Prevention of Mother-to-Child Transmission of HIV: Experience of a Level 2 Health Center in Senegal

The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.

Appraisal of Existing HIV/AIDs Prevention and Control Measures and Presentation of Innovative Strategies to End HIV/AIDS Epidemic by 2030

Background: Globally, UNAIDS report 2022 shows, there are 84.2 million people affected by HIV/AIDS and 40.1 million deaths from AIDS since the start of epidemic. In sub-Saharan Africa, women and girls accounted for 63% of all new HIV infections in 2021 with, six in seven new HIV infections among adolescents aged 15 - 19 years being girls. Key populations accounted for 70% of HIV infections globally in 2021, with 51% of these new HIV infections in sub-Saharan Africa. Reflecting on the 4 decades’ journey of HIV epidemic amidst local, national and international efforts, the UN target of ending AIDS as a public health threat by 2030 remains questionable unless new innovative ways are used. This study aimed at analyzing existing HIV/AIDS interventions, discuss UN interventions in line with ending HIV/AIDS by 2030 then, suggest and discuss new innovative ways of ending HIV scourge by 2030. Methods: Systematic literature review methodology was used to extract existing published information on HIV prevention strategies from 1981 to 2023. The articles were previewed by 2 experts for quality and grouped by intervention. Of the 637 articles accessed, on HIV prevention/control only 45 met the inclusion criteria. Data were synthesized using a narrative synthesis approach following standard guidelines on synthesis without meta-analysis. Descriptive analysis was done, strength and limitations were identified. UNAIDS recommendations for ending HIV/AIDS by 2030 identified and analyzed. New Innovations in HIV/AIDS were presented and discussed. The scope of the reviewed literature was limited to HIV preventive strategies practiced between 1981 and 2023. Results: Findings show that, Uganda’s HIV prevalence was at a peak in 1991 of 15% (30% among pregnant women in urban areas). ABC strategy is claimed to have turned sharply downward the prevalence through the mid-1990s and reached 5% (14% for pregnant urban women) by 2001. Analysis of the strategy showed that the achievements of the strategy could not be sustained, subsequently HIV prevalence rose again. This is because none of the ABC components can independently reduce HIV problem. In the real world, 100% abstinence has failed, condom use only reduces infection by 90% (WHO), and lifelong monogamy is impractical. Such limitations weaken ABC strategy. The study established that Post-exposure prophylaxis (PEP) i.e. taking HIV medicines within 72 hours (3 days) after a possible exposure to HIV infection is a safe, effective and a globally practiced HIV preventive intervention in emergency situations of HIV exposure. However, PEP is limited to care sought within 72 hours after exposure and yet timely access especially in rural areas and for key populations remains a big challenge. Oral PrEP was also identified as effective HIV preventive measure that can reduce HIV risk from sex by about 99% and from injection drug users by 74%. However, like PEP, timely access especially in rural areas and for key populations remains a big challenge. The UNAIDS 95-95-95 strategy (i.e. 95% of people know their HIV status, 95% with +HIV status be on sustained ART and 95% on ART get viral load suppression) formed the basis for setting the target of ending HIV/AIDS epidemic by 2030. However, our analysis shows that this target is unrealistic given the above highlighted limitations/ barriers in preventive measures and the unlikely perfect adherence (100%) to ART by all enrolled HIV positive persons. Conclusion: Ending HIV/AIDS by 2030 cannot be achieved by implementing the current preventing strategies and control measures. This study established that most of the existing HIV preventive strategies and control measures have a number of limitations. However, with sustained UN 95-95-95 strategy supplemented with additional innovative ways, there is hope that the UN dream of ending HIV/AIDS though not necessarily by 2030, can in the long run be achieved.

A Life-skills-based HIV/AIDS Prevention Education for Rural Students of Primary Schools in China:What Changed? What Have We Learned?

