Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV among Infected Pregnant Women at the Yaounde Central Hospital

INTRODUCTION:

The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied.

AIM:

To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon).

METHODS:

A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014.

MAIN OUTCOME MEASURES:

Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs.

RESULTS:

Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P < .0001). Twenty-nine percent of women preferred intermittent sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P < .05); and no association existed between the number of living children and future pregnancies (r_s = -0.217; P = .036).

CONCLUSION:

HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission.

Full article at:   http://goo.gl/RE0oku

By:  Kuete M1, Yuan H2, He Q3, Tchoua Kemayou AL4, Ndognjem TP4, Yang F2, Hu Z2, Tian B2, Zhao K2, Zhang H2, Xiong C5.

• 1Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 2Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 3Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
• 4Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon.
• 5Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address: clxiong951@sina.com. 
• Sex Med. 2016 Mar 19. pii: S2050-1161(16)00031-3. doi: 10.1016/j.esxm.2016.01.004.

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Attitudes & Beliefs About Mental Illness among Church-Based Lay Health Workers: Experience from a Prevention of Mother-To-Child HIV Transmission Trial in Nigeria

Common mental disorders are prevalent in Nigeria. Due to stigma and a limited number of trained specialists, only 10% of adults with mental illness in Nigeria receive any care. 

The Healthy Beginning Initiative is a community-based maternal/child health program that includes screening for perinatal depression and was implemented by lay, volunteer, church-based health advisors (CHAs). 

The aim of the study was to assess the beliefs and attitudes about mental illness among the CHAs. The study used a cross-sectional survey of 57 CHAs, who completed a 43-item, self-administered questionnaire that assessed their beliefs and attitudes about mental illness. 

The response rate was 71%. Respondents were mostly female (79%), married (83%) and aged 40-49 years (M = 41.16 SD = 10.48). Most endorsed possession by evil spirits (84%), traumatic events (81%) and witchcraft (60%) as causes of mental illness. A majority (69%) believed that people with mental illness were a nuisance, and less than half (46%) believed that mental disorders were illnesses like any other illness. 

It is concluded that stigmatizing attitudes and beliefs about mental illness are common among the CHAs. Training for lay health workers in Nigeria should include education on the known bio-psycho-social basis of mental disorders and the role of social inclusion in recovery.

Differences in beliefs and attitudes by gender, education and area of living.

	Gender			Education			Area of living
	Male	Female		Primary/ Secondary	Tertiary		Rural	Urban
Cause of mental illness	N (%) (n = 12)	N (%) (n = 47)	p	N (%) (n = 21)	N (%) (n = 38)	p	N(%) (n = 22)	N (%) (n = 35)	p
Drug /alcohol use	11 (91.7)	44 (93.6)	0.8	18 (85.7)	37 (97.4)	0.08	22 (100)	32 (91.4)	0.16
Evil spirit	11 (91.7)	37 (78.7)	0.3	16 (76.2)	32 (84.2)	0.44	19 (86.4)	27 (77.1)	0.39
Traumatic event	11 (91.7)	35 (74.5)	0.2	16 (76.2)	30 (78.9)	0.8	20 (90.9)	25 (71.45)	0.08
Stress	8 (66.7)	15 (31.9)	0.03	7 (33.3)	16 (42.1)	0.5	13 (59.1)	10 (28.6)	0.02
Genetic inheritance	10 (83.3)	41 (87.2)	0.7	15 (71.4)	36 (94.7)	0.01	21 (95.4)	29 (82.95)	0.15
Physical abuse	4 (33.3)	18 (38.3)	0.7	6 (28.6)	16 (42.1)	0.3	11 (50)	10 (28.6)	0.1
Biological factors	7 (58.3)	33 (70.2)	0.43	12 (57.1)	28 (73.7)	0.19	15 (68.2)	24 (68.6)	0.97
God's punishment	5 (41.7)	25 (53.2)	0.47	10 (47.6)	20 (52.6)	0.71	9 (40.9)	20 (57.1)	0.23
Witchcraft	9 (75)	25 (53.2)	0.17	13 (61.9)	21 (55.7)	0.62	11 (50)	23 (65.7)	0.23
Brain disease	11 (91.7)	40 (85.1)	0.55	16 (76.2)	35 (92.1)	0.08	21 (95.4)	29 (82.8)	0.16
Poverty	5 (41.7)	14 (29.8)	0.43	4 (19.1)	15 (39.5)	0.12	11 (50)	8 (22.9)	0.03
Curse	8 (66.7)	24 (51.1)	0.33	13 (61.9)	19 (50)	0.38	12 (54.5)	19 (54.3)	0.98
People with mental illness
Can be treated outside the hospital	8 (66.7)	30 (63.8)	0.85	13 (61.9)	25 (65.8)	0.76	16 (72.7)	22 (62.8)	0.44
Tend to be mentally retarded	8 (66.7)	25 (53.2)	0.4	6 (28.6)	27 (71.1)	0.002	14 (63.6)	18 (51.4)	0.36
Are a public nuisance	10 (83.3)	26 (55.3)	0.07	11 (52.4)	25 (65.8)	0.31	17 (77.3)	18 (51.4)	0.05
Can work in regular jobs	3 (250	7 (14.9)	0.4	4 (19.1)	6 (15.8)	0.75	4 (18.2)	6 (17.1)	0.92
Are dangerous because of violent behavior	10 (83.3)	39 (82.9)	0.97	17 (80.9)	32 (84.2)	0.74	19 (86.4)	29 (82.9)	0.72
In interacting with someone with mental illness, I would be
Unwilling to share a room	8 (66.7)	32 (68.15)	0.92	10 (47.6)	30 (78.9)	0.01	18 (81.8)	21 (60)	0.08
Would you invite somebody in to your home if you knew they suffered from mental illness	4 (33.3)	21 (44.7)	0.48	5 (23.8)	20 (52.6)	0.03	11 (50)	13 (37.1)	0.34
On social acceptance of someone with mental illness
A woman would be foolish to marry a man with mental illness even though he seems fully recovered	3 (25.5)	13 (33.3)	0.58	10 (55.6)	6 (18.25)	0.006*	3 (14.3)	11 (39.3)	0.04*
Anyone with mental illness should not be given any responsibility	8 (66.7)	11 (26.8)	0.01	7 (36.8)	12 (35.3)	0.91	10 (47.6)	8 (26.7)	0.12
Virtually anyone can become mentally ill	11 (91.7)	34 (85)	0.34*	17 (94.4)	28 (82.3)	0.18*	21 (100)	23 (79.3)	0.02*
People with mental illness are far less of a danger than most people suppose	11 (91.7)	27 (61.4)	0.03*	10 (52.6)	28 (75.7)	0.05*	15 (71.4)	22 (66.7)	0.22*
The best therapy for mentally ill people is to be a part of a normal community	10 (83.3)	22 (48.9)	0.03*	13 (65)	19 (51.5)	0.14*	14 (63.6)	18 (54.5)	0.18*
Residents have nothing to fear from people coming into their neighborhood to obtain mental health services	7 (58.3)	36 (80)	0.09*	13 (65)	30 (81.1)	0.10*	13 (59)	28 (84.8)	0.02*
Mental hospitals are an outdated means of treating people with mental illness	5 (45.5)	20 (44.5)	0.26*	11 (57.9)	14 (37.8)	0.08*	6 (27.3)	19 (59.4)	0.01*

