C-CHANGE
C-Channel:
Issue 22 | JULY/AUGUST
background gradient

HIV prevention and vulnerable populations

C-Channel 22 highlights HIV prevention and vulnerable populations.

Of Interest…

The African Network for Strategic Communication in Health and Development (AfriComNet) is hosting a Practicum on HIV Prevention among Married and Cohabitating Couples in Africa.

The Practicum will be held in Johannesburg, South Africa, 11-13 August 2010. For more information, please visit Africomnet.

Four articles explore HIV prevention, youth, and social networks, while four address HIV prevention and stigma in the context of men who have sex with men (MSM). Two articles focus on HIV prevention and sex workers. Research for these articles was conducted in Bangladesh, Botswana, Brazil, the Caribbean, the Dominican Republic, India, Kenya, Malawi, Namibia, Nigeria, Paraguay, Senegal, Uganda, and Zimbabwe.

C-Change recently began work in Jamaica. It carried out an assessment of government and civil society sector programming around HIV prevention for most-at-risk populations (MARP), particularly men who have sex with men (MSM), and sex workers. Results of the assessment are informing next steps, which include technical assistance to the Ministry of Health and NGO partners to build their capacity to carry out SBCC HIV prevention activities. The ultimate goal is to reduce the number of new HIV infections by 25% by 2013. See the C-Change website for additional information on its SBCC activities.

 

In this issue

HIV, Youth, and Social Networks

1. Targeting HIV interventions for adolescent girls and young women-Zimbabwe

2. Social factors affecting youths' condom use behavior in slums-Nigeria
ONLINE FULL TEXT

3. Community readiness for HIV/AIDS preventive interventions-Bangladesh

4. Extra-marital sexual partnerships and male friendships in rural Malawi

HIV Prevention, MSM, and Stigma

5. HIV vulnerability of men who have sex with men in developing countries

6. Bisexuality, sexual risk taking, and HIV among MSM accessing VCT-India
ONLINE FULL TEXT

7. Bisexual concurrency, bisexual partnerships, and HIV among Southern African MSM

8. Challenges to universal access to HIV prevention, treatment and care-Caribbean
ONLINE FULL TEXT

HIV Prevention and Sex Workers

9. Social norms and condom use among male partners of female sex workers-Dominican Republic

10. Creating "communicative spaces": Organizing the NGO community for HIV/AIDS prevention


HIV, Youth, and Social Networks

1. Targeting HIV interventions for adolescent girls and young women in Southern Africa: Use of the PLACE methodology in Hwange District, Zimbabwe

Authors: Singh K 1; Sambisa W 1; Munyati S 2; Chandiwana B 2; Chingono A 3; Monash R 4; Weir S 1
Institutions: 1 MEASURE Evaluation, UNC-Chapel Hill, Chapel Hill, NC; 2 Biomedical Research and Training Institute (BRTI), Harare, Zimbabwe; 3 University of Zimbabwe, Harare, Zimbabwe; 4 UNICEF Zimbabwe, Harare, Zimbabwe
Source: AIDS and Behavior, Feb 2010; 14(1): 200-8. [Epub before print]

ABSTRACT

This paper addresses the issue of how to target interventions to girls 15-19 and young women 20-24 in a resource poor setting of Hwange District, Zimbabwe. The Priorities for Local AIDS Control efforts methodology was used to understand where these young people socialize and also to understand whether age disparate relationships were a common occurrence. Findings indicated prevention efforts for those 15-19 would need to focus on "everyday" sites as these are the places where the majority of girls socialized. However, the girls 15-19 with the riskiest sexual behaviors were found at venues affiliated with alcohol. Prevention efforts for those 20-24 would also need to largely focus on venues affiliated with alcohol. Women at such sites generally reported more risky behaviors than women in other types of venues. Reporting of a partner 5 or more years older was common across age groups and across venues. Tackling HIV in Zimbabwe will take a multifaceted approach targeted towards the places girls 15-19 and young women 20-24 are meeting new partners.

