HIV/AIDS among Pastoralists & Refugees in North-East Africa: A Neglected Problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. 

This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001-2014. 

Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. 

Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. 

This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.

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By:  Serbessa MK1, Mariam DH1, Kassa A2, Alwan F3, Kloos H4.

• 1 School of Public Health, College of Health Sciences , Addis Ababa University.
• 2 IGAD Regional HIV/AIDS Partnership Program-Programme Facilitation Office (IRAPP-PFO) , Kampala , Uganda.
• 3 Intergovernmental Authority for Development (IGAD) Secretariat , Djibouti.
• 4 Department of Epidemiology and Biostatistics , University of California , San Francisco , USA. 

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The Use of Cash Transfers for HIV Prevention - Are We There Yet?

Poverty and social inequality are significant drivers of the HIV epidemic and are risk factors for acquiring HIV. As such, many individuals worldwide are at risk for new HIV infection, especially young women in East and Southern Africa. By addressing these drivers, social protection programmes may mitigate the impact of poverty and social inequality on HIV risk. 

There is reason to believe that social protection can be used successfully for HIV prevention; social protection programmes, including cash transfers, have led to positive health outcomes and behaviour in other contexts, and they have been used successfully to promote education and increased income and employment opportunities. 

Furthermore, cash transfers have influenced sexual behaviour of young women and girls, thereby decreasing sexual risk factors for HIV infection. When HIV outcomes have been measured, several randomised controlled trials have shown that indirectly, cash transfers have led to reduced HIV prevalence and incidence. 

In these studies, school attendance and safer sexual health were directly incentivised through the cash transfer, yet there was a positive effect on HIV outcomes. In this review, we discuss the growth of social protection programmes, their benefits and impact on health, education and economic potential, and how these outcomes may affect HIV risk. 

We also review the studies that have shown that cash transfers can lead to reduced HIV infection, including study limitations and what questions still remain with regard to using cash transfers for HIV prevention.

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By:  Taaffe J1, Cheikh N1, Wilson D1.

• 1 The World Bank Group , Washington , DC , USA. 
• Afr J AIDS Res. 2016 Mar;15(1):17-25. doi: 10.2989/16085906.2015.1135296.

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High Prevalence of Being Overweight and Obese HIV-Infected Persons, Before and After 24 Months on Early ART in the ANRS 12136 Temprano Trial

BACKGROUND:

HIV is usually associated with weight loss. World health Organization (WHO) recommends early antiretroviral (ART) initiation, but data on the progression of body mass index (BMI) in participants initiating early ART in Africa are scarce.

METHODS:

The Temprano randomized trial was conducted in Abidjan to assess the effectiveness of early ART and Isoniazid (INH) prophylaxis for tuberculosis in HIV-infected persons with high CD4 counts below 800 cells/mm(3) without any indication for starting ART. Patients initiating earlyART before December 2010 were included in this sub-study. BMI was categorized as: underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) and obese (≥30 kg/m(2)). At baseline and after 24 months of ART, prevalence of being overweight orobese and factors associated with being overweight or obese were estimated using univariate and multivariate logistic regression.

RESULTS:

At baseline, 755 participants (78 % women; median CD4 count 442/mm(3), median baseline BMI 22 kg/m(2)) initiated ART. Among them, 19.7 % were overweight, and 7.2 % were obese at baseline. Factors associated with being overweight or obese were: female sex aOR 2.3 (95 % CI 1.4-3.7), age, aOR for 5 years 1.01 (95 % CI 1.0-1.2), high living conditions aOR 2.6 (95 % CI 1.5-4.4), High blood pressure aOR 4.3 (95 % CI 2.0-9.2), WHO stage 2vs1 aOR 0.7 (95 % CI 0.4-1.0) and Hemoglobin ≥95 g/dl aOR 3.0 (95 % CI 1.6-5.8). Among the 597 patients who attended the M24 visit, being overweight or obese increased from 20.4 to 24.8 % (p = 0.01) and 7.2 to 9.2 % (p = 0.03) respectively and factor associated with being overweight or obese was immunological response measured as an increase of CD4 cell count between M0-M24 (for +50 cells/mm(3): aOR 1.01; 95 % CI 1.05-1.13, p = 0.01).

CONCLUSION:

The weight categories overweight and obese are highly prevalent in HIV-infected persons with high CD4 cell counts at baseline, and increased over 24 months on ART in this Sub-Saharan African population.

