Proportion Of New HIV Infections Research Articles

“They call me the ‘Great Queen’”: implementing the Malkia Klabu program to improve access to HIV self-testing and contraception for adolescent girls and young women in Tanzania

BackgroundAdolescent girls and young woman (AGYW) comprise a significant proportion of new HIV infections and unintended pregnancies in sub-Saharan Africa yet face many barriers to accessing family planning and reproductive health (FPRH) information and services. Developed via human-centered design, the Malkia Klabu (“Queen Club”) program aimed to facilitate access to HIV self-testing (HIVST) and FPRH information and products at privately-owned drug shops. We sought to understand barriers and facilitators to program implementation in a 4-month pilot in Tanzania.MethodsForty semi-structured interviews were conducted with participants in a cluster randomized trial of the Malkia Klabu program from November 2019 through March 2020, including 11 with AGYW, 26 with drug shopkeepers, and three with counselors at health facilities to whom AGYW were referred. Interviews were audio-recorded, transcribed, coded, and analyzed to identify key themes. The Consolidated Framework for Implementation Research (CFIR) was used to assess barriers and facilitators to program implementation at multiple levels. CFIR considers the outer setting (e.g., culture and systemic conditions), the inner setting where the intervention is implemented (e.g., incentives, relationships, and available resources), the individuals involved, the innovation as it relates to stakeholder needs, and the implementation process.ResultsThe Malkia Klabu program reshaped and directed the role of drug shopkeepers as providers of information and resources rather than FPRH gatekeepers. Key implementation facilitators included the program’s adaptability to a wide range of needs and stages of readiness among AGYW, ability to capitalize on AGYW social networks for driving membership, responsiveness to AGYW’s need for privacy, and positive contributions to the income and community standing of drug shopkeepers. Components such as HIVST were highly acceptable to both AGYW and shopkeepers, and the introduction of the loyalty program and HIVST kits in shops opened doors to the provision of FPRH products and information, which was further facilitated by program tools such as videos, product displays, and symbol cards. Although some shopkeepers maintained beliefs that certain contraceptive methods were inappropriate for AGYW, most appeared to provide the products as part of the program.ConclusionsThe Malkia Klabu intervention's success was due in part to its ability to address key motivations of both AGYW and drug shopkeepers, such as maintaining privacy and increasing access to FPRH products for AGYW and increasing business for shops. Better understanding these implementation barriers and facilitators can inform the program’s future adaptation and scale-up.Trial registration: clinicaltrials.gov #NCT04045912.

Poor HIV-Related Outcomes In Older Adults Newly Diagnosed with HIV: A Four-Year Retrospective Analysis from A Single Site in Asia.

In resources limited settings, HIV-related services are often targeted to younger key populations though increasing reports have found adults ≥50 years now account for among the highest increase in new HIV diagnosis. We assessed the proportion of new HIV infections among older adults (≥50 years) and compared their socio-demographics, risk behaviours and HIV-related outcomes to newly diagnosed younger adults (<50 years). This retrospective analysis included all new HIV diagnosis from 2016-2019 at University of Malaya Medical Centre, Malaysia. Trends of HIV diagnosis was assessed using joinpoint regression analysis and characteristics between the older and younger adults were compared using χ2 test or Mann-Whitney U test. Kaplan-Meier analysis and log-rank test were used to compare the survival probability in both age groups. From a total of 594 new HIV diagnosis between 2016-2019, 11.5% (N=68) were among older adults with an annual percent increase of 5.50%. Older adults were more likely ethnic Indians (p<0.001), acquired HIV via heterosexual contact (p=0.001), had late presentation to care (p=0.003), and multimorbidity (p<0.001). Immunological responses after 12 months on ART were comparable in both groups. Older adults had a higher probability of death compared to younger adults (aHR 1.81, 95% CI 1.02-3.23, p=0.043) after adjusting for sex, mode of HIV transmission, late presentation to care, ART initiation and multimorbidity. Older adults diagnosed with HIV were associated with late care presentation and increased mortality. There is an urgent need to enhance uptake of HIV testing and linkage to care among older individuals in our setting.