To link to the website to purchase this article, please click here. Access the journal website here.

Return To Top

2. Social factors, social support and condom use behavior among young urban slum inhabitants in southwest Nigeria

Authors: Adedimeji AA 1; Heard NJ 2; Odutolu O 3; Omololu FO 4
Institutions: 1 University of Dublin, Trinity College; 2 Harvard School of Public Health, Boston, MA; 3 Harvard AIDS Prevention Initiative in Nigeria; 4 University of Ibadan, Ibadan, Nigeria
Source: East African Journal of Public Health, Dec 2008; 5(3): 215-22. [Bioline; Open Access]

ABSTRACT

OBJECTIVES: Despite widespread knowledge that condoms offer protection against STIs/HIV when used correctly and consistently, many young people do not regularly use condoms, thus leading to new sexually transmitted infections, including HIV and AIDS. This study explored condom use behaviour, specifically the extent to which beliefs, self efficacy, risk perception and perceived social support act as predictors of use or non-use of condoms among sexually active young people aged 15-24 years.

METHODS: Data was obtained from sexually active 448 boys and 338 girls, who were selected through multistage sampling techniques. Analysis of data, which was done with EPI Info and SPSS version 12, focused on predictors of condom use or non-use.

RESULTS: Generally, there is widespread knowledge and low levels of condoms use, despite high levels of risky sexual behaviour. Although, half of boys and one third of girls report ever using condoms, a considerably lower proportion of male and female adolescents regularly use condoms. Logistic regression models show that among girls, those who perceived social support from peers and non-parental figures were more likely to use condoms while among boys, earning an income, high risk perception and self efficacy were associated with higher odds of condom use.

CONCLUSIONS: Programs aiming to increase condom use among young people need to address these factors through community-based strategies.

To access the FREE full text of this article, please click here. Access the journal website here.

Return To Top

3. An assessment of community readiness for HIV/AIDS preventive interventions in rural Bangladesh

Authors: Aboud F; Huq NL; Larson CP; Ottisova L
Institutions: a McGill University, Montreal, QC, Canada; b International Centre for Diarrhoeal Diseases Research, Bangladesh; c University of British Columbia, Vancouver, Canada
Source: Social Science and Medicine, Feb 2010; 70(3): 360-7. [Epub before print]

ABSTRACT

Efforts to prevent HIV from becoming widespread among the youth population 15-24 years in Bangladesh are in the early stages. However, conservative religious and cultural norms may curtail the dissemination of needed information about sexuality and condoms. The community-readiness stages model was adopted as a framework for assessing the level of preparedness of community leaders to facilitate planned HIV prevention efforts. Six focus group discussions with three professional groups (teachers, businessmen, drugshop vendors) in Hobiganj district were conducted in late 2005, and a single multi-professional group made up of teachers, imams, and drugshop vendors was convened in early 2007 to assess changes. The audio recordings in Bangla were coded as were English translations. Everyone had heard of AIDS and regarded it as a potential catastrophe for the health, economy and social fabric of Bangladesh. Remarks concerning Stage 1-Vulnerability indicated that most did not believe their community to be at risk, though Bangladesh was. Remarks at Stage 2-Knowledge of Transmission were mostly vague but accurately identified sex, blood and needles as the main means of spread; however sex with sex workers was also mentioned in each group. Remarks at Stage 3-Prevention showed strong opposition to condoms for unmarried males and a preference for current means of forbidding sex outside of marriage. A few in each group recognized the importance of condoms for wayward youth. Stage 4-Planning discussions centered on raising awareness and fear, and a desire for government and media to take the lead. By 2007 participants articulated more realistic strategies that they themselves could, and had, implemented, but also raised barriers that authorities should help them overcome. The findings provide formative information on the constraints and opportunities of community groups as partners in HIV preventive interventions and strategies to help them move to a higher stage of readiness. Copyright 2009 Elsevier Ltd. All rights reserved.

