Showing 41 - 60 of 61 Results for "Ethiopia"

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Additional efforts are needed to improve information and counseling about HIV during ANC to ensure that pregnant women and their sexual partners have adequate information. Studies found significant numbers of pregnant women received HIV tests with no counseling and reported that HIV testing was a mandatory part of their antenatal care. Studies also found that HIV-positive women feared transmitting HIV to their babies through casual contact. Studies found some providers assured women that treatment guaranteed that there would be no vertical transmission. In addition, studies found that some couples erroneously believed that sex during pregnancy causes miscarriages. Studies have also found that women who have tested HIV-negative at their first antenatal visit had seroconverted to HIV-positive by 12 months following delivery.
Antenatal Care - Testing and Counseling
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
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
Effective programs (as described here) must be expanded to reach many more young people, especially young people who are most neglected such as very young adolescents, out-of-school youth, young people living with HIV, homeless and rural youth, as well as lesbian, MSM and transgender adolescents and other key populations. [See also %{s:73}] Studies found adolescent girls did not know that anal sex increased the risk of HIV acquisition, did not use condoms, and did not know that oral sex carries a low risk of HIV acquisition. Out-of school-youth were at high risk of early sexual debut. A scan of sex education curricula found that information on key aspects of sex such as information on condoms in addition to negative, fear-based curriculum were prevalent and that less than half of out of school youth were reached. In some countries, pornography was the principal source of information about sex and pornography often depicts condom-free sex and gender inequality, with men in domineering roles (Day, 2014).
Mitigating Risk
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
Intensified efforts are needed to increase male and female condom use and reduce multiple partnerships by people who know their HIV-positive status and are not virally suppressed, including young people. Studies found that consistent condom use between discordant couples (or with partners whose serostatus was unknown) was low and, among those on treatment, decreased over time. Lack of condom use was associated with fear of disclosure. People living with HIV as well as couples also believed that treatment with antiretroviral therapy meant that they were either cured of HIV or could no longer transmit the virus and were less likely to disclose their positive serostatus. In some studies, men are more likely to report condom use than women, "given the limited control that women have over the use of the male condom" (Walusaga et al., 2012: 698). Particular attention is also needed to provide condoms to men living with HIV who frequent sex workers, as well as for sex workers themselves to protect themselves (Paz-Bailey et al., 2012). [See %{s:9}]
Staying Healthy and Reducing Transmission
1 study
Voluntary Medical Male Circumcision
Prevention for Women
Male circumcision has now been shown in three randomized clinical trials to reduce the risk of HIV acquisition for men by 50-60% (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007). Male circumcision at birth as part of postnatal care could result, upon sexual initiation and during his lifetime, in a reduction in the risk of HIV acquisition. Voluntary medical male circumcision (VMMC) ...
Hepatitis
Preventing, Detecting and Treating Critical Co-Infections
Hepatitis is an inflammation of the liver, most often caused by a virus. The most common types of viruses are hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. "Hepatitis A and E are typically caused by ingestion of contaminated food or water and are not known to cause chronic liver disease" (WHO, 2010c). A vaccine exists for hepatitis A and a meta-analysis of eight studies fr...
Voluntary medical male circumcision (VMMC) may be effectively integrated into school programs. [See also %{s:5}]
Mitigating Risk
4 studies Gray IIIb, V adolescents, male circumcision South Africa
Reducing Stigma and Discrimination
Strengthening the Enabling Environment
"...Three decades into the epidemic, stigmatization remains a core feature of the patient experience of HIV/AIDS" (Gilbert and Walker, 2010: 144). Or as one woman living with HIV in Thailand put it: "It does not matter how many thousand people have HIV/AIDS... I would say that only zero percent will accept people living with HIV/AIDS" (Liamputtong et al., 2009: 865). Stigma and discrimination h...
Antenatal Care - Treatment
Safe Motherhood and Prevention of Vertical Transmission
Antiretroviral treatment (ART) for women living with HIV is vital to ensuring safe motherhood and reducing vertical transmission. But not all pregnant women access treatment. For women in high-income countries where access to triple therapy during pregnancy has been the standard of care and is near universal, rates of vertical HIV transmission are as low as 0.4%, for example, in Canada (Forbes ...
Partner Reduction
Prevention for Women
Multiple sexual partnerships have long been a concern in HIV prevention programming, which has focused on partner reduction. Multiple partnerships bring increased risk of HIV acquisition: A meta-analysis of 68 epidemiological studies from 1986 to 2006 with 17,000 HIV-positive people and 73,000 HIV-negative people found that women who reported three or more sex partners had three times as much l...
Antenatal Care - Testing and Counseling
Safe Motherhood and Prevention of Vertical Transmission
In 2007, only an estimated 18% of pregnant women were offered HIV tests (ITPC, 2009). "The purpose of antenatal VCT should be to help a woman prepare for a possible positive HIV diagnosis [and] to provide her with information about PMTCT options" (De Bruyn and Paxton, 2005: 145). In developing country settings, between eight and ten percent of women report having received PMTCT interventions (P...
Orphans and Vulnerable Children
Care and Support
In some countries, three generations have been affected by HIV (Oladokun et al., 2010a). Even as incidence declines, there is a clear need to continue meeting the needs of children orphaned and made vulnerable due to HIV and AIDS. "Nowadays there is a deadly disease called AIDS. This disease is only treated but not cured. Anyone can be infected -- male, female, young, old, rich, poor, educated...
Prevention for Women
In this era of great strides forward in treatment, it is important not to lose sight of the continued need to undertake a range of interventions to prevent HIV transmission. An estimated 2.7 million people newly acquired HIV infection in 2010, as they did for each of the years 2009, 2008 and 2007, down from 3.1 million people in 2002 (WHO et al., 2011b). However, even with all this encouraging ...
Safe Motherhood and Prevention of Vertical Transmission
Three vital components of AIDS programming for women living with HIV are ensuring safe motherhood through access to health care before, during and after pregnancy and childbirth; ensuring access to treatment; and ensuring access to services to prevent vertical HIV transmission. While much progress has been made in reducing vertical transmission, more could be done. A recent demographic model sh...
Addressing Violence Against Women
Strengthening the Enabling Environment
Violence, in addition to being a human rights violation, has been clearly demonstrated as a risk factor for HIV (WHO, 2010f; Stephenson, 2007; Jewkes et al., 2006a; Manfrin-Ledet and Porche, 2003; Dunkle et al., 2004; Quigley et al., 2000b; Silverman et al., 2008). Analysis of DHS data in Rwanda showed that currently married women with few, if any, sexual risk factors for HIV but who have exper...
Provision and Access
Treatment
Antiretroviral therapy has been successfully administered in a range of situations with adherence, retention, and clinical outcomes similar to those achieved in resource-rich countries. Increasing provision and access, grounded in human rights based approaches, across all populations is critical to continuing that success. "I cook scones for my children and do not get tired. I do chores, pound...
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
Given that most HIV transmission occurs through sexual intercourse, it is critical to include a sexual and reproductive health lens in HIV programming. In fact, several European governments have recently revised their international policies, recognizing that HIV/AIDS is a sexual and reproductive health issue (Germain et al., 2009). All women have the right to decide freely and responsibly on t...
Advancing Human Rights and Access to Justice for Women and Girls
Strengthening the Enabling Environment
*Respecting, protecting and fulfilling womens rights, particularly the rights of the most marginalized women, is increasingly understood as fundamental to an effective HIV response. Laws reflecting unequal gender norms that discriminate against women may limit their ability to protect themselves from HIV infection. In many countries where women are most at risk for acquiring HIV, laws to protec...