Stigma, discrimination against HIV-positive patients by healthcare providers

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Equipping healthcare providers with knowledge of HIV, through the provision of protocols and trainings, is of paramount importance in reducing stigma and discrimination against people living with HIV amongst healthcare providers, according to a study conducted in Southwest Ethiopia.

The healthcare providers who were aware of anti-stigma and anti-discrimination rules and regulations were less likely to contribute to stigma and discrimination.

The study also found that healthcare providers share stigma and discrimination not only related to their occupation but also present in their communities. This implies that community-based anti-stigma and anti-discrimination interventions may also be helpful.

The study makes the following recommendations for ministries/departments of health at the national, regional, or local levels, as well as healthcare institutions and non-governmental organizations working with HIV-positive patients:

  • Make available protocols related to HIV to each healthcare provider in healthcare settings.
  • Orient healthcare providers about the contents and relevance of the HIV-related policies.
  • Provide the opportunity for trainings on stigma and discrimination to healthcare providers from time to time.
  • Extend HIV-related care and support services and anti-discrimination interventions to local areas.
  • Involve people living with HIV and religious leaders in these activities.

And lastly, healthcare providers themselves should strive to update their knowledge on HIV/AIDS.

1. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012; 12: 522. (open access)

Using HIV programs to support NCD services

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Although HIV and non-communicable diseases (NCDs) are traditionally thought of as two very different health challenges, some of the systems, tools and approaches developed for HIV programs could be used for NCDs as well, according to an article published in the Journal of Acquired Immune Deficiency Syndromes.

The availability of treatment has transformed HIV into a chronic condition, and local HIV program in low- and middle-income countries have the capability to support continuity care. For example, the appointment books, defaulter tracking, patient counseling, medical records, standardized treatment protocols, referral networks, and linkages to laboratory and pharmacy services available through HIV clinics—and all critical for continuity care—could be used for diabetes and hypertension services.

“Strengthening health systems to deliver continuity care is likely to enhance the performance of both HIV and NCD programs and is a shared priority,” the article concludes.

1. Rabkin M, Nishtar S. Scaling up chronic care systems: Leveraging HIV programs to support noncommunicable disease services. Journal of Acquired Immune Deficiency Syndromes 2011; 57: s87-s90. (open access)

HIV decline in Zimbabwe due to reductions in risky sex

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A study has found convincing evidence of an HIV decline accelerated by changes in sexual behavior in Zimbabwe, an African country ravaged by HIV/AIDS.

HIV prevalence fell in Zimbabwe over the past decade—from 29.3 percent in 1997 to 15.6 percent in 2007. Reductions in the proportions of men and women with non-regular sexual partners and sustained high levels of condom use during this period likely contributed to the decline in HIV prevalence.

Estimates indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s; and multiple local and national surveys showed substantial rises in AIDS-related deaths during the 1990s leveling off after 2000.

However, AIDS-related deaths in Zimbabwe remained at crisis levels in the mid-2000s, according to the study.

1. Gregson S, Gonese E, Hallet TB, et al. HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review. International Journal of Epidemiology 2010; 39(5): 1311-1323. (open access)

Men and women in sub-Saharan Africa have equal chance of having an HIV-positive partner

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Women and men in sub-Saharan Africa are equally likely to be the index partner in a couple where only only partner is HIV-positive, according to a systematic review published in the November 2010 issue of The Lancet Infectious Diseases. These results have important implications for prevention strategies.

Although most social marketing aimed at reducing extramarital relationships is targeted at men, efforts should also take into account the role of women, review authors said. Similarly, both men and women in relationships should be informed about the need for condom use when HIV status is unknown. Although the man’s role in infecting the female partner has been the dominant focus in prevention strategies, the emphasis should be revised in the context of stable couples, since uninfected men and women seem to have an equal chance of having a stable partner who has HIV.

1. Eyawo O, de Walque D, Ford N, et al. HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Infectious Diseases 2010; 10(11): 770-777 (open access; free registration required)

Routine HIV testing helps prevent mother-to-child transmission

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A policy change from voluntary HIV testing to routine HIV testing for pregnant women led to a dramatic and sustained increase in the number of mothers tested for HIV in Mbale, Uganda. The findings are from a seven-year study published on 14 October 2010 in the journal BMC Health Services Research.

The percentage of pregnant women who were tested for HIV increased from 22 percent during the period when HIV testing was recommended on a voluntary basis to more than 87 percent when HIV testing was routine and initiated by health care providers. The study also indicated that the prevalence of HIV-positive prenatal patients at Mbale Regional Referral Hospital over the seven-year study period was 6.1 percent.

Read more at Suite101.

1. Byamugisha R, Tylleskar T, Kagawa MN, et al. Dramatic and sustained increase in HIV-testing rates among antenatal attendees in Eastern Uganda after a policy change from voluntary counselling and testing to routine counselling and testing for HIV: a retrospective analysis of hospital records, 2002-2009. BMC Health Services Research 2010; 10: 290. (open access)

HIV epidemic likely to emerge in the Philippines

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HIV prevalence in the Philippines has been described as “low and slow,” but an HIV epidemic is likely to emerge as the components for such an epidemic are already present in the Philippines, according to a study in the Journal of the International AIDS Society.

While the number of people living with HIV throughout Asia is around 5-10 million—with prevalence estimates well over one percent among adults in numerous countries—the Philippines has maintained an HIV prevalence of less than 0.1 percent.

