Showing 81 - 100 of 121 Results for "South Africa"

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Further interventions are needed to incorporate violence prevention, screening and counseling services into PMTCT testing and counseling. [See also %{s:59}] Studies found high rates of violence, sexual coercion and abuse among HIV-positive pregnant women, particularly when accessing HIV testing or during disclosure.
Antenatal Care - Testing and Counseling
1 study
Additional efforts are needed to ensure confidentiality in testing. Studies found that women were tested without their consent and that providers did not protect women’s confidentiality.
Antenatal Care - Testing and Counseling
1 study
Promoting HIV testing for male and female adolescents prior to pregnancy or fatherhood may increase those on cART prior to pregnancy, thus decreasing viral load prior to pregnancy and increasing the likelihood of reduced risk of vertical transmission
Antenatal Care - Treatment
1 study
Interventions are needed to reduce the higher attrition rate among pregnant adolescents living with HIV, including those perinatally infected, and provide needed support by parents and others. [See also %{c:9}] Additional research may also be needed on how to best care for perinatally-infected pregnant women who have decreased virological suppression, increased risk of vertical transmission and increased challenges in remaining adherent. While currently noted in the United States, it is anticipated to be relevant to low- and middle-income countries as more perinatally-infected women give birth.
Antenatal Care - Treatment
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
HIV prevention interventions are needed for methamphetamine, crack, midazolam and/or heroin. People who use various drugs are at high risk of acquiring HIV and amphetamine is often used to enhance and prolong sexual pleasure and to reduce sexual inhibitions. High rates of HIV were found in a group of female crack users and sex workers using amphetamines. There is no effective pharmacotherapy, such as methadone, for cocaine or methamphetamine.
Women Who Use Drugs and Female Partners of Men Who Use Drugs
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
Interventions are needed for male involvement that do not such reinforce harmful gender norms or increase risk for violence, stigma or discrimination. “Evidence for effectiveness of male involvement in PMTCT programs is scant” (Beckham et al., 2015: 67). One study only evaluated male involvement as accompanying their pregnant partner to ANC care with no HIV related outcomes listed and tasking the woman to require her male partner to come to ANC (Nyondo et al., 2015). Most approaches only reach men through their pregnant spouse, with no services for men beyond HIV testing and use men as an instrument solely to increase access to services by women. Men have been denied involvement in antenatal care, birth and delivery even if the couple so chooses.
Antenatal Care - Treatment
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
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
Strategies need to be identified to empower women to create demand for improved maternal health services and challenge violations of their rights in facility-based childbirth. This is a particularly acute need for women living with HIV. Studies show that HIV-related stigma may reduce the likelihood of delivering in a health facility
Antenatal Care - Treatment
1 study
Additional efforts are needed to provide postpartum women with contraception information and methods so they may space or prevent their next pregnancy and use condoms to reduce the likelihood of HIV transmission upon resumption of sexual activity. [See also %{c:15}] Studies found that women were not given contraceptive counseling or contraceptives postpartum and that transport costs restricted their ability to gain access to their contraceptive method of choice. Studies also found an unmet need for postpartum contraception among women living with HIV. Studies found that sexuality and condom use need to be addressed when sexual activity resumes postpartum. Family planning services are most often not provided postpartum in PMTCT programs. Providers and women did not know that clinically well HIV-positive women can use IUDs. Women lacked the full range of available contraception. No study to date has measured pregnancy intention prospectively in an HIV-discordant couple cohort and measured the effect of desired pregnancy on HIV transmission.
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
Enforcement of standard protocols is needed to reduce the risk of provider coercion in HIV testing, particularly in provider-initiated testing and counseling. Studies found that significant numbers of women reported that they could not refuse an HIV test or that HIV testing was mandatory.
HIV Testing and Counseling for Women
1 study
Interventions are needed to increase adherence for adolescents. Multiple studies from developed and developing countries reported young age as a risk factor for treatment interruption and that adolescents were less adherent to antiretroviral therapy than adults.
Adherence and Support
1 study
Efforts are needed to effectively implement Option B+ in non-prejudicial ways. Women who were sex workers reported being denied care until delivery. Women who were not accompanied by husbands were denied any health services during pregnancy. A sign on health centers read: “Notice: all pregnant women are supposed to come with their husbands/partners at their first visit. You will not be given services without implementing this” (Beckham et al., 2015: 66).
Antenatal Care - Treatment
1 study
Increased efforts are needed to retain women on HAART following birth. Studies found that women who initiated ART during pregnancy were more likely to be lost to follow up than non-pregnant women or that pregnant women who were eligible for HAART according to national guidelines were not provided HAART.
Postpartum
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
Additional support for pregnant women living with HIV who face violence is needed, including establishing proper mechanisms for seeking redress, along with more research on mental health and maternal morbidity among women living with HIV.
Antenatal Care - Treatment
1 study