Showing 21 - 40 of 81 Results for "Uganda"

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Increased financial and other support is needed for adults, especially grandparents, caring for orphans, including those who are HIV-positive. Studies found families caring for orphans lacked adequate food and nutrition and reported financial difficulties in meeting basic needs.
Orphans and Vulnerable Children
1 study
Programs for male circumcision need to provide women, as well as men, with detailed factual knowledge of the benefits and risks of voluntary medical male circumcision. Surveys found that women lacked detailed factual knowledge of the benefits and risks of voluntary medical male circumcision and believed that if their male partner was circumcised (whether medically or traditionally) that condom use was unnecessary to protect them from acquiring HIV. Both women and men needed knowledge that abstinence is necessary during wound-healing. Women also need to know that female genital cutting does NOT protect against HIV acquisition or transmission. Women reported that circumcised men adopted risky sexual behaviors. Women feared that medical male circumcision would reduce their ability to negotiate for safer sex and would increase violence. A study of women who acquired HIV found that a large proportion of women reported not knowing whether their partner was circumcised.
Voluntary Medical Male Circumcision
1 study
While treatment of all STIs can improve everyone’s health and well-being, further interventions are needed to screen and treat ulcerative STIs, which have the most impact on HIV susceptibility and transmission. Studies have found however, that, to date, regimens to suppress genital herpes and other STIs have not been effective in reducing HSV transmission.
Treating Sexually Transmitted Infections (STIs)
1 study
HIV prevention interventions and treatment programs are needed for transgender people. Studies found that despite high rates of HIV, few prevention interventions are for transgender people. Studies showed that providers refused transgender people any services.
Transgender Women and Men
1 study
Increased efforts are needed to reduce stigma against adolescents living with HIV, particularly young key populations. A study found that adolescents living with HIV kept silent about their HIV status to schools, friends and family so as to not experience stigma and discrimination.
Increasing Access to Services
1 study
Legislation and enforcement of legislation that prohibits employment discrimination against people living with HIV is needed so that accessing HIV care is not seen as jeopardizing one's livelihood. Studies found that those who feared that they would lose their employment if found to be taking ARVs discontinued treatment.
Adherence and Support
1 study
Providers and those living with HIV need accurate information on how HIV is transmitted and how most effectively to reduce the likelihood of transmission among serodiscordant couples (or between those who do not know their sero-status), including those who wish to become pregnant – for their own health and that of their future children. [See also %{s:39}] Studies found that both providers and HIV serodiscordant couples were misinformed as to what factors increase the likelihood of HIV transmission.
Staying Healthy and Reducing Transmission
1 study
Further interventions are needed to provide couples counseling and testing to reduce seroconversion during pregnancy. Studies found that inadequate numbers of couples are counseled on safer sex during pregnancy and that despite national guidelines, repeat testing during pregnancy is not routinely done. Studies also found that inadequate spaces for men in antenatal care as well as gender norms that discouraged men from accompanying women to antenatal care discouraged couples testing.
Antenatal Care - Testing and Counseling
1 study
Further interventions are needed to reduce barriers to HIV testing. Studies found that fear of partner notification, risk of domestic violence, the unreliability of rapid HIV tests, test availability, long waiting times at the clinic, costs for transport, lack of childcare and the need for partner consent were barriers to HIV testing. The impact of rapid testing during labor and delivery for HIV-positive women has yet to be assessed and HIV test results were not provided prior to delivery.
Antenatal Care - Testing and Counseling
1 study
Interventions are needed to provide pregnant and breastfeeding women with more food security in order to increase viral suppression. A study found that food insecurity was associated with lower odds of sustained virological suppression.
Antenatal Care - Treatment
1 study
Interventions are needed to ensure that stigma from health care workers does not discourage HIV-positive women from giving birth in safer settings. [See also %{s:67}] Studies found that HIV-positive women experienced discrimination by providers in ANC services or did not attend ANC services due to fear of mistreatment by health providers.
Delivery
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
Greater efforts are needed to help young people personalize HIV risks. Studies found that knowledge about HIV prevention was superficial and that young people believed that they were not personally at risk of HIV acquisition despite risky behaviors and that condoms were not used because of “trust in partners.” Another study found that one adolescent girl reported she did not need to test for HIV as the only people at risk for acquiring HIV were those “who go to beer halls and pubs – prostitutes” (Ferrand et al., 2011). Married adolescent girls who had not become pregnant were significantly less likely to have had HIV testing and counseling (HTC) yet reported high rates of coerced sex within marriage, associated with acquiring HIV. Adolescents in one study suggested visiting hospices or people who were sick with HIV to understand more about HIV.
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
Further research is needed on infant transmission risks of malaria and/or HIV in pregnant women who have malaria-HIV co-infection.
Malaria
1 study
Expansion and scaling up of interventions promoting economic opportunities for women are needed to increase their ability to refuse unsafe sex and reduce stigma for women living with HIV. Studies found that lack of income, food and jobs forced women to sell sex to survive, placing them at risk of HIV acquisition.
Promoting Women’s Employment, Income and Livelihood Opportunities
1 study
Research is needed on treating anemia, malnutrition and other dietary conditions as well as on optimum micronutrients for patients accessing HAART and for patients prior to accessing treatment. [See also %{c:13}] Increased clarity is needed for providers, caregivers and patients on nutritional needs in settings of marked food insecurity. A Cochrane review which included 16 studies with weak methodologies found that “the evidence-base for the specific effect of micronutrient supplements in children and adults with HIV is limited, but sufficient to make some recommendations for practice. In the absence of population-specific adverse effects, there is no reason to decline similar recommendations for HIV-infected populations” (Irlam et al., 2010: 16).
Women and Girls
1 study
Studies found that counselors and serodiscordant couples did not understand that the HIV-negative partner could acquire HIV, even after many years and HIV-positive women reported that their husbands refused to use condoms. Fear of partner reaction was a barrier to HIV testing.
Male and Female Condom Use
1 study
Programs must continue to promote protective behavior such as condom use in addition to male circumcision. Studies found that male circumcision is only partially effective, making protective behavior such as partner reduction and condom use, in addition to circumcision, essential. Men who have been circumcised can still transmit HIV to women if they are HIV-positive. Until healing is complete following circumcision, men are more likely to transmit HIV. A post hoc analysis found the HIV-1 acquisition rate among partners of men who remained uncircumcised was 7.9% during the first 6 months after enrollment compared with 27.8% for partners of men who were circumcised and then resumed sexual activity prior to documented healing of the surgical wound, a substantially increased risk.
Voluntary Medical Male Circumcision
1 study
Health care provider training is needed to increase confidentiality and decrease discrimination against sex workers seeking health services. Studies found that significant proportions of female and transgender sex workers did not visit health facilities because of lack of confidentiality, discrimination, and lack of counseling when accessing HIV testing.
Female Sex Workers
1 study