Development of a tool to assess HIV prevention readiness of adolescent girls and young women in HPTN 082 study.

African adolescent girls and young women (AGYW) represent a large proportion of new HIV infections, a priority population for pre-exposure prophylaxis (PrEP), but adherence remains a challenge. A reliable, valid readiness tool would help identify AGYW motivated to take PrEP who need adherence support. In the HPTN 082 open-label PrEP study (2016-2019), South African and Zimbabwean women ages 16-25 were administered an HIV prevention readiness measure (HPRM). The 25 items in the HPRM included medication beliefs, connection with care, disclosure of PrEP use, social support, and housing stability using a 5-point Likert scale. Exploratory factor analysis (EFA) using polychoric correlations, scale reliability, and predictive validity were performed on data from 315 participants who responded to all items. We assessed the predictive value of HPRM scores with PrEP adherence, defined as tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots, as a continuous measure and dichotomized as high PrEP adherence (≥700 fmol/punch). EFA yielded 23 items with three subscales: self-efficacy (16 items), PrEP disclosure (4 items), and social support (3 items). Cronbach's α ranged from 0.71 to 0.92 for the overall scale and the subscales. The average overall scale and the subscales were predictive of 3-month PrEP adherence for TFV-DP concentrations: for each unit increase of the HPRM score, TFV-DP concentration increased by 103 fmol/punch (95% CI: 16, 189, p = 0.02); the highest HPRM score equated with 608 fmol/punch on average. For the self-efficacy subscale, TFV-DP increased by 90 fmol/punch (95% CI: 7, 172, p = 0.03); PrEP disclosure, 68 fmol/punch (95% CI: 19, 117 p = 0.01); and social support, 58fmol/punch (95% CI: 2, 113, p = 0.04). Higher PrEP disclosure suggests high adherence (OR 1.36, 95% CI: 1.00, 1.86, p = 0.05) and predicted persistent high adherence at both months three and six (OR: 1.50, 95% CI: 1.03, 2.21, p = 0.04). The HPRM scale overall and the subscales individually demonstrated good internal consistency among African young women. PrEP disclosure subscale exhibiting significant association with persistent high PrEP adherence is an important finding for PrEP adherence support programs. Future work will assess replicability and expand self-efficacy and social-support subscales after item revision. ClinicalTrials.gov NCT02732730.

Community Health Posts Impact on Adult Male Access to HIV Services in Lusaka, Zambia

Achieving HIV epidemic control is an ultimate goal for Zambia. To achieve this goal there is need to close services access gaps. Adult men are less likely to utilize existing health facility-based HIV services and they account for a significant proportion of new HIV infections with risk to onward HIV transmission in the community. Almost two-thirds of males (65.1%) and 79.2% of females aged 15-59 years reported ever having been tested for HIV and having received their results. Over two-thirds (67.1%) of HIV-positive males 25-29 years of age reported being unaware of their HIV status. Twenty-five percent of the national pandemic is in Lusaka. This non-experimental, descriptive mixed-methods study shows increase in number of adult males accessing services at community health posts and the impact of community health posts on improving adult male access to HIV services, including improved retention to HIV services and viral load suppression. The attitude or customer care of health care workers and the location of the community health posts played a bigger role in improving adult male access to HIV services, by creating a better, trusted environment and by bringing the services closer to where these males work or live. The community health post improved also the inequality in accessing HIV services for adult males, as this is one of the key factors to achieving the end of HIV pandemic. Keywords: Community Health Post, Control, Epidemic, HIV, Impact, and Inequality, Male Adult.

Psychosocial interventions for improving engagement in care and health and behavioural outcomes for adolescents and young people living with HIV: a systematic review and meta-analysis.

