IntroductionClinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral... more
IntroductionClinical trials in sub-Saharan Africa support that HIV self-testing (HIVST) can increase testing rates in difficult-to-reach populations. However, trials mostly evaluate oral fluid HIVST only. We describe preferences for oral fluid vs. blood-based HIVST to elucidate prior trial results and inform testing programs.MethodsParticipants were recruited from a HIVST randomized controlled trial in Nakuru County, Kenya, which aimed to test the effect of choice between oral HIVST and facility-based testing compared to standard-of-care on HIV testing among truck drivers. We conducted in-depth interviews (IDIs) with purposively sampled trial participants who declined HIV testing at baseline or who were offered access to oral fluid HIVST and chose not to pick up the kit during follow-up. IDIs were conducted with all consenting participants. We first describe IDI participants compared to the other study participants, assessing the statistical significance of differences in characteri...
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The 90-90-90 strategy from the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic by 2020 includes, as its first goal, to have 90% of all people living with HIV to know their status. Achieving this goal will... more
The 90-90-90 strategy from the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic by 2020 includes, as its first goal, to have 90% of all people living with HIV to know their status. Achieving this goal will depend on effectively reaching high risk populations, which include mobile populations such as truck drivers. This study aimed to characterise a sample of 305 truck drivers recruited from 2 roadside wellness clinics in Kenya in terms of anticipated HIV stigma, self-efficacy, fatalism, gender equity, sensation seeking, and self-esteem, and then determine the association of these psychosocial characteristics with HIV testing behaviour. Greater general self-efficacy was associated with higher income and more years working as a truck driver. Greater fatalism was associated with non-Christian religion, being married, and having a lower income. Greater gender equity was associated with completing high school, being married, and having higher income. Greater s...
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New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on "female-controlled" preventive... more
New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on "female-controlled" preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-à-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations-for better and for worse-shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneous...
Research Interests: Anthropology, Health Promotion, Global Health, Public Health, Medicine, and 15 moreHumans, Female, Gender Relations, Self Disclosure, Interpersonal Relations, Public health systems and services research, Sex Factors, Psychology of Power, Microbicide, Microbicides, Safe Sex, attitude to health, HIV infections, Antimicrobial agent, and diaphragm
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Research Interests: Psychology, Family, Medicine, Humans, Longitudinal Analysis, and 13 moreFemale, Male, Follow-up studies, Psychological Tests, Longitudinal Studies, Psychosomatic, Adult, Sick Role, Colorectal Neoplasms, Breast Neoplasms, Psychology and Cognitive Sciences, Medical and Health Sciences, and lung neoplasms
Research Interests: Occupational Health, Behavior, Developing Countries, China, Health, and 15 moreCultural Anthropology, Knowledge, Population, Humans, Global Public Health, Female, HIV Prevention, Profitability, Occupational Safety and Health, Middle Aged, Adult, Female Sex Workers, Mixed Method, anthropology cultural, and HIV infections
Among South African university students, HIV prevalence is lower than in age-peers, but at 3.8% it is not negligible. We examined prevalence of factors potentially associated with HIV risk, focusing on partnership characteristics and... more
Among South African university students, HIV prevalence is lower than in age-peers, but at 3.8% it is not negligible. We examined prevalence of factors potentially associated with HIV risk, focusing on partnership characteristics and consistent condom use. We hypothesised that contraceptive-related factors, for example, desire to prevent pregnancy and not using hormonal contraceptives, would be positively associated with consistent condom use. Data were drawn from a representative interviewer-administered survey of 2nd to 4th year students conducted during registration at a university campus in KwaZulu-Natal. Of 576 students, 218 (83 women, 135 men) reported vaginal intercourse in the past 2 months. Of these, 7% of women and 43% of men reported past-year concurrent partnerships, and 24% knew/ suspected partner non-monogamy. Although reported condom use at last intercourse was 90%, 2-month consistent use was 53% (women) and 73% (men). Reported hormonal contraception use was low (wome...
