high-HIV Area Research Articles

Demographics and incidence of anal squamous cell carcinoma in people living in high HIV prevalence geographical areas

ObjectivesAnal squamous cell carcinoma (ASCC) is an uncommon cancer that is rapidly increasing in incidence. HIV is a risk factor in the development of ASCC, and it is thought that...

Women’s economic status and sexual negotiation: re-evaluation of the ‘normative precedent’ in Tanzania

Women's ability to negotiate the conditions and circumstances of sexual relations is central to their sexual and reproductive health, including mitigating HIV risk. In Africa, gender-based power imbalances constrain women's sexual agency. Research has suggested that among couples in sub-Saharan African countries, such as Uganda and Nigeria, sexual decision making is defined by a ‘normative precedent’ in the form of a set of rules and practices conferring sexual authority on men. Using qualitative data among women in paid work and among men, this study explored interpersonal relations and sexual negotiation in Tanzania. Data were collected in two sites, Dar es Salaam and Mbeya. The normative precedent for sexual decision making was universally understood by men and women. Women did not perceive paid work as giving them greater bargaining power in the domain of sex. In Mbeya, a high-HIV area, some women perceived that refusing sex would encourage men to have additional sexual partners, thus increasing their susceptibility to HIV. Other women, however, believed that suspicions about men's behaviour combined with accurate HIV knowledge, provided leverage for women to refuse sex. In both sites, challenges to the normative precedent were evident, particularly among younger men. Both men and women expressed a preference for equality in sexual decision making.

Condom Access in San Antonio, Texas: The “Three A's” and HIV/STI Incidence

Condoms are highly effective at reducing STI transmission. Access is a critical precursor to use. This socio-ecologic study operationalizes the concept of condom access by defining it in terms of availability, affordability, and affect, and explores the relationship between these and STI incidence. Three pairs of zip codes, each with similar demographics but different Chlamydia and HIV incidence rates, were identified. Supermarkets, convenience stores, and pharmacies (N = 102) were evaluated for the three A's. Nonparametric methods were used to compare the moderate-Chlamydia areas to the high-incidence areas. High-Chlamydia areas were significantly less likely to have 12-packs available compared to moderate-Chlamydia areas. Prices averaged over $1 per condom and did not vary by incidence. High-incidence areas were significantly less likely to allow patrons to select condoms unassisted. High-HIV areas placed more positively-connoted items near condoms. Improving these factors may improve condom acquisition and in turn reduce STI and HIV incidence rates.

Haemophilus influenzae Type b Disease among Children in Rural Mozambique: Impact of Vaccine Introduction

Haemophilus influenzae type b (Hib) conjugate vaccine has dramatically reduced invasive Hib disease worldwide. Yet, data on protection against pneumonia and among children with HIV are limited. We evaluated the impact of Hib conjugate vaccine introduction in 2009 in a rural, high-HIV prevalence area in Mozambique. From 2006-2011, we conducted hospital-based surveillance for invasive Hib disease and clinical pneumonia (classified as severe and very severe) among children <5 years of age. Incidences calculated using population denominators were compared between baseline (2006-2008) and post-Hib conjugate vaccine (2010-2011) periods. Surveillance data for radiologically-confirmed pneumonia among children <2 years of age in 2011 were compared with baseline data from 2004-2006. Among 50 cases of invasive Hib disease, 5 occurred after Hib conjugate vaccine introduction; 1 case-patient was age-eligible for Hib conjugate vaccine (and had received 3 doses). Four post-Hib conjugate vaccine case-patients (including Hib conjugate vaccine failure) had HIV. Among children <1 and <5 years of age, significant reductions occurred in rates of invasive Hib disease (91% and 85%, respectively) and very severe pneumonia (29% and 34%, respectively). Radiologically-confirmed pneumonia incidence fell significantly (33%) in children <2 years of age. Severe pneumonia incidence did not decline. We demonstrate important reductions in invasive disease and pneumonia following Hib conjugate vaccine introduction in a high-HIV area. Continued surveillance is needed to monitor long-term Hib conjugate vaccine effects, particularly among children with HIV.

Impact of Drought and HIV on Child Nutrition in Eastern and Southern Africa

Intermittent food insecurity due to drought and the effects of HIV/AIDS affect child nutritional status in sub-Saharan Africa. In Southern Africa in 2001-3 drought and HIV were previously shown to interact to cause substantial deterioration in child nutrition. With additional data available from Southern and Eastern Africa, the size of the effects of drought and HIV on child underweight up to 2006 were estimated. To determine short- and long-term trends in child malnutrition in Eastern and Southern Africa and how these are affected by drought and HIV. A secondary epidemiologic analysis was conducted of area-level data derived from national surveys, generally from the mid-1990s to the mid-2000s. Data from countries in the Horn of Africa (Ethiopia, Kenya, and Uganda) and Southern Africa (Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe) were compiled from available survey results. Secondary data were obtained on weight-for-age for preschool children, HIV prevalence data were derived from antenatal clinic surveillance, and food security data were obtained from United Nations sources (Food and Agriculture Organization, International Labour Office, and others). Overall trends in child nutrition are improving as national averages; the improvement is slowed but not stopped by the effects of intermittent droughts. In Southern Africa, the prevalence rates of underweight showed signs of recovery from the 2001-03 crisis. As expected, food production and price indicators were related (although weakly) to changes in malnutrition prevalence; the association was strongest between changes in food production and price indicators and changes in malnutrition prevalence in the following year. Areas of higher HIV prevalence had better nutrition (in both country groups), but this counterintuitive association is removed after controlling for socioeconomic status. In low-HIV areas in Eastern Africa, nutrition deteriorates during drought, with prevalence rates of underweight 5 to 12 percentage points higher than in nondrought periods; less difference was seen in high-HIV areas, in contrast to Southern Africa, where drought and HIV together interact to produce higher prevalence rates of underweight. Despite severe intermittent droughts and the HIV/AIDS epidemic (now declining but still with very high prevalence rates), underlying trends in child underweight are improving when drought is absent: resilience may be better than feared. Preventing effects of drought and HIV could release potential for improvement and, when supported by national nutrition programs, help to accelerate the rates of improvement, now generally averaging around 0.3 percentage points per year, to those needed to meet Millennium Development Goals (0.4 to 0.9 percentage points per year).

What Role Does Marriage Play in Urban Africa? Evidence from a High HIV Area in Kenya

The marriage institution, which plays an important role in regulating sexual activity in most societies, traditionally placed few restrictions on male extra-marital relationships in sub-Saharan Africa. If this traditional pattern continues to remain in place today, then it may help explain the relatively high levels of HIV/AIDS in that region of the world. We test the link between marriage and sexual activity on a sample of migrants in the town of Kisumu, Western Kenya, which reported HIV prevalence of 26 percent in 1997. A preliminary regression shows that married men have significantly fewer non-marital partners than single men, but this regression does not account for selective entry into marriage. Indeed, the marriage effect disappears completely when we instrument for marriage. In contrast, marriage has a strong influence on employment, income, and remittances among the migrants (after instrumenting), consistent with the view that marriage improves labor market outcomes and facilitates reciprocal exchange in this network-based economy. Sexual activity appears to lie outside the range of influence of the marriage institution due to historical circumstance, not because the institution per se is ineffective.