Experts are predicting a dramatic increase in HIV cases in the Philippines due to several factors: low rates of condom use, increasing casual sexual activity, needle sharing among injection drug users (IDUs) and lack of education about HIV/AIDS, among other factors.

Read more at Suite101.

1. Farr AC, Wilson DP. An HIV epidemic is ready to emerge in the Philippines. Journal of the International AIDS Society 2010; 13: 16. (open access)

HIV/AIDS education improved by digital audio technology

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An HIV/AIDS education program implemented in rural Nigeria that incorporated digital audio technology and was tailored to the culture and language of the community may provide a feasible and cost-effective alternative to improving HIV/AIDS knowledge in low-literacy rural settings.

A study, which compared the technology-assisted program to a conventional seminar/pamphlet-based program, was published in the journal BMC International Health and Human Rights.

The audio device-assisted intervention was associated with more improved HIV/AIDS knowledge among participants than the conventional approach of educating the public through seminars and pamphlet distribution, the study found.


1. Ofotokun I, Binongo JNG, Rosenberg ES, et al. Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study. BMC International Health and Human Rights 2010; 10: 2. (open access)

Factors that predict HIV-positive persons’ desires to have children in Uganda

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Since access to antiretroviral therapy has improved quality of life and survival for people living with HIV, many contemplate having children. But a study from Uganda indicates that being on antiretroviral therapy had little to no effect on the desire to have a child in the near future. The study did find that HIV-positive individuals who were of young age, were single or had lost some children were unlikely to desire a child in the near future.

Researchers interviewed 400 HIV-positive patients in southwestern Uganda. Three-fourths were women, 47 percent were aged 25-34 years, over 85 percent were currently married or had ever been married, and 62 percent had primary level of education or less. More than 17 percent had produced a child since the HIV diagnosis was made and 29 percent reported that they would like to have a child in the near future.

Fertility intentions among HIV-positive persons are more common in developing countries (where the overall fertility in the population is still high, contraceptive use is low and unmet need for contraception is high). Previous studies from Zambia and Zimbabwe have also found no effect of HIV diagnosis on subsequent childbearing, implying that pregnancy intentions were unaffected by HIV diagnosis.

“Identification of contextual determinants of decision to have children among HIV positive couples is useful for designing of policies and establishing intervention priorities in reproductive health for this population,” according to the study.

1. Kakaire O, Osinde MO, Kaye DK. Factors that predict fertility desires for people living with HIV infection at a support and treatment centre in Kabale, Uganda. Reproductive Health 2010; 7: 27. (open access)

Traditional birth attendants in India lack basic HIV information

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Traditional birth attendants in rural India lack basic information about HIV/AIDS and safe delivery practices, according to a study conducted in 144 villages in the Indian state of Karnataka.

Only 12 percent of traditional birth attendants in the study reported awareness of HIV/AIDS, a surprising finding given that the HIV/AIDS epidemic in India is more than two decades old. Of those who had heard about HIV/AIDS, only 72 percent correctly reported that the virus could be spread from mother to child; 74 percent identified unprotected sex as a mode of transmission; and 51 percent correctly said healthy looking people could spread HIV. Just 44 percent knew that infected mothers could lower the risk of transmitting the virus to their infants.

The level of knowledge about safe birthing practices was also low among the traditional birth attendants. Considering that obstetrical hemorrhage and sepsis are still the leading cause of maternal death in India, researchers said it was not surprising that only 13 percent of of the traditional birth attendants referred mothers experiencing excessive bleeding following birth to a medical center, and that only about half sterilized equipment prior to deliveries.

Other unsafe procedures still practiced among traditional birth attendants included sucking secretions out of a baby’s mouth and nose with their mouth, applying cow dung, ghee (clarified butter) and other preparations on the umbilical cord, and inducing vomiting by stuffing hair in a woman’s throat to stimulate contractions of the uterus to clear the placenta.

Even more concerning, traditional birth attendants appeared to have low levels of awareness about when clients should be referred to a hospital. Less than five percent said they would refer a mother to a medical center if the umbilical cord was wrapped around the baby’s head, and just over half (57 percent) would refer the mother if the baby was coming out the wrong way. Most but not all (70 percent) would refer the woman if the baby was stuck inside the birth canal.

1. Madhivanan P, Kumar BN, Adamson P, Krupp K. Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India. BMC Public Health 2010; 10: 570. (open access)

Homeless youth at high risk of HIV in Ukraine

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Ukraine has the highest HIV prevalence in Europe, with young people being at a particularly high risk. A study conducted in four Ukrainian cities shows that homeless youth are at high risk of contracting HIV due to high injection drug use, commercial sex work, and unprotected heterosexual sex and male-to-male sex.

More than 15 percent of the adolescents (aged 10-19 years) in the study reported injection druge use. Almost three-fourths were sexually active, most of which started before age 15. Almost 10 percent of boys engaged in male-to-male sex. More than 56 percent of girls and 17 percent of boys reported receiving money, gifts or drugs in exchange for sex.

The study also highlighted the disturbing reality of regular violence, including by police. Nearly half of girls experienced forced sex and boys that engage in male-to-male sex were also at higher risk of sexual assault.

1. Busza JR, Balakireva OM, Teltschik A, et al. Street-based adolescents at high risk of HIV in Ukraine. Journal of Epidemiology and Community Health, published online 23 Sep 2010. (open access)

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