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From September 1990 through August 1991, 2655 (49%) of the 5457 women reported with acquired immunodeficiency syndrome (AIDS) in the United States had been injecting-drug users (IDUs), and 1136 (21%) had had sexual intercourse with men... more
From September 1990 through August 1991, 2655 (49%) of the 5457 women reported with acquired immunodeficiency syndrome (AIDS) in the United States had been injecting-drug users (IDUs), and 1136 (21%) had had sexual intercourse with men who were IDUs (1). During the same period, 413 (56%) of the 735 children (aged less than 13 years) reported with AIDS were born to mothers who were either IDUs (38%) or sex partners of IDUs (18%) (1). Even though messages and services regarding prevention of human immunodeficiency virus (HIV) infection and pregnancy planning for women at high risk for HIV infection should be tailored to their specific needs, information regarding pregnancy history, plans for childbearing, and contraceptive use among such women is limited. This report characterizes the childbearing and contraceptive-use plans of women at high risk for HIV infection interviewed during 1989-1991 in three settings--methadone-maintenance programs, drug-free outpatient programs, and detenti...
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We welcome Anne Philpott and colleagues proposal that barriers against sexually transmitted diseases should be designed to promote sexual pleasure. We agree that the uptake and consistency of use of such barriers and hence their... more
We welcome Anne Philpott and colleagues proposal that barriers against sexually transmitted diseases should be designed to promote sexual pleasure. We agree that the uptake and consistency of use of such barriers and hence their effectiveness would be thereby enhanced. This is surely a concern to be kept in mind by those who design physical and chemical barriers. Also those who aim to dispense them to potential users have to work within the cultural constraints of the society to maximise their pleasurable use. An issue no less fundamental and in need of attention however is that for many young women and men conception is also an integral part of sexual relationships. Fertility is not only desirable but essential to the maintenance of the community. There are many individuals who will accept neither physical barriers such as condoms nor microbicides that are contraceptive even if the risk of infection is reported to be high. (excerpt)
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Research Interests: Psychology, Family, Medicine, Humans, Longitudinal Analysis, and 13 moreFemale, Male, Follow-up studies, Psychological Tests, Longitudinal Studies, Psychosomatic, Adult, Sick Role, Colorectal Neoplasms, Breast Neoplasms, Psychology and Cognitive Sciences, Medical and Health Sciences, and lung neoplasms
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Research Interests: Program Evaluation, Adolescent, Multidisciplinary, Humans, Female, and 14 moreMale, Young Adult, PLoS one, Adult, Time Factors, Survival Rate, Odds ratio, World Health Organization, Self report, Proportional Hazards Models, Cohort Studies, Interviews as topic, Anti-retroviral agents, and HIV infections
Research Interests: Communication, Research Methodology, HIV and AIDS education, Developing Countries, Health, and 15 morePublic Health, Health Policy, Medicine, Safety, Commerce, South Africa, Humans, Comparative studies, Female, Male, Developed Countries, Public health systems and services research, Microbicides, HIV infections, and Antimicrobial agent
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The South African National Department of Health has rapidly extended free public-sector antiretroviral treatment for people living with HIV from 2007. Approximately 6 million people are living with HIV in South Africa, with 3.1 million... more
The South African National Department of Health has rapidly extended free public-sector antiretroviral treatment for people living with HIV from 2007. Approximately 6 million people are living with HIV in South Africa, with 3.1 million currently on treatment. HIV disclosure stigma has been reduced in high prevalence, generalized epidemic settings, but some remains, including in research interviews. This paper documents the unexpected reactions of people living with HIV to interviewers. It highlights shifts over time from discussing daily events with researchers to later expressing distress and then relief at having an uninvolved, sympathetic person with whom to discuss HIV disclosure. While there are commonalities, women and men had gendered responses to interviewers. These are apparent in men's uncharacteristic emotional responses and women's shyness in revealing gendered aspects of HIV acquisition. Both women and men expressed stress at not being allowed or able to fulfill...
Although male partner cooperation is often essential for successful use of the female condom, only a few studies have directly assessed men's experiences of using the device. We examined barriers to and facilitators of female condom... more
Although male partner cooperation is often essential for successful use of the female condom, only a few studies have directly assessed men's experiences of using the device. We examined barriers to and facilitators of female condom use via qualitative in-depth interviews with 38 young men (18 to 28 years) in South Africa whose partners, all university students, were enrolled in a female condom intervention trial. In all, 21 men used the female condom; the remaining 17 did not attempt use. The main facilitators to female condom use were convenience of use for men, curiosity to see how female condoms compared to male condoms, enhanced sexual sensation, and perceptions of better safety and comfort of the device compared to male condoms. The main barriers were men's limited familiarity with the device, insertion difficulties, and men's concerns about loss of control over sexual encounters. We recommend that human immunodeficiency virus (HIV) prevention and condom promotion ...