Objective To evaluate a four-hour life-skills-based HIV/AIDS prevention curriculum among 5th grade students in rural primary schools of Hainan province.Methods The study included two stages.Stage one （September 2006-May 2007） was a pre-post-quasi experimental design;a total of 2 413 students aged 9 to 14 years from fifth grade classes of nine primary schools completed a baseline survey （1 720 students were in the intervention group,693 in the control group）,and over 98% of them took part in a short survey.The experimental curriculum was provided to the intervention group.At stage two （September 2008）,a cross-sectional questionnaire was administered to 6 923 students in 7th grade classes of eight middle schools in the same study sites.There were 1 437 students in the intervention group when the curriculum was conducted.Results Students tended to score higher in areas of HIV/AIDS related knowledge and attitudes,if they were younger than average,lived in the county seat,had access to the internet,and their parents had completed higher levels of education.Path analysis showed that,after controlling for characteristics such as family and community factors,the total effects of curriculum on knowledge in the short-term model increased remarkably compared with the baseline,and maintained major contributions to knowledge in the mid-term model.The positive effect of knowledge on attitudes was significantly improved in the short-term model as well.Conclusion A life-skills based curriculum can improve HIV/AIDS related knowledge and self-perceived level of life-skills among primary school students in rural areas in a short time,and these positive effects can still be observed at least 2 years post participation in the curriculum.

The Current HIV/AIDS Prevention Strategies—Widely Outsmarted by Omitting Realities: A Socio-Critical Analysis in the Context of Powerless Law, Ethics and Asymmetric Interpretation of Human Rights

The HIV pandemic seems to be fading to some degree—but there are regional exceptions. The current liberal prevention strategy with programs aimed at risk reduction interventions in particular for sexual behavior and injecting drug use has been expanded by antiretroviral treatment approaches. It was expected to keep the prevalence of infectious individuals below a certain threshold to curb self-sustaining chains of HIV infections. The introduction of biomedical approaches by ART/HAART with regard to practicing risk reduction behavior has been received as an exemption of responsibility by certain populations who are defined as “at-risk” population. Certain parts of the hard-to-reach, high-risk population have returned to unsafe sex practices leading to careless behavior which in turn has promoted the spread of HIV. This is supported by modern trends in risk societies where with regard to HIV basic principles of ethics and tenets of the Human Rights like “don’t harm other people” have lost any normative power. In addition, with the support of NGOs, legal norms such as protecting the “bodily integrity of individuals” have been ignored, allowing the “passing of HIV to partners” to become socially acceptable behavior. As a whole, in defiance of the endeavors of prevention applied so far, certain societies are exposed to an ongoing spread of HIV.

Prevention of Maternal-to-Child Transmission of HIV: Knowledge, Attitude and Factors Influencing Active Participation among HIV-Positive Men in a Military Health Facility in Lagos, South Western Nigeria

Introduction: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. Design: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. Result: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). Conclusion: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.

The Disregarded HIV Prevention Strategies—Their Potential to Uphold the Pandemic, and the Challenges Facing Societies

The ongoing spread of HIV after sobering news about the goal “End of AIDS” is not encouraging, apart from regional differences. We focus on the consequences of the two essentially failed HIV prevention strategies in certain countries. The first failed because the correct messages concerning preventive behavior did not reach the required levels of target populations to interrupt HIV infection chains. There was a lack of appropriate framework conditions for the target populations to engage in the required scale. The additional biomedical strategy “Treatment as Prevention” didn’t achieve the breakthrough as was hoped. The consequences thereof affect the financial burden on societies, which can take several decades. We draw attention to the unbalanced principles of proportionality to which governments are committed, but which are practiced in favor of those vulnerable people;these people abuse their autonomy and contribute to the further spread of HIV at the expense of financial burdens, social and medical care systems;this behavior is tolerated, although the transmission of HIV is mostly preventable. We point to extreme tendencies, such as the chem-sex settings, whose unswayable participants engage in indirect violence against the societies. Another possible consequence of the still uncontrolled spread of HIV is the potential for HIV to increase its virulence.

Knowledge, Attitudes and Perceptions of Secondary School Teenagers towards HIV Transmission and Prevention in Rural and Urban Areas of Central Uganda

HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly;weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can’t contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information could be the reason for the increased HIV prevalence reported among the adolescents in the schools. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention.

Missed Opportunities for Prevention of Mother-to-Child Transmission of HIV (PMTCT) in Ibadan, Southwest Nigeria

Background: Nigeria has the largest paediatric HIV-infected population in the world. Missed opportunities for prevention of mother-to-child transmission of HIV (PMTCT) compromise efforts at eliminating new pediatric HIV infections. Methods: Six hundred children, aged < 15 years, presenting to the pediatric units of the University College Hospital (UCH), Ibadan Southwest Nigeria between June to December 2007 were studied. The demographics, HIV status and socioeconomic status of mothers and their children were studied. A 4-step hierarchy was used to assess the missed opportunities for PMTCT. Step 1: utilization of a health facility for antenatal care and delivery;Step 2: maternal HIV status determination during pregnancy;Step 3: provision of antiretroviral medication to HIV-infected mother and baby;and Step 4: avoidance of mixed feeding in HIV-exposed children. The rates of missed opportunities for PMTCT services at different steps in the PMTCT cascade, perinatal transmission rates, and associated factors were reported. Results: There were 599 mothers and 600 children (one set of twins), 60 (10%) were HIV infected and 56 (93.3%) of these were adjudged perinatally infected. Of 78 HIV-infected women, 7 (9.0%) accessed all interventions in the PMTCT cascade and 71 (91.0%) had missed opportunities for PMTCT. Missed opportunities for PMTCT occurred 42.9% in cascade Step 1, 64.2% in Step 2, 52.6% in step 3 and 73.7% in Step 4. All mother-baby pairs who accessed complete PMTCT interventions received care at a teaching hospital. Among infants with perinatal HIV infection, 53 (94.6%) were born to mothers who had missed opportunities for PMTCT. Most women with missed opportunities attended antenatal care outside the teaching hospital setting and belonged to low socioeconomic status. Conclusion: It is imperative to expand PMTCT access to women who receive antenatal care outside the teaching hospitals and to those of low socioeconomic status.

An Appraisal of Sexual Behaviors, STI/HIV Prevalence, and HIV Prevention Programs among Truckers in India: A Critical Literature Review

Background: A systematic review portraying the changing pattern of sexual behaviors, STI and HIV prevalence and key strategies curb HIV and STI among truckers in India is lacking. This paper therefore aims to present a chronological review of literature regarding sexual behaviors, STI/HIV prevalence, and various HIV prevention programs implemented among truckers in India. Methodology: Published and unpublished studies (1990-2011) were identified through electronic databases, and hand searching. Results: Most studies on sexual behaviors and STI/HIV prevalence among truckers focused only on drivers and ignored their helpers. Evidences suggest that consistent condom use by truckers with both paid and non-paid female partners has increased during the past decade. Many recent studies suggest that the HIV prevalence among truckers is about 2% and it has been declining slowly during the past decade. The HIV prevention programs among truckers which started with the aim of raising awareness about HIV during early 1990s, have grown multi-folds to encompass not only the standard strategies like mid-media events, interpersonal counselling and STI care for HIV prevention, but also innovations such as the use of business franchisee models, and integrated research and evidence based planning in the program. The possibilities of using new approaches such as male circumcision and the use of pre-exposure prophylaxes are underway. Conclusion: More studies are needed to explore helpers’ vulnerabilities to HIV. Very few studies have attempted to examine the impact of large-scale prevention programs among truckers. Efforts are required to examine the impact of different components of such programs to guide the HIV prevention efforts among truckers in India.