Below:  Changes of BMI vs baseline (Mean and 95 % confidence intervals) according to initial BMI category, among 597 patients who attended the 24-month visit in the Temprano trial. N number, % percentage, BMI body mass index, underweight BMI <18.5 kg/m², normal BMI 18.5–24.9 kg/m², Overweight BMI 25–29.9 kg/m², Obese BMI >30 kg/m²

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

By:  Guehi C1, Badjé A2, Gabillard D3, Ouattara E4, Koulé SO1, Moh R5, Ekouevi D2, Ahibo H6, N'Takpé JB7, Menan GK7, Deschamps N7, Lecarrou J3, Eholié S5,Anglaret X4, Danel C2.

• 1Unité de Soins Ambulatoire et de Conseil (USAC), 18 BP, 1125 Abidjan 18, Côte d'Ivoire.
• 2Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire ; Inserm U 1219, Bordeaux University, Bordeaux, France.
• 3Inserm U 1219, Bordeaux University, Bordeaux, France ; ISPED, Bordeaux University, Bordeaux, France.
• 4Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire ; Inserm U 1219, Bordeaux University, Bordeaux, France ; ISPED, Bordeaux University, Bordeaux, France.
• 5Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire ; Department of Infectious Diseases, Treichville Hospital, Abidjan, Côte d'Ivoire.
• 6Centre de Recherche et Diagnostic sur le SIDA, (Cedres) CHU de Treichville, Abidjan, Côte d'Ivoire.
• 7Programme PACCI, ANRS research Site, Abidjan, Côte d'Ivoire. 
• AIDS Res Ther. 2016 Feb 25;13:12. doi: 10.1186/s12981-016-0094-y. eCollection 2016.

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Epidemiology of HIV/AIDS and Hep B among African Immigrants: Current Status, Barriers & Challenges

Via:  http://goo.gl/khv6Dh

'The Darkest Times Of My Life': Recollections of Child Abuse among Forced Migrants Persecuted Because of Their Sexual Orientation & Gender Identity

Numerous studies demonstrate that lesbian, gay, bisexual, and transgender (LGBT) children and youth are likely to experience abuse by peers, parents, and other adults and that these experiences correlate with a host of mental health problems. However, there is little understanding of the experiences of LGBT children and youth living in countries where social and legal protections for sexual and gender minorities are limited or nonexistent. 

This qualitative study used thematic analysis to explore the child and adolescent abuse experiences and their impact on the pre-migration mental health of LGBT forced migrants. We analyzed 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity. Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. 

Analysis revealed the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings indicate that participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. 

Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We conclude with implications for refugee adjudication practices, mental health care, and international policy.

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By:  Alessi EJ1, Kahn S2, Chatterji S3.

• 1School of Social Work, Rutgers, The State University of New Jersey, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07102, USA.
• 2School of Social Work, McGill University, 3506 University Street, Room 426, Montreal, QC, Canada H3A 2A7.
• 3School of Social Work, Rutgers, The State University of New Jersey, 536 George Street, New Brunswick, NJ 08901, USA. 

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Age and Intimate Partner Violence: An Analysis of Global Trends among Women Experiencing Victimization in 30 Developing Countries

Purpose

Young women are at elevated risk of violence victimization, yet generalizable evidence on age at which abuse first occurs is lacking. This analysis provides new descriptive evidence on age and duration into partnership of women's first intimate partner violence (IPV) victimization.

Methods

Data come from ever married women ages of 15–49 years in nationally representative Demographic and Health Surveys in 30 countries collected from 2005 to 2014 in Africa, Asia, Eastern Europe, and Latin America and the Caribbean. Descriptive analysis is performed.

Results

Approximately 29.0% of women reported any physical or sexual IPV. Among ever married women who first experienced violence post-union, abuse began, on average, 3.5 years, after union formation. Approximately 38.5% and 67.5% of those ever experiencing abuse did so within 1 year and 3 years, respectively, of union formation. Regionally, average years into union of abuse initiation showed little variation and average age at first abuse among once married women is 22.1 years.

Conclusions

Results imply that primary prevention for IPV must take place on average before first union before age 19 years, to capture the most relevant and at risk target population. Resources allocated toward risk factors in childhood and adolescence may be most effective in combating initiation of IPV globally. Despite this finding, there remains a lack of evidence on effective interventions for primary prevention of abuse during women's early years in developing settings.

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By:  Amber Peterman, Ph.D., Jennifer Bleck, Ph.D., M.P.H., Tia Palermo, Ph.D.

• Social and Economic Policy Unit, UNICEF Office of Research—Innocenti, Florence, Italy

Correspondence

• Address correspondence to: Amber Peterman, Ph.D., UNICEF Office of Research—Innocenti, Piazza SS. Annunziata 12, 50122 Florence, Italy.

  

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Contemporary Issues on the Epidemiology & Antiretroviral Adherence of HIV-Infected Adolescents in Sub-Saharan Africa: A Narrative Review

Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour.

We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed.

Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV.

Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.

