-8.
Abstract: BACKGROUND: In sub-Saharan Africa, the prevalence of orphanhood among children has been greatly exacerbated by the HIV/AIDS pandemic. If orphanhood harms a child's development and these effects perpetuate into adult life, then the African orphan crisis could seriously jeopardize the continent's future generations. Whether or not there exists an adverse, causal and intergenerational effect of HIV/AIDS on development is of crucial importance for setting medical priorities. This study is the first to empirically investigate the impact of orphanhood on health and schooling using long-term longitudinal data following children into adulthood. METHODS: We examined a cohort of 718 children interviewed in the early 1990s and again in 2004. Detailed survey questionnaires and anthropometric measurements were administered at baseline and during a follow-up survey. Final attained height and education (at adulthood) between children who lost a parent before the age of 15 and those who did not were compared. RESULTS: On average, children who lose their mother before the age of 15 suffer a deficit of around 2 cm in final attained height (mean 1.96; 95% CI 0.06-3.77) and 1 year of final attained schooling (mean 1.01; 95% CI 0.39-1.81). This effect is permanent and the hypothesis that it is causal cannot be rejected by our study. Although father's death is a predictor of lower height and schooling as well, we reject the hypothesis of a causal link. CONCLUSIONS: The African orphan crisis, exacerbated by the HIV/AIDS epidemic will have important negative intergenerational effects.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | COHORT ANALYSIS | PREVALENCE | ORPHANS AND VULNERABLE CHILDREN | CHILD HEALTH | CHILD DEVELOPMENT | HIV | AIDS | HUMAN CAPITAL | IMPACT | Developing Countries | Research Methodology | Measurement | Family and Household | Sociocultural Factors | Health | Biology | HIV Infections | Viral Diseases | Diseases | Human Resources | Economic Factors | Communication
Document Number: 341016

27.
Title: The President's Emergency Plan for AIDS Relief in Africa: an evaluation of outcomes.
Author: Bendavid E; Bhattacharya J
Source: Annals of Internal Medicine. 2009 May 19;150(10):688-95.
Abstract: BACKGROUND: Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. However, the effect of PEPFAR on HIV-related outcomes is unknown. OBJECTIVE: To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa. DESIGN: Comparison of trends before and after the initiation of PEPFAR's activities. SETTING: 12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007 (451 country-year observations). INTERVENTION: A 5-year, $15 billion program for HIV treatment, prevention, and care that started in late 2003. MEASUREMENTS: HIV-related deaths, the number of people living with HIV, and HIV prevalence. RESULTS: Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5% lower in the focus countries than in the control countries (P = 0.001). The difference in trends between the groups before 2003 was not significant. The annual growth in the number of people living with HIV was 3.7% slower in the focus countries than in the control countries from 1997 to 2002 (P = 0.05), but during PEPFAR's activities, the difference was no longer significant. The difference in the change in HIV prevalence did not significantly differ throughout the study period. These estimates were stable after sensitivity analysis. LIMITATION: The selection of the focus countries was not random, which limits the generalizability of the results. CONCLUSION: After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ. Assessment of epidemiologic effectiveness should be part of PEPFAR's evaluation programs. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | CAUSES OF DEATH | HIV INFECTIONS | AIDS | PROGRAM EFFECTIVENESS | PROGRAM EVALUATION | Developing Countries | Studies | Research Methodology | Measurement | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration
Document Number: 341612

28.

29.

Peer Reviewed

Title: Preventive service needs of young people perinatally infected with HIV in Uganda.
Author: Birungi H; Obare F; Mugisha JF; Evelia H; Nyombi J
Source: AIDS Care. 2009 Jun;21(6):725-731.
Abstract: This study examines the sexual expressions and experiences as well as the preventive practices of 732 adolescent boys and girls aged 15-19 years who were born with HIV. The data come from a project on the sexuality of young people perinatally infected with HIV conducted in 2007 in four districts of Uganda. The analysis involves both quantitative and qualitative approaches. The quantitative approach entails cross-tabulations with chi-square tests as well as significance tests of proportions. The qualitative approach involves an analysis of individual case stories, in-depth probes, and focus group discussions for content. The findings show disconnect between: (1) the information service providers give to young people and young people's actual needs and desires; (2) adolescents' fears and their actual preventive practices; and (3) the high level of reported condom use and the frequency of use. Programs need to recognize that young people perinatally infected with HIV are sexually active or anticipatebeing so in future.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | DATA ANALYSIS | YOUTH | PERSONS LIVING WITH HIV/AIDS | ADOLESCENT PREGNANCY | HIV INFECTIONS | AIDS | HIV PREVENTION | SEX BEHAVIOR | FEAR | CONDOM USE | PREGNANCY, UNWANTED | REPRODUCTIVE HEALTH | HEALTH SERVICES | NEEDS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Reproductive Behavior | Fertility | Population Dynamics | Behavior | Emotions | Psychological Factors | Risk Reduction Behavior | Health | Delivery of Health Care | Economic Factors
Document Number: 339860

30.

Peer Reviewed

Title: Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit.
Author: Black V; Brooke S; Chersich MF
Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 1):292-9.
Abstract: OBJECTIVE:: To review facility-based maternal deaths at a tertiary-level center in Johannesburg, South Africa, during a 5-year period (2003 to 2007) and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduced in late 2004. METHODS:: Patient case files, birth registers, death certificates, and mortality summaries were reviewed. Cause of death was assigned through clinical case discussion. Annual maternal mortality ratios were calculated and disaggregated by HIV status. RESULTS:: During the 5-year period, 106 maternal deaths occurred out of 36,708 births (facility-based maternal mortality ratios 289/100,000 live births, 95% confidence interval [CI] 237-349/100,000). In 72% of cases, HIV status was known (76/106), with the majority being HIV-infected (78%, 59/76). Among HIV-infected women, only two had initiated antiretroviral treatment, and 70% of deaths were HIV-related (41/59), mainly from tuberculosis (21) and pneumonia (12). Direct obstetric causes of death such as hypertension and pregnancy-related sepsis predominated in women who were HIV-negative or of unknown status (48.9%, 23/47). Maternal mortality ratios in HIV-infected women were 776/100,000 (95% CI 591-1,000/100,000), 6.2-fold higher (95% CI 3.6-11.4) than in HIV-negative women (124/100,000, 95% CI 72-199/100,000). Changes in mortality over time were not detected. Although HIV testing increased 1.4-fold each year (95% CI 1.3-1.4) and estimated coverage of antiretroviral treatment for pregnant women reached 59.2% in 2007, levels remain suboptimal. CONCLUSION:: In Johannesburg, HIV remains the major cause of maternal mortality despite integration of antiretroviral treatment into prenatal services. Maternal health services should target barriers to uptake of HIV treatment and care. LEVEL OF EVIDENCE:: III.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | PREGNANT WOMEN | HYPERTENSION | MATERNAL-CHILD HEALTH SERVICES | HIV INFECTIONS | AIDS | MATERNAL MORTALITY | CAUSES OF DEATH | HIV/FP INTEGRATION | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Vascular Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Viral Diseases | Mortality | Population Dynamics | Medical Procedures | Medicine
Document Number: 342270


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