To link to the website to purchase this article, please click here. Access the journal website here.

Return To Top

4. Extra-marital sexual partnerships and male friendships in rural Malawi

Author: Shelley Clark
Source: Demographic Research, 5 Jan 2010; 22(1): 1-28.

ABSTRACT

Extra-marital sexual partnerships (EMSPs) are a major route of HIV/AIDS transmission in sub-Saharan Africa. In this paper, we investigate the roles of two types of male friendships - best friends and friends with whom they talk about AIDS - in determining whether men have EMSPs. Using data from men in rural Malawi, we find that men's current extra-marital sexual behavior is most closely correlated with their best friends', but that the behaviors of both types of friends are associated with men's subsequent EMSPs. These findings suggest that men's friendships could be used to help combat the AIDS epidemic.

To access the FREE full text of this article, please click here. Access the journal website here.

Return To Top

HIV Prevention, MSM, and Stigma

5. HIV vulnerability of men who have sex with men in developing countries: Horizons studies, 2001-2008

Authors: Geibel S; Tun W; Tapsoba P; Kellerman S
Institution: Population Council, Nairobi, Kenya
Source: Public Health Reports, Mar-Apr 2010; 125(2): 316-24.

ABSTRACT

While male-to-male sexual behavior has been recognized as a primary risk factor for human immunodeficiency virus (HIV), research targeting men who have sex with men (MSM) in less-developed countries has been limited due to high levels of stigma and discrimination. In response, the Population Council's Horizons Program began implementing research activities in Africa and South America beginning in 2001, with the objectives of gathering information on MSM sexual risk behaviors, evaluating HIV-prevention programs, and informing HIV policy makers. The results of this nearly decade-long program are presented in this article as a summary of the Horizons MSM studies in Africa (Senegal and Kenya) and Latin America (Brazil and Paraguay), and include research methodologies, study findings, and interventions evaluated. We also discuss future directions and approaches for HIV research among MSM in developing countries.

To purchase the full text of this article, please click here. Access the journal website here.

Return To Top

6. Bisexuality, sexual risk taking, and HIV prevalence among men who have sex with men accessing voluntary counseling and testing services in Mumbai, India

Authors: Kumta S 1; Lurie M 2; Weitzen S 2,3; Jerajani H 4; Gogate A 5; Row-kavi A 6; Anand V 6; Makadon H 7,8; Mayer KH 8,9
Institutions: 1 Bill and Melinda Gates Foundation, New Delhi, India; 2 Warren Alpert Medical School of Brown University, Providence, RI; 3 Women and Infants Hospital of RI; 4 LTM Medical College/LTM General Hospital; 5 Health Centre, Mumbai University, Mumbai, India; 6 Humsafar Trust; 7 Harvard Medical School, Harvard University, Boston, MA; 8 The Fenway Institute, Fenway Community Health, Boston, MA; 9 The Miriam Hospital, Providence, RI
Source: Journal of Acquired Immune Deficiency Syndromes, 1 Feb 2010; 53(2): 227-33. [PubMed Central]

ABSTRACT

OBJECTIVES: To describe sociodemographics, sexual risk behavior, and estimate HIV and sexually transmitted infection (STI) prevalence among men who have sex with men (MSM) in Mumbai, India.

METHODS: Eight hundred thirty-one MSM attending voluntary counseling and testing (VCT) services at the Humsafar Trust, answered a behavioral questionnaire and consented for Venereal Disease Research Laboratory and HIV testing from January 2003 through December 2004. Multivariate logistic regression was performed for sociodemographics, sexual risk behavior, and STIs with HIV result as an outcome.

