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Showing 121 - 140 of 160 Results for "Kenya"

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Further interventions to provide support programs, including counseling, are needed for AIDS-orphaned children and their caregivers to combat depression, social isolation and stigma. Studies found that AIDS orphans reported insufficient food, depression and stigma.
Orphans and Vulnerable Children
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
Women living with HIV need information and access to services for emergency contraception and post-abortion care (PAC) services. Studies found that women did not have adequate knowledge of emergency contraception, nor access to services for post-abortion care.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
Further interventions are needed to ensure that women, especially women living with HIV, are screened and treated for cervical pre-cancer and cancer. Studies found that women were not aware of and/or did not receive regular screening and treatment of cervical cancer, despite higher risk of developing cervical cancer.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
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
Stigma reduction interventions are needed so that women with HIV can choose replacement feeding, breastfeeding and weaning schedules. Studies found that HIV-positive women feared that if they used infant formula or abruptly weaned, they would be stigmatized for their HIV-positive serostatus.
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
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
Male and female condoms when used consistently and correctly, are comparable in effectiveness.
Male and Female Condom Use
4 studies Gray II, V female condoms
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
Interventions, policies and budgets are needed to reduce sexual coercion and rape of both boys and girls, create awareness in communities that violence against children is unacceptable, strengthen child statutory protection systems, and conceptualize and implement appropriate child protection services in developing countries. Access to post-exposure prophylaxis in case of rape when the perpetrator is HIV-positive is also needed. [See also %{c:21}] In most countries of Eastern and Southern Africa, the age of consent for sex is 16. Despite these restrictions, more than 10% of girls have had sexual debut before age 15. A study found that in a sample of more than 1,000 males and more than 1,000 females, large numbers had experienced high rates of physical punishment, emotional abuse and touching of sexual organs when not wanted or sex due to force or coercion prior to age 18 and that incident HIV infections were more common in women who suffered emotional abuse, sexual abuse and physical punishment. Sexual abuse in men was associated with alcohol abuse and depression. Other studies found high rates of sexual coercion and high-risk behaviors among street children. “Few children disclose abuse, fewer still seek services and report to authorities, virtually no children actually receive services and perpetrators rarely suffer consequences” (Sommarin et al., 2014: S213). Most research does not provide adolescent-specific data on violence, instead listing results for ages 15 to 49. Reviews have not found evidence that preventive responses have had an impact on rates of sexual abuse. Effective programs in the US and Canada have not been assessed for adaptation in other countries.
Mitigating Risk
1 study
Programs must adhere to the longstanding international agreement to voluntarism, informed consent, and ensuring the right of individuals and couples to decide freely and responsibly the number and spacing of their children. Studies found that women living with HIV had been sterilized against their will, were pressured by providers to terminate a pregnancy, or were stigmatized for becoming pregnant. Studies also found that provision of antiretroviral therapy was conditional on using certain types of contraception. Litigation is currently being undertaken. A study found that HIV-positive women who accessed contraceptive services were not informed of the benefits of PMTCT programs in reducing vertical transmission.
Meeting the Sexual and Reproductive Health Needs of Women Living With HIV
1 study
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
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
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) ...
PMTCT-Plus (family-focused) HIV care can increase the numbers of women and their partners who access treatment and remain adherent. Note: This should not be implemented in any way that prejudices women who do not want to disclose to partners (see overview).
Antenatal Care - Treatment
4 studies Gray IIIa, IIIb PMTCT Plus, PMTCT-Plus, pregnancy, treatment Africa, Botswana, Côte d’Ivoire, South Africa, Tanzania, Uganda, Zambia
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...
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 ...