Evaluation of the Implementation of the WHO’s 2010 Guide on Prevention of Mother To-Child Transmission (PMTCT) of HIV/Aids: Case of Two Hospitals in Yaoundé

Introduction: The prevalence of HIV infection amongst pregnant women in Cameroon is 5.6%. Mother-to-child transmission is a major expansion factor. In 2010, Cameroon adopted new strategies pegged to WHO guidelines. Objectives: The objective of this study was to evaluate the implementation of the new guidelines of prevention of mother to-child transmission (PMTCT) of HIV in the Yaoundé Central Hospital and the Yaoundé Teaching Hospital. Methodology: It was a cross sectional descriptive and prospective study over a period of 6 months in Yaoundé. It included all HIV-positive women, doing their antenatal care in the above cited hospitals, and having given their consent. The studied variables included socio demographic features, obstetrical history, the antenatal care, the initiation of anti retroviral (ARV) drugs, the ARV regimen, the number of years on ARV drugs, the mode of delivery and the mother and child outcome. The data was collected using a pre-tested questionnaire. They were obtained by interview of the seropositive pregnant women. Data were analysed using Epi info 3.5.3. Results: We performed 3104 antenatal consultations and 287 women were recruited in the study. The prevalence of HIV infection was 9.24%. The mean age of women was 28.77 (SD: 5.13) years. The women were aged between 20 and 29 years in 51.20%. Amongst the 156 women who knew their status before pregnancy, 109 (70.50%) had their first ANC in the first trimester. All were managed according to the 2010 WHO recommendations on PMTCT of HIV. Amongst the women unaware of their status, 25.20% had their booking ANC in the first trimester, 25.14% started ARVs at 14 weeks, 69.46% at 28 weeks. We had 125 live births, 84.8% by vaginal route, neonatal prophylaxis in all babies was effective. Conclusion: PMTCT of HIV is available and guidelines are well applied in Yaoundé. Late treatment initiation still remains a problem to optimize care.

Cameroonian Preadolescents’ Perspectives of an HIV Prevention Intervention

Purpose: Determining and incorporating the perspective of the target population is important to the developments of effective and sustainable HIV prevention efforts. Cameroonian preadolescent females remain at high risk for contract-ing HIV and have not benefitted from targeted HIV prevention efforts. In this report, findings are presented from data collected from 60 Cameroonian preadolescent females;ages 10-12 years;following their completion of an HIV preven-tion intervention. Methods: The theory-based intervention utilized the World Health Organization’s Responsible Be-havior: Delaying Sex curriculum which had been tailored for the target population with the assistance of Cameroonian experts. The data reported here were collected as part of a questionnaire participants completed post-intervention. Re-sults: With only a few exceptions, participants perceived the intervention to be appropriate and relevant. No significant differences were found in participants’ assessment of the intervention across different ages and ethnic groups. Discus-sion: Evaluating the appropriateness of interventions to the developmental level, gender, and culture of participants is an essential step in developing effective and sustainable interventions. Findings in this study are encouraging and indi-cate that interventions adapted with the assistance of local experts can be perceived relevant and appropriate by par-ticipants.

猴痘合并HIV感染疾病特征的研究进展

猴痘病毒的传播对HIV感染者构成了巨大威胁。一方面,猴痘病毒在HIV感染者中的感染率居高不下,在其他性传播疾病中的感染率也较高,如梅毒、淋病等;另一方面,尽管猴痘是自限性疾病,但与非HIV感染的猴痘患者相比,猴痘合并HIV感染患者的重症和死亡风险显著提升,尤其是在免疫重建不全的HIV感染者中。此外,在猴痘合并HIV感染的患者中,尤其是在CD4^(+)T淋巴细胞计数小于200×10^(3)/L的免疫重建不全的HIV感染者中,其临床症状比普通猴痘患者更加持久和严重,诊疗难度大。因此,全面了解猴痘合并HIV感染患者的疾病特征对于有效预防及减少猴痘传播至关重要。本文对猴痘合并HIV感染患者的病原学特征、流行病学特点、临床特征、诊断治疗和预防等方面进行阐述,旨在增强对猴痘合并HIV感染患者的全面了解,为针对这一类特殊人群制定精准防控策略提供理论支持。

Beliefs and practices of young women on utilization of prevention of mother to child transmission of HIV services in Malawi

This study explored beliefs and actual practices of young women on utilization of Prevention of Mother to Child Transmission (PMTCT) of HIV services in Balaka district of Southern Malawi. The study design wascross sectional which utilized qualitative data collection and analysis methods. In-depth interviews were conducted on 12 young mothers of 15 to 24 years old. The respondents were drawn from 6 health centres in the district during their visits to either the under-five clinic, HIV and AIDS support groups or HIV follow up clinics. Data were analyzed using thematic analysis approach. Overall the respondents had positive beliefs on utilization of PMTCT services. They believed that adherence to PMTCT guidelines such as condom use, taking of Nevirapine (NVP) and exclusive breastfeeding protected the baby from contracting the virus. Nevertheless, all respondents believed that HIV testing was mandatory and that early weaning caused malnutrition and death of babies. Actual practice was very low. Very few young mothers breastfed exclusively, weaned their babies abruptly and took NVP as recommended. Not all positive beliefs translated into positive behavior. Lack of male support, inability of the midwives to provide comprehensive care to HIV infected mothers and their infants, and fear of stigma and discrimination were other factors that hindered utilization of PMTCT services. Culture was also a major barrier because traditionally babies are expected to be breastfed and supplements are fed to babies too. Therefore, there is a need to mobilize communities on PMTCT of HIV. Education programmes in HIV should emphasize behavior change interventions and should focus on both men and women and significant others. There is also need to intensify monitoring and evaluation of health workers’ activities to ensure that beliefs translate into positive behavior.

HIV prevention: Towards a “structural-plus” approach

Lack of integration and coordination between HIV prevention programmes and developmental programmes explain why many countries have not been able to halt the epidemic, and others still have unacceptably high prevalence. A framework is presented here with supporting evidence to argue that existing structural interventions may be unsustainable in the long run because they do not address core developmental issues or the “structural plus factors”. This problem emanates from the almost total administrative and intellectual disconnect between policies that address development issues and those that address HIV prevention. Usual prevention packages may result only in short term benefits. To get the most out of limited global resources on prevention, it is critical that planners recognize and understand that parallel policies for AIDS prevention and development are not going to be cost-effective and sustainable, and the only option is to approach prevention as well as development in an integrated manner.

HIV Prevention in Papua New Guinea: Is It Working or Not?

Introduction: There is a global call for structural approaches to HIV that go beyond awareness and HIV testing to approach prevention work via the social and economic drivers of the epidemic. Papua New Guinea is the epicentre of the HIV epidemic in the Pacific, with an adult prevalence rate of 0.9%. Since 2004, there has been a concerted response to HIV, with vastly increased rates of HIV testing and roll-out of antiretroviral therapy, and considerable funding for HIV prevention. Objectives: While incidence is slowing there are still a considerable number of new infections each year and many commentators are worried that HIV prevention is not working in that country. This article aims to critically examine HIV prevention programs in Papua New Guinea to show whether HIV prevention is effectiveness in reaching those most vulnerable to infection. Methods: Using data from HIV prevention programs and behavioural surveys this article will assess how HIV prevention has been carried out and the effectiveness of those programs. Results: There is little evidence to indicate that HIV prevention in Papua New Guinea, particularly among those most at risk of HIV has been successful. Conclusion: there is a dearth of HIV prevention interventions in Papua New Guinea that go beyond awareness-raising to deal with the structural drivers of the epidemic.