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The Center for Adherence Support Evaluation (CASE) Adherence Index, a simple composite measure of self-reported antiretroviral therapy (ART) adherence, was compared to a standard three-day self-reported adherence measure among... more
The Center for Adherence Support Evaluation (CASE) Adherence Index, a simple composite measure of self-reported antiretroviral therapy (ART) adherence, was compared to a standard three-day self-reported adherence measure among participants in a longitudinal, prospective cross-site evaluation of 12 adherence programs throughout the United States. The CASE Adherence Index, consisting of three unique adherence questions developed for the cross-site study, along
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Combination HIV prevention is being widely promoted by funders. This strategy aims to offer HIV prevention choices that can be selected and combined to decrease HIV risk in ways that fit with each... more
Combination HIV prevention is being widely promoted by funders. This strategy aims to offer HIV prevention choices that can be selected and combined to decrease HIV risk in ways that fit with each individual's situation. Treatment as prevention and pre-exposure prophylaxis are two new evidence-based strategies to decrease HIV incidence, both of which require high HIV testing rates to be effective, and the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a goal of 90% of HIV-positive individuals knowing their status by 2030. However, HIV testing rates in many countries remain suboptimal. Just as no single HIV prevention method is ideal for all people in all situations, no single HIV testing modality is likely to be acceptable to everyone. By offering HIV testing choices, we may be able to increase testing rates. However, many low-resourced countries have been slow to take up new HIV testing options such as the self-administered at-home oral HIV test that is currently available in the United States. In this paper, we present findings from 20 in-depth interviews, conducted in 2010, documenting opinions about self-administered at-home oral HIV testing, a testing modality still largely unavailable in Africa. Participants were clients of three primary healthcare clinics in South Africa. Self-testing was seen as enabling confidentiality/privacy, saving time, and facilitating testing together with partners. However, concerns were raised about psychological distress when testing at home without a counsellor. Some suggested this concern could be minimised by having experienced clinic-based HIV testing and counselling before getting self-testing kits for home use. Thus, self-administered HIV testing could be an option added to the current testing modalities to address some important barriers to testing.
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Research Interests: Bioinformatics, Immunology, Research Methodology, Behavior, Health Care, and 15 moreLife Sciences, Developing Countries, Health, Medicine, Knowledge, Interviews, Biomedical Research, HIV Prevention, AIDS, Data Collection, Hiv Infection, Private Sector, Microbicides, Qualitative Method, and Health Care Provider
We conducted a structural intervention to promote the female condom (FC), comparing 44 agencies randomized to a Minimal Intervention (MI) [developing action plans for promotion and free access] or an Enhanced Intervention (EI) [with the... more
We conducted a structural intervention to promote the female condom (FC), comparing 44 agencies randomized to a Minimal Intervention (MI) [developing action plans for promotion and free access] or an Enhanced Intervention (EI) [with the addition of counselor training]. Intervention effects were evaluated via surveys with agency directors, counselors and clients at baseline and 12 months. Agency-level outcomes of the FC did not differ between the two interventions at follow-up. Counselors in the EI showed significantly greater gains in FC knowledge and positive attitudes, although there was no difference in the proportion of clients counseled on the FC, which significantly increased in both conditions. There was a greater increase in intention to use the FC among clients in EI agencies. Intervention effects were stronger in medical agencies. Findings suggest that making subsidized FCs available and assisting agencies to formulate action plans led to increased FC promotion. Limitation...