Below:  Map of Africa showing estimated number of adolescents aged 10 to 19 years living with HIV in Africa by country in 2013

Table 1

Number of people aged 0 to 14 years living with HIV and prevalence by sex among 20 to 24 year olds in 2013, by Joint United Nations Programme on HIV/AIDS

	Estimates of young people living with HIV, 2013
Region	Children and adolescents 0 to 14 years (% of total no.) with HIV	Estimated number living with HIV (all ages)	Percent of 20 to 24 year-olds with HIV (females)	Percent of 20 to 24 year-olds with HIV (males)
Sub-Saharan Africa	2,900,000 (11.7)	24,700,000	2.2	1.1
Asia and the Pacific	210,000 (4.4)	4,800,000	<0.1	<0.1
Caribbean	17,000 (6.8)	250,000	0.5	0.4
Eastern Europe and Central Asia	14,000 (1.3)	1,100,000	0.2	0.2
Latin America	35,000 (2.2)	1,600,000	0.1	0.3
Middle East and North Africa	16,000 (7.0)	230,000	<0.1	<0.1
Western and Central Europe and North America	2800 (0.1)	2,300,000	<0.1	0.2
GLOBAL	3,200,000 (9.1)	35,000,000	0.4	0.3

Joint United Nations Programme on HIV/AIDS (UNAIDS), Epidemic Monitoring and Analysis, Gap Report and 2013 estimates.

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By:  Olurotimi A Adejumo,§,1 Kathleen M Malee,2 Patrick Ryscavage,3 Scott J Hunter,4 and Babafemi O Taiwo5

1Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria

2Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

3Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA

4Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA

5

1Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria

2Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

3Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA

4Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA

5Division of Infectious Diseases, Northwestern University, Chicago, IL, USA

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HIV Prevention & Care Services for Female Sex Workers: Efficacy of a Targeted Community-Based Intervention in Burkina Faso

Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso.

The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01–5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients and with regular clients.

Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours.

Table 1

Baseline participant characteristics and comparison with potentially eligible female sex workers who missed their enrolment visit in Ouagadougou

	Enrolled N=321	Eligible but not enrolled N=118
	n (%) or median [IQR]	N (%) or median [IQR]	p
Socio-demographic characteristics
Age (years)	21 [19–23]	20 [19–23]	0.42
Marital status (married or cohabiting)	109 (34)	31 (26)	0.13
Sex work status			<0.001
Professional	121 (38)	23 (20)
Non-professional	200 (62)	94 (80)
Education			0.29
None	87 (27)	32 (27)
1–6 years (primary)	145 (45)	45 (38)
≥7 years (secondary or superior)	89 (28)	41 (35)
Median monthly income (€)	91 [53–149]	63 [38–114]	<0.001
Sex work is the main income source	211 (66)	60 (51)	0.003
Drug and alcohol consumption
Druga consumption	14 (4)	–	–
Any alcohol consumption	202 (63)	68 (58)	0.37
Previous HIV-testing	231 (72)	74 (63)	0.06
Child desire	67 (21)	25 (21)	1.00
Sexual behaviours
Age of sex debut (years)	16 [15–18]	17 [15–18]	0.04
Duration of sex work (years)	1 [0.1–3.0]	1 [0.0–2.0]	<0.001
Number of casual clients (previous week)	2 [1–3]	1 [1–1]	0.01
>1 regular clients (last month)	136 (42)	27 (23)	<0.001
>1 regular partner (last month)	59 (19)	21 (18)	0.88
>1 previous pregnancy	93 (29)	22 (19)	0.03
Always condom use with casual clients	273 (95)	86 (93)	0.45
Always condom use with regular clients	150 (77)	31 (70)	0.43
Always condom use with regular partner	128 (50)	59 (56)	0.29
Vaginal infections
Vaginal candidiasis	36 (13)	15 (16)	0.38
Bacterial vaginosis	37 (13)	12 (13)	0.73
STI
Trichomoniasis vaginalis	8 (3)	3 (4)	1.00
HSV-2 infection	91 (28)	–	–

aInclude cannabis, volatile solvents, hallucinogens and amphetamines.

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By: Isidore T Traore,§,1 Nicolas Meda,1,2 Noelie M Hema,3 Djeneba Ouedraogo,3 Felicien Some,3 Roselyne Some,3 Josiane Niessougou,3 Anselme Sanon,1 Issouf Konate,1 Philippe Van De Perre,4,5 Philippe Mayaud,6 and Nicolas Nagot4,5

²Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa

³Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa

⁴UMR 1058, INSERM/University of Montpellier/EFS, Montpellier, France

⁵CHRU Montpellier, Montpellier, France

⁶

1Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa

2Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa
3Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa
4UMR 1058, INSERM/University of Montpellier/EFS, Montpellier, France
5CHRU Montpellier, Montpellier, France
6Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK

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1Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa