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'Dare To Be Different': Enhancing Life Skills Education For Hiv Prevention In South African Schools, Tobey Nelson Sapiano, Nathi Sohaba, Eka Esu-Williams

HIV and AIDS

In South Africa, approximately 5.5 million people are living with HIV. One of the main strategies the South African Government has used to build HIV prevention awareness and promote behavior change among young people is school-based life skills education. Since 2000, the Horizons Program has conducted research exploring the impact of life skills education and other school-based HIV prevention activities on young South Africans. In contrast to the high HIV prevalence among youth ages 15–24, estimated to be over 10 percent, prevalence for youth ages 10–14 is estimated at just over 1 percent. People aged 10–14 are particularly receptive to …

Food On The Table: The Role Of Livelihood Strategies In Maintaining Nutritional Status Among Art Patients In Kenya And Zambia, Fiona Samuels, Naomi Rutenberg, Joseph Simbaya, Jerry Okal, Nicodemus Kisengese, Stanley Luchters, Susan Kaai, Scott Geibel

HIV and AIDS

As understanding of the multidimensional nature of HIV epidemics improves, it is increasingly recognized that policy and program interventions, whether focusing on prevention, treatment and care, or impact mitigation, must take into account the integral role of food and nutrition security. More broadly, interventions need to consider how people’s livelihoods evolve and adapt to deal with the multifaceted nature of HIV. In eastern and southern Africa, evidence pointing to a vicious cycle between HIV and food and nutrition insecurity is mounting. Programs are now being implemented that link HIV to food and nutritional security, as well as to livelihoods. However, …

Involving Young People In The Care And Support Of People Living With Hiv In Zambia: An Evaluation Of Program Sustainability, Eka Esu-Williams, Catherine Searle, Anderson Zulu

HIV and AIDS

In 2005, approximately 17 percent of the population of reproductive age in Zambia was infected with HIV and nearly 710,000 under the age of 18 were orphans. As the needs of people living with HIV (PLHIV) and orphans and vulnerable children (OVC) escalate, communities are seeking new ways of helping those affected by the disease. A Horizons intervention study conducted in northern Zambia from 2000–02 found that youth could be trained to help meet the care and support needs of PLHIV and their families, including OVC. Study participants belonged to anti-AIDS clubs that taught about HIV and how to prevent …

Idhini Fahamishi Katika Majaribio Ya Kikliniki Ya Ukingaji Wa Virusi Vya Ukimwi, Population Council

HIV and AIDS

Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health International in May 2005. The brief focuses specifically on tools and strategies presented at the workshop that are being used in HIV-prevention trials to facilitate informed consent, explain difficult concepts, and assess comprehension among trial participants. Illustrative examples from completed and ongoing trials are highlighted. This brief will be useful for an audience of local researchers, advocates, and clinical trial staff.

Patterns And Implications Of Male Migration For Hiv Prevention Strategies In Maharashtra, India, Niranjan Saggurti, Ravi K. Verma, Anrudh K. Jain, Pranita Achyut, Saumya Ramarao

HIV and AIDS

Maharashtra was one of the first states to be affected by HIV in India. Results from the National Family Health Survey (NFHS-3) in 2005–06 indicate that 0.62 percent of men and women aged 15–49 years were infected with HIV, as compared to the national average of 0.28 percent. HIV sentinel surveillance data from sites across Maharashtra indicate that 1.3 percent of pregnant women receiving antenatal care (ANC) and 10.4 percent of patients receiving treatment for sexually transmitted infections in 2005 were infected with HIV. At the same time, Maharashtra ranks first nationally in the proportion of total migrants, and there …

Patterns And Implications Of Male Migration For Hiv Prevention Strategies In Karnataka, India, Niranjan Saggurti, Ravi K. Verma, Pranita Achyut, Saumya Ramarao, Anrudh K. Jain