HIV and Other Sexual Transmitted Infections—Challenges for Liberal Prevention Strategies

Many countries use similar strategies in prevention campaigns, but despite that the spread of HIV is unabated. The basic messages of the current liberal prevention strategies aim to promote changes in individual behaviour so as to prevent HIV transmission. The strategies avoid any kind of regulation, prescription and controls, and trust solely on the readiness of the sexually active part of the general population, and in particular the “at-risk populations” to cooperate with those messages. However, only a small number of people have cooperated. The increase in the incidence of HIV over the past decade in the countries listed discloses the failures of the current prevention strategies. With respect to the goal of trying to influence those people prone to high-risk sexual lifestyles, and the injecting drug users, the prevention strategies have not had a meaningful effect in the long term. This is also reflected in the increase of other STIs such as hepatitis C, syphilis, and the human papilloma virus, which are worse when there is co-infection with HIV. The liberal prevention strategies turned out to be inadequate for the goal, and must be adjusted to real life situations to counteract their misuse. Meanwhile there are ample evidence-based measures which must be implemented into concerted efforts by complementing the current strategies with respect to a person-to-person bound infection. Medical care policies have to consider the non-adherence behaviour of those in need.

Gender Sensitive STIs/HIV/AIDS Prevention Policies: A Qualitative Study

Background: The global incidence of STIs is rising. It is estimated that 499 million new cases of curable STIs occur every year. The existence of more than one million reported cases of STIs annually in Iran shows that addressing this issue must be a priority for Iranian health authorities. While recognition of the importance of gender issues to reproductive health (RH) programs has grown significantly in the past several years, major challenges remain in implementing gender-sensitive programs. Gender mainstreaming in Iranian reproductive health program is a relatively new issue, so this study aims to explore gender sensitive STIs/HIV/AIDS prevention policies. Method: This study employed a qualitative research design. Participants were health managers, health policy makers and reproductive health providers. They were selected purposefully and then continued by snowball sampling method. 43 semi-structured in-depth interviews with 37 key informants were done. All the interviews were recorded and transcribed. The data were analyzed by content analysis method. Trustworthiness of the data was achieved by using credibility, trans-ferability and conformability. Results: Key informants clearly explained the gender sensitive STIs/ HIV/AIDS prevention policies in three main categories: 1) advocacy, 2) collaboration between different sectors and 3) community empowerment to gender sensitive STIs/HIV/AIDS prevention programs. Conclusion: Changing gender neural STIs/HIV/AIDS prevention policy to more complete gender sensitive policy needs advocacy, collaboration of sectors and community empowerment.

The Role of Religiosity in HIV Prevention in Uganda: A Case-Control Study among Muslim and Christian Youth in Wakiso District

Background: In Uganda's HIV prevention strategy religious institutions are encouraged to deliver HIV prevention messages to the general public and to integrate HIV prevention into faith-based activities such as worship, funerals and marriage ceremonies. However, there is limited data on the relationship between religiosity and HIV prevalence. Objectives: The main objective was to assess the association between religiosity, HIV-risk behaviors and HIV prevalence. Methods: A case-control study was done among Muslim and Christian youth. Cases were defined as HIV positive youth and controls were HIV negative youth. Respondents were interviewed and then tested for HIV. A religiosity index was constructed to assess the association between religiosity, HIV-risk behaviors and HIV infections. Results: Higher levels of religiosity were significantly associated with abstaining from sex, avoiding drinking alcohol and avoiding narcotics. Higher levels of religiosity were also associated with lower HIV-infections. HIV infections were significantly associated with low religiosity, having one or both parents dead, and having multiple sexual partners. Conclusions: Religiosity appears to have an important role in HIV prevention among many Ugandans. These should be encouraged and made to feel proud of using religiosity in their HIV prevention efforts. Their numbers should also be increased. Religious leaders should be energized by the study findings and they should be supported to take the lead in the efforts of using religiosity for HIV prevention. All Ugandans should use the power of God within each of them for HIV prevention in line with their motto: 'For God and my country'. Religiosity for HIV prevention is readily available, accessible and affordable to the majority of Ugandans. This option should be supported by all stakeholders including government, non-governmental organizations, faith-based organizations and external support agencies, by mobilizing appropriate human, technical and financial resources to accelerate its implementation.