IntroductionAdolescents and young people comprise a growing proportion of new HIV infections globally, yet current approaches do not effectively engage this group, and adolescent HIV‐related outcomes are the poorest among all age groups. Providing psychosocial interventions incorporating psychological, social, and/or behavioural approaches offer a potential pathway to improve engagement in care and health and behavioural outcomes among adolescents and young people living with HIV (AYPLHIV).MethodsA systematic search of all peer‐reviewed papers published between January 2000 and July 2020 was conducted through four electronic databases (Cochrane Library, PsycINFO, PubMed and Scopus). We included randomized controlled trials evaluating psychosocial interventions aimed at improving engagement in care and health and behavioural outcomes of AYPLHIV aged 10 to 24 years.Results and discussionThirty relevant studies were identified. Studies took place in the United States (n = 18, 60%), sub‐Saharan Africa (Nigeria, South Africa, Uganda, Zambia, Zimbabwe) and Southeast Asia (Thailand). Outcomes of interest included adherence to antiretroviral therapy (ART), ART knowledge, viral load data, sexual risk behaviours, sexual risk knowledge, retention in care and linkage to care. Overall, psychosocial interventions for AYPLHIV showed important, small‐to‐moderate effects on adherence to ART (SMD = 0.3907, 95% CI: 0.1059 to 0.6754, 21 studies, n = 2647) and viral load (SMD = −0.2607, 95% CI −04518 to −0.0696, 12 studies, n = 1566). The psychosocial interventions reviewed did not demonstrate significant impacts on retention in care (n = 8), sexual risk behaviours and knowledge (n = 13), viral suppression (n = 4), undetectable viral load (n = 5) or linkage to care (n = 1) among AYPLHIV. No studies measured transition to adult services. Effective interventions employed various approaches, including digital and lay health worker delivery, which hold promise for scaling interventions in the context of COVID‐19.ConclusionsThis review highlights the potential of psychosocial interventions in improving health outcomes in AYPLHIV. However, more research needs to be conducted on interventions that can effectively reduce sexual risk behaviours of AYPLHIV, as well as those that can strengthen engagement in care. Further investment is needed to ensure that these interventions are cost‐effective, sustainable and resilient in the face of resource constraints and global challenges such as the COVID‐19 pandemic.

Estimating HIV pre-exposure prophylaxis need and impact in Malawi, Mozambique and Zambia: A geospatial and risk-based analysis.

BackgroundPre-exposure prophylaxis (PrEP), a WHO-recommended HIV prevention method for people at high risk for acquiring HIV, is being increasingly implemented in many countries. Setting programmatic targets, particularly in generalised epidemics, could incorporate estimates of the size of the population likely to be eligible for PrEP using incidence-based thresholds. We estimated the proportion of men and women who would be eligible for PrEP and the number of HIV infections that could be averted in Malawi, Mozambique, and Zambia using prioritisation based on age, sex, geography, and markers of risk.Methods and findingsWe analysed the latest nationally representative Demographic and Health Surveys (DHS) of Malawi, Mozambique, and Zambia to determine the proportion of adults who report behavioural markers of risk for HIV infection. We used prevalence ratios (PRs) to quantify the association of these factors with HIV status. Using a multiplier method, we combined these proportions with the number of new HIV infections by district, derived from district-level modelled HIV estimates. Based on these numbers, different scenarios were analysed for the minimum number of person-years on PrEP needed to prevent 1 HIV infection (NNP).An estimated total of 38,000, 108,000, and 46,000 new infections occurred in Malawi, Mozambique, and Zambia in 2016, corresponding with incidence rates of 0.43, 0.63, and 0.57 per 100 person-years. In these countries, 9%–20% of new infections occurred among people with a sexually transmitted infection (STI) in the past 12 months and 40%–42% among people with either an STI or a non-regular sexual partner (NP) in the past 12 months (STINP). The models estimate that around 50% of new infections occurred in districts with incidence rates ≥1.0% in Mozambique and Zambia and ≥0.5% in Malawi. In Malawi, Mozambique, and Zambia, 35.1%, 21.9%, and 12.5% of the population live in these high-incidence districts. In the most parsimonious scenario, if women aged 15–34 years and men 20–34 years with an STI in the past 12 months living in high-incidence districts were to take PrEP, it would take a minimum of 65.8 person-years on PrEP to avert 1 HIV infection per year in Malawi, 35.2 in Mozambique, and 16.4 in Zambia. Our findings suggest that 3,300, 5,200, and 1,700 new infections could be averted per year in the 3 countries, respectively. Limitations of our study are that these values are based on modelled estimates of HIV incidence and self-reported behavioural risk factors from national surveys.ConclusionsA large proportion of new HIV infections in these 3 African countries were estimated to occur among people who had either an STI or an NP in the past year, providing a straightforward means to set PrEP targets. Greater prioritisation of PrEP by district, sex, age, and behavioural risk factors resulted in lower NNPs thereby increasing PrEP cost-effectiveness, but also diminished the overall impact on reducing new infections

Determinants of uptake of PMTCT services by HIV positive mothers accessing care in Akure, Ondo State, Nigeria

BACKGROUND: Mother-to-child transmission (MTCT) of HIV remains a major public health challenge which account for substantial proportion of new HIV infections among children. Global interventional programme such as Prevention of mother to child transmission (PMTCT) of HIV has been initiated to protect children from the scourge of HIV pandemics. However, it is faced by multiple challenges in Africa. This study assessed the influencers of PMTCT services uptake among HIV-positive mothers in Akure.METHODS: A cross-sectional descriptive survey was employed using quantitative and qualitative design among 300 HIV positive pregnant and lactating mothers. Information on knowledge, awareness, and factors influencing uptake of PMTCT were collected using semi structured questionnaire. Data was analysed using SPSS v.20.RESULT: The average age of the respondents was 31.07 ±5.0 years with 77% being married. Majority (83%) were aware of PMTCT. The uptake level of PMTCT services was 89%. Knowledge on PMTCT (χ2 = 9.3, P value 0.002), Partner Support (χ2= 5.09, p=0.024), Religion (Christianity) (χ2=7.264, p=0.007), Occupation (unskilled) (χ2=12.6, p=0.002) were factors found to be significantly associated with the uptake of PMTCT services among HIV positive mothers.CONCLUSION: The uptake of PMTCT services among HIV positive mothers was high in Akure. Knowledge of the respondent on PMTCT, Partner Support, Religion and occupation were factors that influenced level of uptake of PMTCT service. Health workers should intensify quality counselling and health talks by taking time to explain extensively in English and their mother tongues

Sexual Health of Rural and Urban Young Male Couples in the United States: Differences in HIV Testing, Pre-exposure Prophylaxis Use, and Condom Use.

Young men who have sex with men (YMSM) are disproportionally affected by HIV, and main partnerships account for a large proportion of new HIV infections. HIV prevention is largely focused on urban YMSM, and less is known about sexual health of rural male couples. The present study used data from a randomized controlled trial of a relationship education and HIV prevention program for male couples to test associations of rurality with HIV/STI testing, PrEP use, number of sexual partners, and condomless anal sex (CAS) acts. Participants were 430 YMSM in relationships. Rural YMSM were less likely to have been tested for HIV/STIs, and to have used PrEP, compared to urban YMSM. Although higher rurality was associated with fewer CAS acts, CAS was not infrequent among rural YMSM, highlighting the need for increased HIV prevention geared toward young male couples living in rural, less resourced areas.

Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya.

Introduction A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya. Methods We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples' clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes. Results Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p = 0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.Conclusion The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.

Filling the gaps in the Peruvian care continuum for HIV-infected pregnant mothers: a case-control study in metropolitan Lima-Callao, Peru.

Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case-control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR]: 0.72; 95% confidence interval [CI]: 0.55-0.94, p = 0.012) and having more children (OR: 0.10, 95% CI: 0.01-0.79, p = 0.029). Risk factors included later maternal diagnosis (OR: 1.19; 95% CI: 1.06-1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR: 1.05; 95% CI: 1.01-1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.

Perceptions of PrEP Use Within Primary Relationships Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men.