HIV and AIDS

Karnataka is one of the high HIV prevalence states in India. Results from the National Family Health Survey indicate that 0.69 percent of adults aged 15–49 were infected with HIV in 2005–06. According to sentinel surveillance system data, HIV prevalence among pregnant women receiving antenatal care (ANC) in Karnataka was 1.3 percent. Further, 18 of the state's 27 districts have recorded HIV prevalence of more than 1 percent among pregnant women receiving ANC in sentinel sites. Strong male migration patterns are evident in some of the state’s high HIV prevalence districts. According to the 2001 census, Karnataka ranks fourth in …

Building The Capacity Of Faith-Based Organizations To Promote Mutual Monogamy In South Africa, Waimar Tun, Nathi Sohaba, Unathi Malinzi, Matthew Nqono, Osborne Mzilikazi, Bonisiwa Mgujulwa, Moses Madywabe, Mbulelo Fatyeni, Christine Fontecchio

HIV and AIDS

In South Africa, where sex partnerships outside primary relationships are common even among church members, HIV-prevention programs focusing on mutual monogamy (MM) are needed. Church leaders, highly regarded by the community, may be effective in reaching congregation members with HIV-prevention messages. However, implementing programs that promote faithfulness pose several challenges. In response to a lack of research on effective strategies to promote MM, the Horizons Program, in partnership with the Eastern Cape Provincial Council of Churches and the South African Council of Churches, piloted an intervention to promote MM. A curriculum was developed covering topics including HIV transmission, personal relationships, …

Consentimiento Informado En Ensayos De Prevención Del Vih: Aspectos Destacados De Un Taller Internacional, Population Council

HIV and AIDS

Resumen adaptado del informe del taller organizado conjuntamente por el Population Council y Family Health International en mayo de 2005. El resumen se centra específicamente en las herramientas y estrategias presentadas en el taller que se están usando en ensayos de prevención del VIH para facilitar el consentimiento informado, explicar conceptos difíciles, y evaluar la comprensión entre los participantes del ensayo. Se destacan ejemplos ilustrativos de ensayos concluidos y en curso. Este resumen será útil para una audiencia de investigadores locales, defensores y personal de ensayos clínicos.

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Brief adapted from the report of a workshop co-hosted by the Population …

Consentimento Informado Nos Ensaios De Prevenção Do Hiv: Pontos Altos Dum Workshop Internacional, Population Council

HIV and AIDS

Resumo adaptado do relatório do workshop organizado pelo Population Council e Family Health International em maio de 2005. O resumo se concentra especificamente nas ferramentas e estratégias apresentadas no workshop que estão sendo usadas em testes de prevenção do HIV para facilitar o consentimento informado, explicar conceitos difíceis e avaliar a compreensão entre os participantes do estudo. Exemplos ilustrativos de ensaios concluídos e em andamento são destacados. Este resumo será útil para um público de investigadores locais, advogados e equipe de ensaios clínicos.

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Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health …

Imvume Unolwazi Ocwaningweni Lokuvimbela Igciwane Lesandulela Ngculaza, Population Council

HIV and AIDS

Brief adapted from the report of a workshop co-hosted by the Population Council and Family Health International in May 2005. The brief focuses specifically on tools and strategies presented at the workshop that are being used in HIV-prevention trials to facilitate informed consent, explain difficult concepts, and assess comprehension among trial participants. Illustrative examples from completed and ongoing trials are highlighted. This brief will be useful for an audience of local researchers, advocates, and clinical trial staff.