HIV/STIs and Pregnancy Prevention, Using a Cervical Barrier and Microbicide

Objectives: (A) HIV prevention, using a mechanical cervical barrier in combination with microbicide. (B) Prevention of pregnancy. (C) Shield the cervix to prevent sperm penetration and Gonorrhea, Chlamydia and HIV virus invasion. Methods: We investigated a new FDA approved cervical barrier FemCap (Figure 1). The FemCap is a contraceptive device that is designed with a unique delivery system for microbicides on its cervical and vaginal sides (Figure 4) to ensure better coverage, and retention of gel on the cervix and vagina. We also compared the acceptability and adherence with the FemCap, and retention of a stained vaginal lubricant when delivered with the FemCap versus the vaginal lubricant when delivered using a traditional vaginal applicator (Figure 2). We used the same vaginal applicator utilized in the CAPRISA 0041 study, to deliver Tenofovir microbicide. Thirty women compared the use of a vaginal applicator to deliver a high viscosity stained vaginal lubricant before and after intercourse, versus the FemCap to deliver the same lubricant once before intercourse. The acceptability and efficacy of this delivery system was evaluated. Results: Forty percent (12) women missed the application of the lubricant with the vaginal applicator before intercourse and 10% missed it after intercourse. Amongst FemCap users (3) women (10%) missed application of the vaginal lubricant before intercourse and all of them inserted it after intercourse. The stained gel was better retained over the cervix (Figure 5) by single application with the FemCap versus two applications with the traditional applicator (Figure 2). Conclusions: Women in this study preferred the FemCap due to elimination of leakage and the single application, method versus two applications with the traditional vaginal applicator. The use of the FemCap, can prevent pregnancy, HIV mother-to-child transmission, enhance compliance and retention of gel over the cervix and vagina that may potentially prevent STIs and increase the efficacy of Tenofovir.

Partnering with Batswana Youth and Families for HIV and AIDS Prevention

Introduction: This qualitative study triangulated data from adolescents, parents, and key informants in Gaborone, Botswana on adolescents’ risks for HIV infection, STIs and pregnancy, the types of relationships they get into, and preventive measures they use to protect themselves against HIV infection. The goal of this qualitative research is to inform adaptation of an intervention originally developed, implemented, and evaluated in the US that was effective in reducing the risk of HIV infection and early pregnancy by delaying initiation of sexual relationships of abstinent adolescents and lowering sexual risk behaviours of adolescents who were already sexually active. The objectives of this study were to conduct in-depth interviews with youth, key informants and parents;determine the behavioural risks that young people face;Assess youth and parents’ attitudes toward providing a risk reduction programme for adolescents and Use the data to adapt an evidence-based programme for Botswana. Methodology: In-depth qualitative interviews with 40 youth, 20 key informants and 40 parents elicited information on the risks and relationships that youth engaged in and their suggestions how their risky behaviours could be minimized or counteracted. Findings: Youth of both sexes engage in risky sexual behaviours that could predispose them to contracting HIV and STI infections or unplanned pregnancies. Risks were associated with use of alcohol and drugs: commonly marijuana, and engaging in unsafe sexual relations. Youth, key informants and parents showed a high level of acceptability for offering a primary prevention intervention program for adolescents. In addition, all groups of participants concurred on the importance of offering a separate program for parents to equip them with skills that can enable to them to guide their adolescents to safely transit into adulthood through education and family communication skills. Other risks confronting adolescents included sexual initiations from either older men or women (sugar daddy and mummy syndrome) in exchange for material and financial gains. Conclusion: Informants endorsed the need for primary prevention programs addressing adolescents and their families to reduce risk behaviours among Batswana youth to provide them with skills and minimise the risk of HIV infection among adolescents.