RESULTS: HIV prevalence among MSM was 12.5%. MSM who were illiterate [adjusted odds ratio (AOR) 2.28; 95% confidence interval (CI): 1.08 to 4.84], married (AOR 2.70; 95% CI: 1,56 to 4.76), preferred male partners (AOR 4.68; 95% CI: 1.90 to 11.51), had partners of both genders (AOR 2.73; 95% CI: 1.03 to 7.23), presented with an STI (AOR 3.31; 95% CI: 1.96 to 5.61); or presented with a reactive venereal disease research laboratory test (AOR 4.92; 95% CI: 2.55 to 9.53) at their VCT visit were more likely to be HIV infected.

CONCLUSIONS: MSM accessing VCT services in Mumbai have a high risk of STI and HIV acquisition. Culturally appropriate interventions that focus on sexual risk behavior and promote condom use among MSM, particularly the bridge population of bisexual men, are needed to slow the urban Indian AIDS epidemic.

To access the FREE full text of this article, please click here. Access the journal website here.

Return To Top

7. Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men (MSM)

Authors: Beyrer C 1; Trapence G 2; Motimedi F 3; Umar E 4; Iipinge S 5; Dausab F 6; Baral S 1,7
Institutions: 1 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; 2 Center for the Development of People, Blantyre, Malawi; 3 Botswana Network on Ethics, Law, and HIV/AIDS, Botswana; 4 Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi; 5 University of Namibia, Windhoek, Namibia; 6 The Rainbow Project, Windhoek, Namibia; 7 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
Source: Sexually Transmitted Infections, 21 Apr 2010; doi:10.1136/sti.2009.040162. [Epub before print]

ABSTRACT

OBJECTIVE: The sexual behaviour of men who have sex with men (MSM) in southern Africa has been little studied. We present here the first data on bisexual partnerships and bisexual concurrency among MSM in Malawi, Namibia and Botswana.

METHODS: A cross-sectional probe of a convenience sample of 537 men who have ever reported anal sex with another man using a structured survey instrument and rapid-kit HIV screening.

RESULTS: 34.1% of MSM were married or had a stable female partner, and 53.7% reported both male and female sexual partners in the past 6 months. Bisexual concurrency was common, with 16.6% of MSM having concurrent relationships with both a man and a woman. In bivariate analyses, any bisexual partnerships were associated with lower education (OR 1.6, 95% CI 1.1 to 2.3), higher condom use (OR 6.6, 95% CI 3.2 to 13.9), less likelihood of having ever tested for HIV (OR 1.6, 95% CI 1.1 to 2.3), less likelihood of having disclosed sexual orientation to family (OR 0.47, 95% CI 0.32 to 0.67) and being more likely to have received money for casual sex (OR 1.9, 95% CI 1.3 to 2.7). Bisexual concurrency was associated with a higher self-reported condom use (OR 1.7, 95% CI 1.0 to 3.1), being employed (OR 1.8, 95% CI 1.2 to 2.9), lower likelihood of disclosure of sexual orientation to family (OR 0.37, 95% CI 0.22 to 0.65) and having paid for sex with men (OR 2.0, 95% CI 1.2 to 3.2).

CONCLUSIONS: The majority of MSM in this study report some bisexual partnerships in the previous 6 months. Concurrency with sexual partners of both genders is common. Encouragingly, men reporting any concurrent bisexual activity were more likely to report condom use with sexual partners, and these men were not more likely to have HIV infection than men reporting only male partners. HIV-prevention programmes focussing on decreasing concurrent sexual partners in the African context should also target bisexual concurrency among MSM. Decriminalisation of same-sex practices will potentiate evidence-based HIV-prevention programmes targeting MSM.

To access the FREE full text of this article, please click here. Access the journal website here.

Return To Top

8. The HIV epidemic in the Caribbean: Meeting the challenges of achieving universal access to prevention, treatment and care

Author: Figueroa JP
Institution: Epidemiology and AIDS, Ministry of Health, Kingston, Jamaica
Source: West Indian Medical Journal, Jun 2008; 57(3): 195-203.

ABSTRACT

The HIV prevalence in the Caribbean is estimated at 1.0% (0.9% - 2%) with 230,000 persons living with HIV/AIDS. HIV rates vary among countries with the Bahamas, Guyana, Haiti and Trinidad and Tobago having HIV rates of 2% or above while Cuba's rate is less than 0.2%. However throughout the Caribbean, HIV rates are significantly higher among those groups most at risk such as commercial sex workers, men who have sex with men and crack/cocaine users. The Caribbean Community (CARICOM) Heads of Governments declared AIDS to be a regional priority in 2001. The Pan Caribbean AIDS Partnership (PANCAP) was formed to lead the regional response to the HIV epidemic. National HIV Programmes have made definite progress in providing ARV treatment to persons with HIV/AIDS and reducing death rates due to AIDS, decreasing HIV mother-to-child transmission and providing a range ofHIVprevention programmes. However HIV stigma remains strong in the Caribbean and sexual and cultural practices put many youth, women and men at risk of HIV The Caribbean has set itself the goal of achieving universal access to HIV prevention, treatment and care. Several challenges need to be addressed. These include reducing HIV stigma, strengthening national responses, scaling-up better quality prevention programmes with greater involvement of vulnerable populations, more supportive HIV policies and wider access to ARV treatment with better adherence. In addition, there needs to be improved coordination among PANCAP partners at the regional level and within countries.

To access the FREE full text of this article, please click here. Access the journal website here.

Return To Top

HIV Prevention and Sex Workers

9. Talking the talk, walking the walk: Social network norms, communication patterns, and condom use among the male partners of female sex workers in La Romana, Dominican Republic

Authors: Barrington C a,b; Latkin C c; Sweat MD d; Moreno L e; Ellen J f; Kerrigan D g,h
Institutions: a University of North Carolina at Chapel Hill, Chapel Hill, NC; b Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; c Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; d Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC; e Centro de Orientacion e Investigacion Integral, Santo Domingo, Dominican Republic; f Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; g Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; h Sexual and Reproductive Health Unit, Ford Foundation, NY
Source: Social Science and Medicine, Jun 2009; 68(11): 2037-44. [Epub before print; PubMed Central]

ABSTRACT

Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N =318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners.

To access the FREE full text of this article, please click here. Access the journal website here.

Return To Top

10. Creating "communicative spaces": A case of NGO community organizing for HIV/AIDS prevention

Author: de Souza R
Institution: Department of Communication, University of Minnesota, Duluth, MN
Source: Health Communication, Dec 2009; 24(8): 692-702.

ABSTRACT

This study uses the case study method to investigate the processes used by a local nongovernmental organization called the Society for People's Action for Development to organize sex workers in the slums of Bangalore, India, for HIV/AIDS prevention. The nongovernmental organization-facilitated HIV/AIDS program is based on the new paradigm of community organizing that encourages community participation and capacity building. Grounded in the culture-centered approach, this study documents the processes used to organize the women, while highlighting the role of communication in these processes. The study identifies 4 primary processes used to mobilize the community, namely collectivization, community awareness and sensitization, capacity building, and providing legal education and support. Each of these processes highlights the importance of attending to the economic, social, and political realities that shape the health of women. The common thread linking these processes together is the notion of "voice." More specifically, each process serves as a catalyst to produce discursive practices that enable women to provide support to each other, increase awareness in the community about the problems that they face, build self-reliance through financial skills training and communication training, and defend their legal rights. In addition, the study suggests that the primary role of nongovernmental organizations should be the creation of "communicative spaces," which are discursive and material spaces within marginalized communities and mainstream society where cultural participants can identify problems (oftentimes beyond the realm of health), manage solutions to those problems, and advocate for health and social change.

To purchase the full text of this article, please click here. Access the journal website here.

Return To Top


USAIDC-CHANGEFHi 360 Satellife Center for Health Information and Technology


This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of C-Change, and do not necessarily reflect the views of USAID or the United States Government.

To contact us, please send an email to c-channel@healthnet.org.
Additional information about the project is available at the website
www.c-changeprogram.org/