Has The Hiv Epidemic Peaked?, John Bongaarts, Thomas Buettner, Gerhard Heilig, Francois Pelletier

Poverty, Gender, and Youth

This working paper reviews the highly diverse regional and country patterns of HIV epidemics and discusses possible causes of the geographic variation in epidemic sizes. The main finding of this analysis is that the HIV epidemic reached a major turning point over the past decade. The peak years of HIV incidence rates are past for all regions, and the peaks of prevalence rates are mostly in the past except in Eastern Europe, where it is expected to peak in 2008. But owing in part to the life-prolonging effect of antiretroviral therapy and to sustained population growth, the absolute number of …

Exploring Positive Women's Lives In Namakkal District, India, P. Kousalya, Deepika Ganju

Reproductive Health

This report describes an initiative that was undertaken to document the experiences of HIV-positive ever-married women in Namakkal district, Tamil Nadu, India. The initiative sought to explore the circumstances in which women learned about their HIV status; their feelings on finding out they were HIV-positive; the nature of husband–wife relationships prior to and following disclosure of women’s HIV status; the extent of support or discrimination that women experienced from family members, friends, and neighbors; treatment-seeking behaviors; and women’s perspectives about ways in which the multiple needs of HIV-infected women can be met. Drawing on the testimonies of these women gathered …

Voices From The Street: Comics For Young Men On Masculinity, Sexuality And Hiv—An Evidence-Based Communication Initiative, Vijaya Nidadavolu, Leena Joshi, Vinita Nathani, Atanu Ghosh, Isidore Phillips

HIV and AIDS

HIV infection is spreading rapidly among young people in India. With more than 30 percent of new infections in 2006 in the 15–29-year age group, the need to address the vulnerability of this population subgroup is pressing. Existing literature shows that young men subscribe to norms of masculinity that lead to risky behavior patterns. Misinformation about HIV coupled with a low perception of risk to themselves make young men even more vulnerable. To bring about social and attitude change in the long-term, communication strategies that are evidence-based, culturally appropriate, and designed in consultation with target audiences are needed. The Population …

Reaching Truckers In Brazil With Non-Stigmatizing And Effective Hiv/Sti Services, Magda Chinaglia, Sheri A. Lippman, Julie Pulerwitz, Maeve De Mello, Rick Homan, Juan Diaz

HIV and AIDS

A study conducted by the Population Council in 2001 found that truckers crossing Brazil’s southern border had easy access to commercial sex and extremely limited access to health services, condoms, HIV testing and counseling, and HIV/STI prevention messages. In response, the Population Council’s Horizons Program conducted an intervention study from 2002 to 2005. The study examined the feasibility, acceptability, and impact of providing a range of health services to truckers at a health post inside a customs station, where truckers wait anywhere from one day to a week for documents and cargo to clear customs. As noted in this brief, …

Preparedness Of Kenyan Health Workers To Deliver Hiv/Aids Services, National Aids And Std Control Programme, Ministry Of Health Kenya, Centers For Disease Control And Prevention, Horizons Program

HIV and AIDS

Most Kenyan adults do not know their HIV status. Patients who present to a health facility can learn their status as part of a diagnostic assessment, enabling health-care personnel to provide a more accurate clinical evaluation and accelerate access to comprehensive care. This is particularly relevant in Kenya because up to 60 percent of all medical ward hospital beds are occupied by HIV-infected patients. Therefore provider-initiated HIV testing and counseling, which includes diagnostic testing and counseling (DTC), provides an opportunity to interrupt the cycle of HIV transmission to patients’ partners and children. In 2004, the Kenya Ministry of Health launched …

Impact Of Antiretroviral Therapy On Household Economics: Findings From Mombasa, Kenya, Rick Homan, Desai Jaikishan, Paul Munyao, Avina Sarna, Scott Geibel

HIV and AIDS

While the clinical impact of receiving antiretroviral therapy (ART) on individuals living with HIV is well documented, less is known about how the receipt of ART affects household economics. This analysis examined the direct and indirect effects of receiving ART on household economics. A direct effect is reduced spending on health services as a result of the improved health status of the household member on ART. The potential indirect effects include increased labor-force participation by the household member on ART, a change in how other household members spend their time (working or in school), and a shift in composition of …