A significant proportion of new HIV infections among gay, bisexual, and other men who have sex with men (MSM) occur within primary relationships. Although PrEP use continues to increase, there is a need to better understand the factors that contribute to PrEP decision-making within primary relationships. We qualitatively examined how relationship context influences perceptions of PrEP and decisions to initiate and discontinue PrEP among young Black MSM to provide a nuanced understanding of PrEP use within relationships. Between late 2017 and mid-2018, we conducted 10 focus groups with young Black MSM (n = 80) in Milwaukee, WI, Minneapolis, MN, Kansas City, KS, and Detroit, MI. We used inductive thematic analysis to examine how young Black MSM make decisions about PrEP use within the context of primary relationships. We identified three primary themes: (1) perceptions of PrEP as an indication of distrust and infidelity, (2) perceptions of PrEP use as necessary, even in primary relationships, and (3) the influence of partners on PrEP. Our results demonstrate the considerable variation in how young Black MSM view PrEP within primary relationships and the influence of primary partners in PrEP use decisions. The dynamics between two or more individuals can shape an individual's conceptualizations of and decisions around PrEP use, and these may be key drivers of racial disparities in HIV and PrEP use.

Factors Affecting Married, Monogamous Women’s Risk of HIV Infection in India: Traditional Gender Roles and Husbands’ High-Risk Sexual Behaviours

International Journal of Medicine and Public Health,2019,9,4,112-117.DOI:10.5530/ijmedph.2019.4.25Published:December 2019Type:Review Article Factors Affecting Married, Monogamous Women’s Risk of HIV Infection in India: Traditional Gender Roles and Husbands’ High-Risk Sexual BehavioursKelly A A Leslie Kelly A. A. Leslie Department of Psychiatry, University of Toronto, Toronto, Ontario, CANADA. Abstract:The prevalence of HIV in India has been steadily increasing over the last three decades and India is now thought to possess the third largest number of cases out of any country in the world. India is currently experiencing a significant feminization of its HIV epidemic; a large proportion of new HIV infections are observed in women and the majority of all HIV cases in India are contracted by heterosexual transmission. While married, monogamous women were initially considered at low risk for contracting HIV in India, they are now recognized as being a high-risk group, as the prevalence of HIV among women who have ever been married is higher than the national average. Because the vast majority of these women report that unprotected intercourse with their husband is their only risk factor for HIV infection, it can be concluded that they have likely been infected by their husband. This review investigates the principal factors involved in the infection of married, monogamous Indian women with HIV by their husbands, within the context of traditional Indian gender roles and cultural expectations of behaviour. Specifically, this article examines three high-risk sexual behaviour commonly perpetrated by Indian men: extramarital sexual relations, lack of condom use during sex and intimate partner violence. Given the magnitude of the problem of HIV in India and its implications for the spread of HIV throughout the world, the topic of women’s risk of HIV infection in India is clearly of immense public health significance. Keywords:HIV, India, WomenView:PDF (228.06 KB)

Sources of Resilience as Mediators of the Effect of Minority Stress on Stimulant Use and Sexual Risk Behavior Among Young Black Men who have Sex with Men.

The greatest proportion of new HIV infections among men who have sex with men (MSM) is occurring among young Black MSM (YBMSM) ages 13-24. Consequently, research is needed to understand the psychosocial pathways that influence HIV risk and resilience in YBMSM. Minority Stress Theory proposes that the stigma, prejudice, and discrimination facing sexual and racial minorities are chronic stressors that lead to increased engagement in risk behaviors. The present study examined whether minority stress is associated with stimulant use and sexual risk behaviors by depleting psychosocial resilience. We recruited 1817 YBMSM, ages 18-29, from multiple venues in two major cities in Texas for participation in a brief survey. Results from structural equation modeling indicated that decreased resilience partially mediated the association of minority stress with sexual risk behavior. Resilience was also negatively associated with stimulant use. Interventions focused on cultivating psychosocial resilience could mitigate the deleterious consequences of minority stress and reduce stimulant use in YBMSM.

Concerns about contracting HIV, knowing partners' HIV sero-status and discussion of HIV/STI with sexual partners as determinants of uptake of HIV testing.