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HIV testing rates in many sub-Saharan African countries have remained suboptimal, and there is an urgent need to explore strategic yet cost-effective approaches to increase the uptake of HIV testing, especially among high-risk... more
HIV testing rates in many sub-Saharan African countries have remained suboptimal, and there is an urgent need to explore strategic yet cost-effective approaches to increase the uptake of HIV testing, especially among high-risk populations. A costing analysis was conducted for a randomized controlled trial (RCT) with male truckers and female sex workers (FSWs) registered in the electronic health record system (EHRS) of the North Star Alliance, which offers healthcare services at major transit hubs in Southern and East Africa. The RCT selected a sample of truckers and FSWs who were irregular HIV testers, according to the EHRS, and evaluated the effect of SMSs promoting the availability of HIV self-testing (HIVST) kits in Kenyan clinics (intervention program) versus a general SMS reminding clients to test for HIV (enhanced and standard program) on HIV testing rates. In this paper, we calculated costs from a provider perspective using a mixed-methods approach to identify, measure, and v...
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One barrier to wider preexposure prophylaxis (PrEP) availability is uncertainty about the most appropriate providers and practice settings for offering PrEP. The authors conducted in-depth interviews with 30 clinicians-primary care and... more
One barrier to wider preexposure prophylaxis (PrEP) availability is uncertainty about the most appropriate providers and practice settings for offering PrEP. The authors conducted in-depth interviews with 30 clinicians-primary care and HIV specialists-in the New York City (NYC) region to explore issues related to PrEP rollout, including who should provide it and in what settings. A diverse group favored offering PrEP in non-HIV specialty settings in order to reach high-risk HIV-negative individuals. Yet, for each clinical skill or ancillary service deemed important for providing PrEP-knowledge of the medications, ability to assess and counsel around sexual risk behavior, and ability to provide support for retention and medication adherence-participants were divided in whether they thought primary care providers/practices could achieve it. Five participants strongly favored providing PrEP in HIV care practices. Although there may be multiple "homes" for PrEP, implementation research is needed to identify the most effective delivery approaches.
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Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of... more
Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified. Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.
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Research Interests: Decision Making, Focus Groups, Health Education, Qualitative Research, Adolescent, and 14 moreGender Identity, South Africa, Pregnancy, Humans, Unwanted pregnancy and abortion, Female, Male, Young Adult, Adult, Public health systems and services research, Curriculum and Pedagogy, Condoms, Sexual Partners, and HIV infections
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Research Interests: Sexual Abuse, Research Methodology, Occupational Health, Social Problems, Behavior, and 25 moreSocial Capital, Risk, Developing Countries, China, Health, Sex Work, Cultural Anthropology, Knowledge, Population, Humans, Global Public Health, Female, HIV Prevention, Profitability, Young Adult, Occupational Safety and Health, Sex Workers, Risk factors, Middle Aged, Adult, Public health systems and services research, Risk Factors, Female Sex Workers, Mixed Method, and Unsafe Sex
Research Interests: Sexual Abuse, Occupational Health, Social Capital, Risk, China, and 16 moreSex Work, Cultural Anthropology, Humans, Global Public Health, Female, HIV Prevention, Profitability, Young Adult, Occupational Safety and Health, Sex Workers, Middle Aged, Adult, Public health systems and services research, Female Sex Workers, Mixed Method, and Unsafe Sex
Partner negotiation and insertion difficulties are key barriers to female condom (FC) use in sub-Saharan Africa. Few FC interventions have provided comprehensive training in both negotiation and insertion skills, or focused on university... more
Partner negotiation and insertion difficulties are key barriers to female condom (FC) use in sub-Saharan Africa. Few FC interventions have provided comprehensive training in both negotiation and insertion skills, or focused on university students. In this study we explored whether training in FC insertion and partner negotiation influenced young women's FC use. 296 female students at a South African university were randomized to a one-session didactic information only minimal intervention (n ¼ 149) or a two-session cognitive-behavioral enhanced intervention (n ¼ 147), which received additional information specific to partner negotiation and FC insertion. Both groups received FCs. We report the 'experiences of' 39 randomly selected female students who participated in post-intervention qualitative interviews. Two-thirds of women reported FC use. Most women (n ¼ 30/39) applied information learned during the interventions to negotiate with partners. Women reported that FC insertion practice increased their confidence. Twelve women failed to convince male partners to use the FC, often due to its physical attributes or partners' lack of knowledge about insertion. FC educational and skills training can help facilitate use, improve attitudes toward the device and help women to successfully negotiate safer sex with partners. Innovative strategies and tailored interventions are needed to increase widespread FC adoption.