Proximate context of HIV-related stigma and utilization of skilled childbirth services in Uganda

Abstract

Background: Recently there have been many encouraging developments in the global effort to combat HIV and AIDS. The latest data collected by UNAIDS on the status of the disease showed a 33% reduction in new HIV cases since 2001 and a decrease of 700,000 deaths annually since the peak in 2005. 1 Within the 34 countries that make up the Organization for Economic Cooperation and Development (OECD), public health efforts have been successful in reducing the incidence of AIDS and improving the survival of those infected with HIV. 2 However, the incidence of new HIV infections remain stubbornly high with socioeconomically deprived communities, and women in particular, making up a disproportionate number of new cases. 3 There is a need for a greater understanding of the prevention interventions which can successfully educate this population, change behaviors associated with transmission and ultimately reduce the spread of sexually transmitted diseases such as HIV. The aim of this work was to identify, characterize and evaluate health interventions aimed at preventing HIV infection in women from socioeconomically disadvantaged ethnic mintority groups in OECD countries. Methods: A systematic review was undertaken of available publications related to HIV prevention interventions for socioeconomically deprived ethnic minority women in OECD member countries. Specific search strategies were designed for the databases Medline (Ovid), CINAHL, Embase, Scopus, and Web of Knowledge. Other searches were also done using relevant keywords in different databases such as Cochrane Library, CRD Databases, metaRegister of Controlled Trials, EURONHEED, CEA Registry, and European Action Program for Health Inequities, among others. When possible, a meta-analysis was performed using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies. Findings: We identified 34 articles analyzing 43 different prevention interventions with a total number of 13,318 participants. All of the interventions were carried out in the United States. The majority of the interventions were based on cognitivebehavioral models directed principally at reducing risky behaviors and were culturally adapted to the target population. Most programs obtained some benefits over control groups in the outcome measures of HIV knowledge, risk related behaviors and STD transmission reduction. A meta-analysis of 5 randomized controlled trials showed a 41% reduction in STD transmission rates (RR .59: 95% CI .46-.75; p < 0.05). Interpretation: HIV prevention interventions for socioeconomically deprived ethnic minority women are efficacious at improving knowledge of HIV, reducing risky behaviors associated with transmission as well as reducing the transmission of STD’s. Future prevention programming should incorporate the identified characteristics associated with successful behavior modification and disease prevention. Additional research is needed of this population outside of the United States. Funding: None. Abstract #: 02CD017