Sexual Risk Behaviors Of Hiv-Positive Persons Receiving Art In Mombasa, Kenya: Longitudinal Study Findings, Stanley Luchters, Avina Sarna, Scott Geibel, Matthew F. Chersich, Paul Munyao, Susan Kaai, Kishorchandra N. Mandaliya, Naomi Rutenberg, Marleen Temmerman

HIV and AIDS

As a result of the success of antiretroviral therapy (ART) in dramatically decreasing morbidity and mortality due to HIV, many HIV-infected individuals are now living longer, healthier, and more sexually active lives. However, unprotected sex by people living with HIV is an area of concern because of the risk of transmission to sero-discordant partners and reinfection with new, drug-resistant viral strains. There is evidence to suggest that some sero-positive individuals continue to engage in unprotected sex that places others at risk for infection and places themselves at risk for contracting secondary infections. To learn more about the impact of ART …

Changes In Stigma Among A Cohort Of People On Antiretroviral Therapy: Findings From Mombasa, Kenya, Susan Kaai, Avina Sarna, Stanley Luchters, Scott Geibel, Paul Munyao, Kishorchandra N. Mandaliya, Khadija Shikely, Marleen Temmerman, Naomi Rutenberg

HIV and AIDS

Stigma has been a reality in the lives of people living with HIV (PLHIV) since the inception of the AIDS epidemic, and it can have profound implications for health, psychosocial well-being, and utilization of health services. In the industrialized world, the availability of antiretroviral therapy (ART) and a subsequent change in perception of AIDS as a chronic manageable disease has coincided with a decrease in stigma and discrimination directed toward PLHIV. However, little is known in developing countries about whether perceptions and experiences of stigma among PLHIV have changed following increased access to ART. The Horizons Program and the International …

Promoting Adherence Through A Directly Administered Antiretroviral Therapy Strategy In Mombasa, Kenya, Avina Sarna, Stanley Luchters, Scott Geibel, Matthew F. Chersich, Paul Munyao, Rick Homan, Susan Kaai, Kishorchandra N. Mandaliya, Marleen Temmerman, Naomi Rutenberg

HIV and AIDS

A principal concern of antiretroviral therapy (ART) programs is the ability of clients to maintain a high level of adherence to medication. Based on formative research conducted with HIV-infected clients and health workers in Mombasa, Kenya, and lessons learned from directly observed therapy strategies to encourage adherence to treatment for tuberculosis, a directly administered antiretroviral therapy (DAART) strategy to promote adherence to ART was developed. This study examines whether the intervention was more effective in fostering adherence to ART than standard follow-up among people living with HIV in Mombasa. Researchers from the Horizons Program and the International Centre for Reproductive …

Implementing Sti/Hiv Prevention And Care Interventions For Men Who Have Sex With Men In Senegal, Amadou Moreau, Placide Tapsoba, Abdoulaye Ly, Cheikh Ibrahima Niang, Abdou Khoudia Diop

HIV and AIDS

Exploratory research conducted by the Horizons Program in 2002 revealed that men who have sex with men (MSM) in Dakar, Senegal, are particularly vulnerable to sexually transmitted infections (STIs) and HIV. Further, the stigma and discrimination suffered by many MSM result in the concealment of sexual behaviors from health-care providers, making it difficult to receive appropriate services. Finally, there is a lack of HIV-prevention campaigns geared to this group. Key stakeholders in Dakar developed and implemented an intervention to meet the STI/HIV prevention needs of MSM and address prevailing stigma that effectively serves as a barrier to care. The intervention …

Psychosocial Benefits Of A Mentoring Program For Youth-Headed Households In Rwanda, Lisanne Brown, Janet C. Rice, Neil W. Boris, Tonya R. Thurman, Leslie M. Snider, Joseph Ntaganira, Laetitia N. Nyirazinyoye, Edward Kalisa, Emmanuel Nshizirungu