Worldwide, adolescents and young adults (aged 15-25 years) account for the highest proportion of new HIV infections, yet the uptake of HIV testing among this cohort is sub-optimal. Understanding factors that predict the uptake of HIV testing among adolescents and young adults is critical for designing effective and relevant interventions to increase testing. Drawing from the psychosocial constructs of the Health Belief Model, the study examined the effects of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake among adolescents and young adults in two Nigerian universities. The study was conducted in 2018 and was cross-sectional in design, with a final sample of 784 male and female students selected using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the effect of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake. Only 50.6% of participants had ever tested for HIV with 30.7% being tested in the last year, with no significant differences by sex. After controlling for other covariates (age, sex and being sexually active), knowing partners' HIV status, having discussed HIV with partners and being very concerned about contracting HIV were found to be significantly associated with ever being tested for HIV and recent HIV testing uptake. Uptake of HIV testing was found to be low in the study setting and fell short of the first '90%' UNAIDS target. Age-appropriate strategies, targeting open communication on HIV/STIs and disclosure of sero-status between sexual partners are required to promote uptake of HIV testing among young adults and adolescents in Nigeria.

Predictors of Recent HIV Testing Among Chinese Men Who Have Sex with Men: A Barrier Perspective.

In China, men who have sex with men (MSM) account for an increasing proportion of new HIV infections. We aim to assess recent HIV testing (in the past 6 months) among Chinese MSM and to identify barriers to testing. A nationwide sample of MSM (n = 1100) from mainland China was recruited. Data on sociodemographics, HIV-related risks, perceived barriers to testing, and testing behaviors were collected. Approximately 30% of MSM had recently undergone HIV testing. With regard to testing, almost half endorsed each of three barriers: did not believe themselves to be at HIV risk, had a fear of being diagnosed HIV positive, and feared their privacy would be violated during testing. Five distinct classes of barriers were identified from the responses. The adjusted multivariable logistic regression model demonstrated that the participants in both the "uncertainty concerning testing sites" and "low risk and privacy violation" classes were less likely to undergo testing than those in the "minimal barrier" class. Men who were unsure of their HIV status were less likely to undergo testing. Furthermore, participants who had multiple male sexual partners and who engaged in substance use over the preceding 6 months were more likely to undergo testing. Distinct subgroups of testing and HIV status varied within the different barrier classifications. Recent HIV testing rates remain low among MSM in China. Barrier factors associated with testing point to the necessity for preventing and controlling HIV, including increasing the privacy of sites or educating MSM on the importance of testing regularly.

Reproductive health service utilization and associated factors: the case of north Shewa zone youth, Amhara region, Ethiopia.

IntroductionMany youth are less informed, less experienced and less comfortable in utilizing reproductive health services. In the Sub-Saharan region the adolescents account for a higher proportion of new HIV infections and unmet need for reproductive health (RH) services. This study assessed reproductive health service utilization and associated factors among the youth in Amhara Region, Ethiopia.MethodsA community based cross-sectional study was conducted from June 15-July 30, 2014. Three hundred ninety one youth were selected by systematic random sampling technique and interviewed using structured questionnaire. Data were anlyzed using SPSS windows version 20. Multiple logistic regression was done to control potential confounding variables. P-values <0.05 were considered statistically significant.ResultsThree hundred and nighty one in-school and out-of-school youth were interviewed; 256 (65.5%) participants were in school and 209 (53.5%) were males. Almost all respondents (93.9%) had heard about reproductive health services and a third 129 (33%) had ever practiced sexual intercourse and 54.7% of them had utilized at least one reproductive health services. Never had sexual intercourse (AOR=3.693, 95%CI: 1.266, 10.775), families that asked their children about friends (parental monitoring) (AOR=1.892, 95%CI: 1.026, 3.491), know where service provided (AOR=3.273, 95%CI: 1.158, 9.247), youths who reads newspaper readers (AOR=3.787, 95%CI: 1.849were independent predictors of youth reproductive service utilization at 95 % CI and p-value <0.05%.ConclusionEven though the youth have information about reproductive health services, youth reproductive health services utilization is very low. Therefore, building life skill, facilitating parent to child communication, establishing and strengthening of youth centres and increasing awareness for youth about those services are important steps to improve adolescents' reproductive health (RH) service utilization.

