Showing 21 - 40 of 57 Results for "Mozambique"

Results

Sex education and condom promotion programs need to take into account the different motivations among young men and women for engaging in unsafe sex. Studies found that boys complained about reduced sensation with condoms to cover their fear of losing their erection when putting on a condom; girls believed that unsafe sex proved their love and trust in their partner
Mitigating Risk
1 study
Successful strategies are needed to increase adherence to ART among adolescents and reduce loss to follow up. A study found that adolescents and young adults aged 15 to 24 living with HIV were more likely, following treatment initiation, to have higher viral loads, higher rates of virological failure and greater low to follow up from services. Another study found that adolescents (ages 9 to 19) had poorer virological outcomes compared to young adults (ages 20 to 28). A review found few estimates on viral suppression among ages 10 to 19 (All in End Adolescent AIDS, 2015c). A specialized HIV management program could not retain a substantial proportion of those who tested positive for HIV in care. A review of studies of adherence among adolescents and children in Lower and Middle Income countries found that most studies were cross-sectional with age data ranging from six months to 21, limiting the ability to define which strategies are key to increasing adherence among ages 10 to 19. Cognitive behavioral therapy can be further explored as a strategy to increase adherence in adolescent populations.
Increasing Access to Services
1 study
Interventions for pregnant women and their partners to stay HIV-negative or reduce HIV transmission are needed. [See also %{c:11} and %{c:13}] Pregnancy is a time of high risk for HIV acquisition. Home-based partner education for couples with no reports of interpersonal violence may be more effective than clinic based interventions, especially when women can opt-out of disclosing their sero-status. A systematic review found that incident infection (i.e. recently acquired during pregnancy) resulted in up to a 15-fold higher risk of vertical transmission.
Antenatal Care - Treatment
1 study
Provision of ART can reduce stigma, but additional interventions are needed. Studies found that lack of knowledge of ARV treatment increased stigma, but that ARV treatment alone did not eliminate stigma and discrimination.
Reducing Stigma and Discrimination
1 study
Sex and age disaggregated data is critical to assess which ages are falling through the cracks in data collection. Current HIV data collection masks critically needed data on adolescents ages 10 to 19. For example, a study that disaggregated ages found that loss to follow up for patients aged 10 to 24 was twice as high for ages 15 to 19 than for ages 10 to 14 (Koech et al., 2014).
Increasing Access to Services
1 study
Improved support systems for lay or basic health workers are needed to facilitate effective care in areas where lay health care workers provide a significant proportion of HIV care. Systems need to be developed specifically for remuneration, retention, and adequate supervision.
Provision and Access
1 study
Increased detection of acute infection, along with immediate, effective counseling and support is needed. A trial is underway in Botswana to identify those with high viral loads to initiate treatment (Novitsky et al., 2010 cited in Delva and Abdool Karim, 2014).
Staying Healthy and Reducing Transmission
1 study
Interventions are needed to scale up CD4 count screening, especially for pregnant women. A study found that several barriers limited CD4 cell count screening in rural areas, including “availability of laboratories equipped to perform CD4 cell count enumeration, reagent stockouts, and lack of sample transport systems” (Carter et al., 2010: 408). For mothers with CD4 counts above 500, there may be a low risk of HIV transmission through breastfeeding, though further research is necessary.
Postpartum
1 study
Tailored interventions are urgently needed to provide greater availability and access to female condoms, along with education and training regarding their use as an additional option to male condoms. Studies found that women, including female sex workers, felt that they could avoid conflict and enhance their safe sex bargaining power by using a female condom when their sexual partner refused to use a male condom.
Male and Female Condom Use
1 study
Concerted efforts are needed to enable adolescents at risk to test confidentially for HIV and be immediately linked to services, with information on where and how to access services. Access to and update of HIV testing and counseling (HTC) by adolescents is significantly lower than for adults. One study found that adolescents who were tested through provider-initiated testing (the WHO standard) had higher loss to follow up if they tested HIV-positive than adolescents who were tested through voluntary testing and counseling (Lamb et al., 2014). HTC must, according to WHO, include consent, confidentiality, counseling, correct test results and connections to treatment, care and prevention services. A recent report found that no data exists for HTC among ages 10 to 14 (All in to End Adolescent AIDS, 2015c). Access to HTC for adolescents who inject drugs is particularly challenging. HTC clients also need counseling on contraception and referral to services.
Increasing Access to Services
1 study
Additional outreach programs are needed for patients who miss ART clinic visits or fail to initiate treatment. A study showed that issues such as provider to patient ratios; adherence support programs; and needing transport from rural areas were associated with lower CD4 counts at initiation of ART. Other studies showed that patients were lost between initiation and maintenance sites. Another study found that one in five treatment-eligible HIV-positive individuals refused to initiate ART (Katz et al., 2011). Others who dropped out of treatment were using unproven remedies.
Provision and Access
1 study
Scale up of testing is needed with competent staff and labs in order to assess CD4 counts and link those who test HIV-positive to treatment. Studies are finding that in some countries, those who test HIV-positive are presenting with AIDS and that patients do not initiate ART despite eligibility. Those who test HIV-positive yet not eligible to receive antiretroviral therapy according to their national guidelines often did not remain in care until they were eligible for treatment.