HIV and AIDS

In Rwanda, the combined effects of the 1994 genocide and the AIDS pandemic have devastated the lives of children and families. More than 300,000 young people have been “left behind,” not only by parents and other caregivers who have died, but also by extended families and communities who stigmatize and fail to support them. The phenomenon of youth-headed households in the region is a relatively recent development. Despite the long history of fostering in sub-Saharan Africa, family and community safety nets are overstretched. Youth-headed households may be a legitimate coping strategy; however, children living in youth-headed households are less likely …

Supporting Volunteer Mentors: Insights From A Mentorship Program For Youth-Headed Households In Rwanda, Lisanne Brown, Tonya R. Thurman, Edward Kalisa, Janet C. Rice, Jean De Dieu Bizimana, Neil W. Boris, Leslie M. Snider, Joseph Ntaganira

HIV and AIDS

In 2004, World Vision Rwanda (WVR), in collaboration with Tulane University and the Rwanda School of Public Health, implemented a program to provide support through regular visits by an adult mentor to youth living without adult care. After completion of baseline quantitative and qualitative research, WVR implemented the program in two areas of a province in southwestern Rwanda. Over an 18-month period, 156 trained adult mentors visited and supported 441 youth-headed households. The mentor training covered key aspects of child development and skills for addressing key psychosocial issues that were identified through the baseline research. Specifically, the training addressed how …

Intergenerational Communication On Sexuality And Hiv/Aids: Exploring Feasibility Of Building Effective Youth-Adult Partnerships To Reduce Young People's Hiv Vulnerabilities, Vaishali Sharma Mahendra, Sarat Chandra Pradhan, Saraswati Swain, Aradhana Nanda, Sanjit Patnayak, Sucheta Panda, Rajendra Prasad

HIV and AIDS

In India, over one-third of all reported AIDS cases occur among people aged 15–24 years. Young people need competencies to navigate daily-life situations and engage in productive activities, and the relationships they form with adults and peers are the source of support and guidance critical to the development of their competencies. The peer-based approach is integral to sexual health and HIV-prevention programs for youth. However, in some settings, program and policy directions have been hampered by adult beliefs of what young people should be permitted to know. Recent projects show that working on changing the norms and beliefs of adults …

Patterns And Implications Of Male Migration For Hiv Prevention Strategies In Andhra Pradesh, Ravi K. Verma, Niranjan Saggurti, Madhumita Das, Saumya Ramarao, Anrudh K. Jain

HIV and AIDS

HIV is widespread in Andhra Pradesh, with high HIV prevalence among pregnant women receiving antenatal care and patients receiving treatment for sexually transmitted infections. High HIV prevalence among women indicates that the infection, rather than being restricted to groups at high risk, is present in the general population. Districts with high HIV prevalence are also destinations for large numbers of male migrants. Migration may be a major contributor to the spread of HIV in the state, however empirical evidence is limited. Furthermore, evidence is required to maximize the impact of programmatic inputs intended to contain the spread of the epidemic. …

Identifying Areas For Linkages Between Hiv And Srh For Vulnerable Populations: An Exploratory Study To Assess Female Sex Workers' Sexual And Reproductive Health Needs, Vaishali Sharma Mahendra, Sushma Mehrotra, B. Srikanthi, Sucheta Panda, Avina Sarna, A.K. Jayasree, Rajendra Prasad, Naomi Rutenberg

HIV and AIDS

Sexual and reproductive ill-health and HIV/AIDS share root causes, including poverty, gender inequality, and social marginalization of the most vulnerable populations. This has prompted the international community to call for policy and program approaches to strengthen the linkages between SRH and HIV/AIDS programs. However, most integration efforts have given priority to family planning, maternal and child health, and STI treatment and to addressing the needs of married women from the general population. Female sex workers have been targeted for HIV prevention efforts but little attention has been given to SRH-related care. To bring sex workers into the focus for SRH-HIV …