EVALUATING THE EFFECTS OF HEALTH EDUCATION ON ADOLESCENTS' KNOWLEDGE AND PERCEPTION OF RISK TO HIV/AIDS IN SOUTHWESTERN NIGERIA

Adolescents constitute a sizeable proportion of new HIV infections. Their reported poor risk perception to HIV/AIDs calls for a more formidable way of reaching them with HIV prevention messages. This study evaluated the effects of peer-led health education on secondary school adolescents' perception and knowledge of risk to HIV/AIDs in urban slum communities of Osun state. Descriptive cross-sectional study of the pre and post-test type was carried out among intervention and control groups of 700 secondary students each, selected using multi-staged sampling method. The intervention group had a six months’ peer-led health education sessions. Research instruments were semi- structured self-administered pre-tested questionnaires. Data was analysed using the SPSS software version 17.0 Two hundred and ninety-six (84.6%) and 283(80.9%) of respondents were aware of HIV/AIDs in the pretest of intervention and control groups respectively. An increase of 12.0% and 1.7% in awareness was recorded among intervention and control group respectively during post-test. With a high-risk knowledge but poor risk perception scores reported among both groups during pretest, there was an increase of 7.4% in risk perception scores among intervention and 3.2% among control group during post-test. Higher education classes and male gender were predictors of good risk knowledge and good risk perception respectively. Adolescents under study had high awareness, high-risk knowledge but poor self-risk perception towards HIV/AIDs. Peer-led health education significantly increased risk knowledge and perception among study group than the control group.

Use of Technology for HIV Prevention Among Adolescent and Adult Women in the United States.

Although the proportion of new HIV infections in the USA among women has decreased over the last few years, still, approximately 20 % of new infections occur annually among adolescent and adult women. The development of effective evidence-based prevention interventions remains an important approach to further decreasing these numbers. Technology-delivered prevention interventions hold tremendous potential due, in part, to their ability to reach beyond the walls of brick-and-mortar intervention sites to engage individuals where they are. While most technology-delivered interventions have focused on adolescents and men who have sex with men, much fewer have specifically targeted adolescent or adult women despite evidence showing that interventions tailored to specific target populations are most effective. We summarize the recently published literature on technology-delivered HIV prevention interventions for US adolescent and adult women and provide suggestions for next steps in this nascent but emergent area of prevention research.

"If I don't use a condom … I would be stressed in my heart that I've done something wrong": Routine Prevention Messages Preclude Safer Conception Counseling for HIV-Infected Men and Women in South Africa.

Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider-client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient-provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable. Supporting providers to assess clients' fertility intentions and offer appropriate advice, and public health campaigns that address sexual HIV transmission in the context of conception may improve awareness of and access to safer conception strategies.

Reproductive health services utilization and its associated factors among Madawalabu University students, Southeast Ethiopia: cross-sectional study.

BackgroundYouths in Sub-Saharan region including Ethiopia account for higher proportion of new HIV infections, maternal mortality ratios, and unmet need for reproductive health information and services. This study assessed reproductive health services utilization and its associated factors among Madawalabu University Students, Southeast Ethiopia.MethodsInstitutional-based cross-sectional study was conducted among regular under graduate Madawalabu University students in May 2014. Data were collected from randomly selected students through self-administered pre-tested structured questionnaire. Data were entered in to EpiData 3.1 and exported to SPSS-16.0 for analysis. Descriptive, bivariate and multivariate analyses were employed.ResultFrom the total 568 respondents 507(89.3%) of them knew modern family planning. 457(80.5%) of them had ever utilized at least one reproductive health services. Students who ever made discussion on VCT with health profession utilized the VCT two times than those hadn’t made discussion (AOR 2.06, 95% CI 1.21-3.48). Discussion also triple reproductive health services utilization (AOR 3.76, CI 1.55-9.11).ConclusionUtilization of reproductive health services for the three indexed variables namely: modern contraceptives, STI diagnosis and treatment, and VCT is fair. But utilization of specific reproductive health services is under expectation. Discussion on reproductive health services between health worker and students, and focusing other identified factors are the way of reproductive health problems intervention in the University.