Provision and Access
1 study
Women and their sexual partners need access to comprehensive pre-conception care so they can make informed decisions about pregnancy before conception. Studies found that HIV-positive women could not access pre-conception advice on safer pregnancy options, as health providers discouraged pregnancy. Studies found that significant numbers of pregnant women did not know any way to prevent vertical transmission and face dilemmas with balancing the desire for children with fear of risking acquiring HIV or transmitting HIV to their partner or infant. Studies also showed that women did not understand the relationship between high CD4 counts and reducing the risk of HIV transmission.
Pre-Conception
1 study
Laws and practices that obstruct adolescents’ access to services, such as parental consent requirements, age, and marital status requirements, must be aligned with the actual behavior of adolescents. Studies found that legal requirements restricted adolescents from getting tested for HIV even if they were sexually active and at risk for HIV. "There is a strong evidence base that the stigma, discrimination and criminalization affecting adolescent key populations aged 10 to 17 is intensified due to domestic and international legal constructs that rely on law-enforcement based interventions dependent upon arrests, pre-trial detention, incarceration and compulsory ‘rehabilitation’ in institutional placements," particularly among adolescents who sell sex or inject drugs (Conner, 2015: para 1).
Increasing Access to Services
1 study
Barriers such as cost of medications, stigma, long clinic waits, lack of food, and child-care responsibilities, among others, may discourage women living with HIV from accessing antiretroviral therapy. A study found that patients who were living with HIV but did not access antiretroviral therapy were twice as likely as patients on antiretroviral therapy to report not having enough food to take with treatment as a concern, in addition to concerns about cost barriers. Another study found that cost of ARVs, with direct out of pocket payment at point of care delivery decreased access to ARVs. Another study found transport costs and waiting time a barrier to access to treatment. Increased efforts are needed so that those in pre-ART care understand that HIV can be transmitted prior to ART eligibility.
Provision and Access
1 study
Changing laws and policies, ending police violence, and other mechanisms are needed to protect sex workers from violence and rape. Studies found sex workers experienced high rates of violence and rape from clients and police, and that fear of arrest was a barrier to accessing health services. Studies also found that violence was associated with inconsistent condom use and HIV incidence. Studies also found high rates of violence from intimate partners and clients, but inability to press charges.
Female Sex Workers
1 study
Interventions, policies and budgets are needed to reduce sexual coercion and rape of both boys and girls, create awareness in communities that violence against children is unacceptable, strengthen child statutory protection systems, and conceptualize and implement appropriate child protection services in developing countries. Access to post-exposure prophylaxis in case of rape when the perpetrator is HIV-positive is also needed. [See also %{c:21}] In most countries of Eastern and Southern Africa, the age of consent for sex is 16. Despite these restrictions, more than 10% of girls have had sexual debut before age 15. A study found that in a sample of more than 1,000 males and more than 1,000 females, large numbers had experienced high rates of physical punishment, emotional abuse and touching of sexual organs when not wanted or sex due to force or coercion prior to age 18 and that incident HIV infections were more common in women who suffered emotional abuse, sexual abuse and physical punishment. Sexual abuse in men was associated with alcohol abuse and depression. Other studies found high rates of sexual coercion and high-risk behaviors among street children. “Few children disclose abuse, fewer still seek services and report to authorities, virtually no children actually receive services and perpetrators rarely suffer consequences” (Sommarin et al., 2014: S213). Most research does not provide adolescent-specific data on violence, instead listing results for ages 15 to 49. Reviews have not found evidence that preventive responses have had an impact on rates of sexual abuse. Effective programs in the US and Canada have not been assessed for adaptation in other countries.
Mitigating Risk
1 study
Programs must adhere to the longstanding international agreement to voluntarism, informed consent, and ensuring the right of individuals and couples to decide freely and responsibly the number and spacing of their children. Studies found that women living with HIV had been sterilized against their will, were pressured by providers to terminate a pregnancy, or were stigmatized for becoming pregnant. Studies also found that provision of antiretroviral therapy was conditional on using certain types of contraception. Litigation is currently being undertaken. A study found that HIV-positive women who accessed contraceptive services were not informed of the benefits of PMTCT programs in reducing vertical transmission.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
Further interventions are needed to provide support (physical, psychological, technological, economic) to patients and caregivers. Studies showed that patients and caregivers have many physical, psychological, and economic unmet needs, with high rates of depression and poverty, and in some cases, rely on their young children or relatives to provide care with no outside support. Some studies show that caregivers suffer from stigma attached to caring for someone HIV-positive. [See also %{s:67}] Some studies showed that women have a lower quality of life than men. A study in a high HIV prevalence area showed that for women, lack of control in sexual decision-making was associated with depression, while for men, intergenerational sex was associated with depression.
Women and Girls
1 study
Evaluated interventions are urgently needed to reduce multiple and concurrent partnerships – particularly for both men and women where perceived HIV risk is low and the woman is subjected to gender norms of faithfulness while the man is subjected to gender norms of having multiple sexual partners. [See also %{s:57}] Studies found that married women were at risk of HIV acquisition, but were either unaware of the risk or did not believe they were at risk. Studies found that extra-relational sex on the part of the husband was common. Other studies found that a significant portion of women have had high rates of multiple partners. Other studies found that serial monogamous relationships led to a high risk of HIV acquisition.
Partner Reduction
1 study