Exploring The Barriers To Accessing Care And Treatment For Hiv-Infected Children In India: A Diagnostic Study, Avina Sarna, Jaleel Ahmad, Glory Alexander, Vaishali Sharma Mahendra, Ashok Rau, Arjun Singh, Naomi Rutenberg

HIV and AIDS

Each year 27 million births take place in India. A conservative estimate of HIV prevalence of 1 percent among antenatal women translates to about 80,000 HIV-infected children being born annually. The latest figures from the National AIDS Control Organisation show that there are about 5,600 documented HIV-positive children (0–14 years), but a very small number are receiving antiretroviral therapy. The Population Council and partners conducted a qualitative study in three high-prevalence states of India to explore the facilitators and barriers to accessing care for HIV-positive children and assessed the current level of adherence to ART among children receiving treatment. A …

Injecting Drug Users In India: Understanding Sexual Behaviours And Sexual Networks To Design Effective Behaviour Change Strategies, Avina Sarna, Waimar Tun, Aruna Bhattacharya, Vaishali Sharma Mahendra, Neville Selhore, Arjun Singh, Louis Apicella

HIV and AIDS

The practice of injecting drug use has been spreading to different parts of India since the early 1980s and is associated with an increase in HIV prevalence rates. Injecting drug users (IDUs) engage in both risky injection and sexual practices that increase the risk for HIV transmission. While risky injection practices are well understood, there is limited understanding of IDUs’ sexual behaviors and social networks. The Population Council conducted a cross-sectional study to explore patterns of risky sexual behaviors, sexual network characteristics, and drivers of high-risk behaviors of IDUs in Delhi and Imphal. The contrasting settings were selected to allow …

Current Research And Good Practice In Hiv And Aids Treatment Education, Avina Sarna, Ellen Weiss

HIV and AIDS

This report was prepared by UNESCO and WHO for presentation at the HIV and AIDS Treatment Education Technical Consultation in Paris, November 22–23, 2005. There is a growing realization among program managers and donors that merely providing antiretroviral therapy (ART) and training health providers is not sufficient and that unless efforts are made to engage communities and individuals to improve their knowledge and understanding of HIV, AIDS, and ART, programs will not meet the targets set by these initiatives and will fall short of contributing to the goal of attaining universal access to treatment. This report describes current research and …

Engaging Advocates From Concept To Results: Summary Report Of The Advocates' Consultation On Hiv Prevention Trials: Carraguard And Voice Studies, Johannesburg, South Africa, 18-19 October 2007, Microbicide Trials Network, Population Council

HIV and AIDS

Advocate consultations are increasingly becoming the rule, not the exception in the HIV-prevention research field. As an increasing number of Phase III trials enter the field, research groups are seeking new ways to collaborate with advocates and maximize civil society input and engagement. The Advocates’ Consultation for HIV Prevention Trials: Carraguard and VOICE Studies provided leaders from African NGOs a unique opportunity to learn about the clinical trial process from beginning to end, and to collectively identify ways to influence how scientific research is formulated. Participants represented a wide range of advocacy groups from Southern African countries, including those working …

The Hiv/Aids Prevention Project For Vulnerable Youth In Northern Nigeria: Community Advocates Training Manual, Population Council, Adolescent Health And Information Projects, Federation Of Muslim Women's Associations In Nigeria, Islamic Education Trust

HIV and AIDS

This Community Advocates training manual contains a curriculum developed by the Population Council, Nigeria, under the HIV Prevention Project for Vulnerable Youth in Northern Nigeria funded by USAID/Nigeria. The curriculum was developed as a tool for training community advocates in conducting advocacy activities on the issues of early marriage, HIV/AIDS, and reproductive health. The curriculum aims to improve knowledge and strengthen the skills of community representatives from the northern region of Nigeria so they can openly discuss sensitive issues relating to HIV/AIDS, reproductive health, and marriage. Designed to be adapted or implemented as written, the curriculum is based on the …