SAHARA-J: Journal of Social Aspects of HIV/AIDS

Factors influencing the adoption of HIV prevention measures in low socio-economic communities of inner-city Durban, South Africa

Firoza Haffejee — 2024-01-18

South Africa is the epicentre of the HIV pandemic. Although there have been health promotion education campaigns to reduce HIV incidence, these have not achieved the desired outcomes. When exploring the effectiveness of these campaigns, it is useful not only to examine HIV knowledge, but also to explore the relationship between that knowledge and health-related behaviour. This study aimed to determine the (1) level of knowledge of HIV prevention, (2) relationship between the level of knowledge and the adoption of these behaviours and (3) barriers to sexual behaviour change of vulnerable women in Durban’s city centre, KwaZuluNatal, South Africa. A mixed methods approach was used to collect information from a marginalised population of women (n = 109) attending a non- governmental organisation, which provides for the needs of people from low socio-economic strata. Data were collected during September 2018 at a wellness day programme at the centre. A total of 109 women, over the age of 18 years answered the questionnaire. Knowledge of HIV transmission was high, with majority of participants correctly identifying modes of transmission. Almost all the participants (91.2%) had been tested for HIV, with 68.8% tested a minimum of three times. Despite this, sexual risk behaviour was high. Despite the high level of knowledge of HIV transmission, there was no relationship between HIV knowledge and adoption of behaviours for the prevention of HIV transmission (p = .457). However, bivariate analysis showed an association between transactional sex and living in informal housing (OR = 31.94, 95% CI: 5.65–180.63, p < .001). Living in informal housing was also associated with having multiple current sexual partners (OR = 6.30, 95% CI: 1.39–28.42, p = .02). Multivariate analysis, after adjusting for all other factors, indicated that the odds of having transactional sex was increased by 23 times in those who did not have formal housing (OR = 23.306, 95% CI: 3.97– 144.59, p = .001). Qualitative responses showed that women perceived poverty as the overarching factor determining the lifestyle choices which impacted their health. They indicated a need for employment opportunities and provision of housing to alleviate both poverty as well as transactional sex. Although, participants from this study understood the benefits of the protective behaviours to prevent HIV transmission, economic and social factors do not afford this vulnerable group the opportunity nor the motivation to adopt such behaviours. In the current climate of increasing unemployment and escalating GBV, urgent interventions are needed in terms of employment opportunities and empowerment drives to prevent an increase in HIV transmission.

“ … [I]f I can [be] infected now that means I am going to die … ”: an explorative study focusing on vulnerable, immunocompromised groups and caregivers experiences and perceptions of the Covid-19 pandemic in South Africa

Alicia North — 2024-01-18

In this paper, we explored how vulnerable, immunocompromised groups and caregivers of the elderly experienced and perceived the onset of the Covid-19 pandemic in South Africa. Semistructured interviews were conducted remotely between the 5th andthe 18th of April 2020 in the three South African provinces hardest hit by Covid-19, namely Gauteng, KwaZulu-Natal and the Western Cape. In total, 60 qualitative key informant interviews and one focus group discussion were conducted. Study participants expressed concerns for elderly people and people with underlying health conditions because of their increased vulnerability to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). People living with HIV expressed an increased fear of infection following the advent of the Covid-19 pandemic in South Africa. The sidelining of healthcare services and stock-outs of medication proved to be an added concern in particular for vulnerable and immunocompromised groups. Overall, the data suggest that the fear of infection is ubiquitous for people who live in unstable environments such as overcrowded townships and informal settlements. Given the increased fears of infection brought on by the Covid-19 pandemic, the mental health of vulnerable communities and those caring for them becomes an added burden for people living in unstable environments.

Spatial variations in STIs among women enrolled in HIV prevention clinical trials in Durban, KwaZulu-Natal, South Africa

Reshmi Dassaye — 2024-01-18

South Africa is faced with a high HIV and STI prevalence and incidence, respectively, with pockets of high burden areas driving these diseases. Localised monitoring of the HIV epidemic and STI endemic would enable more effective targeted prevention strategies. We assessed spatial variations in curable STI incidence among a cohort of women enrolled in HIV prevention clinical trials between 2002 and 2012. STI incidence rates from 7557 South African women enrolled in five HIV prevention trials were geo-mapped using participant household GPS coordinates. Age and period standardised incidence rates were calculated for 43 recruitment areas and Bayesian conditional autoregressive areal spatial regression (CAR) was used to identify significant patterns and spatial patterns of STI infections in recruitment communities. Overall age and period standardised STI incidence rate were estimated as 15 per 100 PY and ranged from 6 to 24 per 100 PY. We identified five significant STI high risk areas with higher-than-expected incidence of STIs located centrally (three- locations) and southern neighbouring areas of Durban (two-locations). Younger age (<25), not married/cohabitating, parity <3 and poor education were all significant correlates of high STI communities. Findings demonstrate sustained STI incidence rates across the greater Durban area. The role of STI incidence in HIV acquisition in high HIV endemic areas need to be revisited as current highly effective PrEP interventions do not protect from STI acquisition. In these settings there is an urgent need for integrative HIV and STI prevention and treatment services.