Note: Results shaded in grey were considered statistically significant when p < .05. *Fisher's exact; DF = 1.

Full article at:   http://goo.gl/YlpgZw

By:  Iheanacho T1, Kapadia D2, Ezeanolue CO3, Osuji AA4, Ogidi AG4, Ike A4, Patel D5, Stefanovics E1, Rosenheck R1, Obiefune M6, Ezeanolue EE5.

• 1Department of Psychiatry, Yale University School of Medicine (http://medicine.yale.edu/psychiatry/), New Haven , USA.
• 2Avalon University School of Medicine , Girard , USA.
• 3HealthySunrise Foundation , Las Vegas , USA.
• 4Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria.
• 5HealthySunrise Foundation, Las Vegas, USA; University of Nevada School of Medicine, Las Vegas, USA.
• 6HealthySunrise Foundation, Las Vegas, USA; Prevention, Education, Treatment, Training and Research Global Solutions, Enugu, Nigeria. 
• Int J Cult Ment Health. 2016 Jan 2;9(1):1-13. Epub 2015 Sep 11.

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Conditional Cash Transfers & Uptake Of & Retention in Prevention of Mother-To-Child HIV Transmission Care

BACKGROUND:

Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission (PMTCT) services in sub-Saharan Africa. We aimed to determine whether small, increasing cash payments, which were conditional on attendance at scheduled clinic visits and receipt of proposed services can increase the proportions of HIV-infected pregnant women who accept available PMTCT services and remain in care.

METHODS:

In this randomised controlled trial, we recruited newly diagnosed HIV-infected women, who were 32 or less weeks pregnant, from 89 antenatal care clinics in Kinshasa, Democratic Republic of Congo, and randomly assigned (1:1) them to either the intervention group or the control group using computer-based randomisation with varying block sizes of four, six, and eight. The intervention group received compensation on the condition that they attended scheduled clinic visits and accepted offered PMTCT services (US$5, plus US$1 increment at every subsequent visit), whereas the control group received usual care. Outcomes assessed included retention in care at 6 weeks' post partum and uptake of PMTCT services, measured by attendance of all scheduled clinic visits and acceptance of proposed services up to 6 weeks' post partum. Analyses were by intention to treat. This trial is registered with ClinicalTrials.org, number NCT01838005.

FINDINGS:

Between April 18, 2013, and Aug 30, 2014, 612 potential participants were identified, 545 were screened, and 433 were enrolled and randomly assigned; 217 to the control group and 216 to the intervention group. At 6 weeks' post partum, 174 participants in the intervention group (81%) and 157 in the control group (72%) were retained in care (risk ratio [RR] 1·11; 95% CI 1·00-1·24). 146 participants in the intervention group (68%) and 116 in the control group (54%) attended all clinic visits and accepted proposed services (RR 1·26; 95% CI 1·08-1·48). Results were similar after adjustment for marital status, age, and education.

INTERPRETATION:

Among women with newly diagnosed HIV, small, incremental cash incentives resulted in increased retention along the PMTCT cascade and uptake of available services. The cost-effectiveness of these incentives and their effect on HIV-free survival warrant further investigation.

Purchase full article at:   http://goo.gl/v1xZ3I

By:  Yotebieng M1, Thirumurthy H2, Moracco KE3, Kawende B4, Chalachala JL4, Wenzi LK4, Ravelomanana NL5, Edmonds A5, Thompson D5, Okitolonda EW4,Behets F6.

• 1The Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH, USA; The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA. Electronic address: yotebieng.2@osu.edu.
• 2The University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, NC, USA.
• 3The University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC, USA.
• 4The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
• 5The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA.
• 6The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA; The University of North Carolina at Chapel Hill, Department of Social Medicine, Chapel Hill, NC, USA. 
• Lancet HIV. 2016 Feb;3(2):e85-93. doi: 10.1016/S2352-3018(15)00247-7.

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