Showing 1 - 18 of 18 Results for "Sub-Saharan Africa"

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Increased links are needed for women who access treatment to receive counseling concerning desired children and contraception. [See also Meeting the Sexual and Reproductive Health Needs of Women Living with HIV and Safe Motherhood and the Prevention of Vertical Transmission] A study with patients from multiple sites in sub-Saharan Africa found that within four years of follow up for 4,531 women, one-third experienced a pregnancy.
Provision and Access
1 study
Well-functioning laboratory systems are needed to measure viral load via PCR to assess effectiveness of treatment. However, adequate clinical results can also be cost-effective and meet patient needs. A study in sub-Saharan Africa found that more than half of test results for viral load were invalid or inaccurate. A review done in low and middle-income countries showed that lack of routine virologic monitoring in resource limited ART programs led to the development of cross-resistance to the NRTI component of second-line treatment. Even where virological monitoring is available and demonstrates virological failure, delayed switching of patients to alternative antiretroviral therapy regimens occurs.
Provision and Access
1 study
Legislation that allows women the right to refuse forced marriage and to divorce and that penalizes marital and non-marital rape is necessary to reduce coercive sex and the risk of HIV transmission. Studies found that in some countries, particularly in regions where there are generalized epidemics, legislation penalizing marital rape does not exist. For younger women: laws stating that a girl under age 16 cannot consent to sex but also that she cannot claim protection from the law if someone has sex with her against her will must be changed: "By granting her neither agency nor security, the law renders her a non-person" (Global Commission on HIV and the Law, 2012).
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Supportive legal and policy frameworks are needed to prevent and redress all forms of violence against women, particularly women living with HIV, women engaged in sex work and women who have sex with women, including in intimate partner settings. [See %{c:7} and %{s:59}]
Advancing Human Rights and Access to Justice for Women and Girls
1 study
Improvements are needed in health services, such as increased or flexible clinic hours, to reduce wait times and to encourage ART initiation. Interviews with people living with HIV eligible for ART who refused ART found that "the problem is…services….The process is so long" (Musheke et al., 2013a: 236). In addition, waiting to access ART jeopardizes livelihoods. Information systems that can track patients across sites can assist in tracking patients who need care.
Provision and Access
1 study
Actions are needed to increase young people’s knowledge of when and where to access health services, including access to contraception and condoms. A UNESCO review found that young people lacked knowledge of where to access health services to meet their needs. Adolescents in numerous countries are sexually active, yet have low rates of contraceptive use. Adolescents need accurate detailed information about the level of risk of different sex acts (oral, genital and anal). Studies found that youth aged 15 to 24 were at high risk of either acquiring HIV or testing HIV-positive, yet less likely to report having been tested for HIV. Increased knowledge that HIV-positive infants can survive to adolescence is also needed so that these young people can get tested for HIV and access services. In some countries, HIV prevalence among both female and male adolescents who tested for HIV was as high as 16%. [See also Meeting the %{s:35}]
Increasing Access to Services
1 study
Efforts are needed to implement and research interventions to alleviate stigma and discrimination on the basis of HIV status, gender, sexual orientation, gender identity, sex work and drug use in the health care sector, social services, police and the judiciary. [See %{s:67} and %{c:7}]
Advancing Human Rights and Access to Justice for Women and Girls
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
Multiple strategies are needed to promote male involvement in ways that meet pregnant women’s needs. Studies found that some women found their partners’ involvement controlling and/or violent and other women wanted more autonomy in health decision-making. Studies also found men lacked information on vertical transmission and felt excluded from PMTCT programs. Other studies found that women indicated that they could not discuss their HIV serostatus with their husbands.
Antenatal Care - Testing and Counseling
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
Women and men need accurate information on vertical transmission, treatment adherence strategies, the importance of their viral load and the low risk of vertical transmission if virally suppressed. Adherence has been challenging for women living with HIV postpartum, even for those initiating ART during pregnancy at CD4 counts under 350, with adequate adherence dropping from 75.7% during pregnancy to 53% postpartum globally (Nachega et al., 2012 cited in Coutsoudis et al., 2013). Knowledge of HIV and vertical transmission has shown to be correlated with increased initiation, adherence and retention for pregnant women living with HIV.
Antenatal Care - Treatment
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
Strategies, including legal strategies, are needed to empower pregnant women living with HIV to ask questions, be properly informed and to challenge stigma, disrespect and abuse. [See also %{s:67}] Consequences for violating patient confidentiality, redress for women with HIV facing discrimination in facilities, and stigma reduction efforts are needed to increase adherence to cART, prior to, during and post pregnancy, including training for providers.
Antenatal Care - Treatment
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
Mandating pregnant women to enroll in ART on the same day they test HIV positive may violate their human rights and may result in loss-to-follow up, increasing the risk of mortality, morbidity and drug resistance. Providing enough counseling and information to pregnant women found positive before being initiated on lifelong treatment helps in reducing cases of loss to follow up. Active tracing of women lost to follow up in a way that does not violate consent, confidentiality and human rights, may be warranted. An analysis of national facilities with over 20,000 women started on cART under Option B+ found that loss to follow up was highest in patients who began cART at large clinics on the day they were diagnosed with HIV. After controlling for age and facility type, Option B+ patients who started on ART on the same day of testing were almost twice as likely to never return to the clinic than other Option B+ patients. Note: WHO September 2015 guidelines do not specify when during pregnancy a woman living with HIV should be initiated on cART
Antenatal Care - Treatment
1 study
Initiatives that provide for early diagnosis and appropriate longitudinal care prior to treatment eligibility are needed to reduce mortality rates and costs among adults accessing treatment. A review found that early mortality among adults accessing antiretroviral therapy can be attributed to late diagnosis of HIV. Despite multiple interactions with parts of the healthcare system, a study of women in Uganda found that late presentation for HIV care resulted largely from the, “inability of the medical system to link women to appropriate care,” (McGrath et al., 2012: 1095). Women entered care only when symptomatic. Another study found that more than a quarter of HIV patients in care prior to ART initiation did not start ART according to national guideline criteria. Another study found that women did not know where to go to access treatment. A review found that a process is needed to optimize transfers of care without treatment interruption and with appropriate medical documentation. Another study found that over half of patients who were not yet known to be eligible for ART at enrollment but who had tested HIV-positive, including a quarter who had CD4 counts taken, were lost to follow up. Another review found that asymptomatic patients perceived little need to initiate ART. Another study found that those with higher CD4 counts who were not yet eligible for ART lacked social support and social capital, yet needed this support.
Provision and Access
1 study
Interventions are needed to reduce cross-generational sex and marriage. Studies found that young women relied on older men to pay their school fees in exchange for sex. Numerous studies found significant numbers of young girls having sexual relationships with older men, who are more likely to be HIV-positive and seek sexual partnerships with younger women. Studies also found that due to poverty, parents encouraged transactional sex and that efforts are needed to address parental pressures.
Mitigating Risk
1 study