positive prevention

Conclusions HIV-infected women reduced the number, but not the proportion, of unprotected acts. HIV-negative women did not increase condom use after testing and counselling, but neither did they decrease condom use, suggesting that testing negative was not interpreted as endorsement of risky behaviour.

In contemporary youth justice in England and Wales, there is too much emphasis on offence- and offender- focused approaches and an insufficient focus on promoting positive outcomes for children in conflict with the law. What is more, since the Crime and Disorder Act 1998, the voices of children embroiled in the Youth Justice System have been marginalised and their participatory rights rendered invalid. Both children and Youth Offending Team workers are finding involvement in the Youth Justice System (e.g. assessment, planning, intervention, supervision and review) to be a disempowering and disengaging experience. In this paper, we outline a number of contemporary tensions and conflicts in relation to youth justice law, policy and practice: the highly political context of youth justice, the criminalising risk, prevention and early intervention agendas and the unique and specialised nature of youth justice services. We also introduce a focus for future developments and 'creative p...

Introduction: In 2018, there were appropriately 20.6 million [18.2 million–23.2 million] people living with HIV in Eastern and Southern Africa, and an estimated 67% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of clinical staff. Methods: We conducted a randomised trial in Tanzania and Zambia to test an innovative intervention that involved the use of lay health workers and screening for cryptococcal meningitis and tuberculosis. Here we describe the model of care with a particular focus on the trained lay worker component. Lay workers carried out home visits to patients in the intervention arm to deliver antiretroviral drugs, provide adherence counselling, and conduct simple monitoring for treatment side effects and other medical conditions. Lay workers were responsible for referring patients with conditions that might require further medical attention as well as discouraging self-referral...

Introduction: In 2018, there were appropriately 20.6 million [18.2 million–23.2 million] people living with HIV in Eastern and Southern Africa, and an estimated 67% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of clinical staff. Methods: We conducted a randomised trial in Tanzania and Zambia to test an innovative intervention that involved the use of lay health workers and screening for cryptococcal meningitis and tuberculosis. Here we describe the model of care with a particular focus on the trained lay worker component. Lay workers carried out home visits to patients in the intervention arm to deliver antiretroviral drugs, provide adherence counselling, and conduct simple monitoring for treatment side effects and other medical conditions. Lay workers were responsible for referring patients with conditions that might require further medical attention as well as discouraging self-referral...

Background: While much is written about the scale up of HIV counselling and testing (HCT) and antiretroviral therapy (ART), little research has been done on the expansion of routine preART HIV care. Objective: To assess the quality of preART care in Cape Town and its continuity with HCT and ART. Methods: The scale up of the HCT, preART and ART service platform and programmatic support in Cape Town is described. Data from the August 2010 routine annual HIV/TB/STI evaluation, from interviews with 133 facility managers and a folder review of 634 HCT s who tested positive and 1115 clients receiving preART HIV care are analysed. Results: Historically the implementation and management of preART care has been relatively neglected compared with the scale-up of HCT and ART. The CD4 count was done on 77.5% positive HCT clients and 46.6% were clinically staged-crucial steps that determine the care path. There were: gaps in quality of care-32.2% of women had a PAP smear; missed opportunities for integrated care-67% were symptomatically screened for tuberculosis; and positive prevention-48.3% had contraceptive needs assessed. Breaks in the continuity of care of preART clients occurred with only 47.2% of eligible clients referred appropriately to the ARV service. Conclusion: While a package of preART care has been clearly defined in Cape Town, it has not been fully implemented. There are weaknesses in the continuity and quality service delivered that undermine the programme objectives of provision of positive prevention and timeous access to ART.

Background: To stem AIDS-morbidity and stop HIV transmission, UNAIDS recommends that 90% of HIV-positive people know their status by 2020, including adolescents. HIV-positive adolescents who engage in unsafe sex are at risk of transmitting HIV to partners and children. Little is known about linkages between knowing and disclosing one’s HIV-positive status and practicing safe sex among adolescents. Methods: This study tests whether (1) knowledge of one’s own HIV-positive status, (2) disclosure of HIV-positive status to partners, and (3) knowledge of partner HIV-status – positive or negative – are associated with protective sexual practices. The study interviewed n=1,527 HIV-positive and negative adolescents (10-19 years old, 57% female) in a health district in South Africa’s poorest province. N=1,425 adolescents who were either HIV-positive status aware or status-unaware (positive or negative) were included in the analyses, N=794 of whom were HIV-positive status-aware adolescents. In...

Introduction Noncommunicable diseases are increasing in developing countries, exacerbated by growing urbanization. We examined the experiences and perceptions about noncommunicable diseases of people who migrated from rural areas to urban Cape Town, South Africa. Methods We conducted a qualitative study in an impoverished periurban township that has a noncommunicable disease prevention program, including health clubs. We used in-depth interviews, participatory reflection and action groups, and focus group discussions. Results Participants described changes in eating patterns and levels of physical activity. These changes were a result of socioeconomic and environmental constraints. However, respondents were not concerned about these changes. Despite hardships, they were pleased with their urban lifestyle. Furthermore, they approved of their weight gain because it signified dignity and respect. Participants who attended health clubs found them informative and socially and emotionally supportive. Conclusion The study highlighted the complexity of the risk factors for noncommunicable diseases and the need to develop prevention strategies that extend beyond the traditional focus on diet and exercise.

Objective: To describe growth during puberty in young people with vertically acquired HIV. Design: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. Methods: 1094 children initiating an NNRTI-or boosted PI-based regimen aged 1 to 10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using 3 parameters (average height, timing and shape of the growth spurt), dependent on age and height-forage z-score (HAZ) (World Health Organisation references) at ART initiation. Multivariate regression explored characteristics associated with these 3 parameters. Results: At ART initiation median age and HAZ was 6.4[IQR:2.8,9.0] years and-1.2[-2.3,-0.2], respectively. Median follow-up was 9.1[6.9,11.4] years. In females, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41(95% CI 0.20,0.62) years later in children starting ART age 6-<11 years compared to 1-<3 years and 1.50(1.21,1.78) years later in those starting with HAZ<-3 compared to HAZ≥-1. Later growth spurts in females resulted in continued height growth into later adolescence. In males starting ART with HAZ<-1, growth spurts were later in children starting ART in the oldest age group, but for HAZ≥-1 there was no association with age. Males and females who initiated ART with HAZ≥-1 maintained a similar height to the WHO reference mean. Conclusions: Stunting at ART initiation was associated with later growth spurts in females. Children with HAZ≥-1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age.

Identifying factors, which influence health behaviors is critical to designing appropriate and effective preventive programs. Human immunodeficiency virus (HIV) transmission is highly related to people behaviors and understanding factors influencing healthy behaviors among Iranian people living with HIVs (PLHIVs)/acquired immunodeficiency syndrome (AIDS) is very important to tailor an effective response to HIV/AIDS epidemic. This study was conducted as a qualitative study by methods of focus group discussion and in-depth interview in six provinces of Iran with 64 PLHIVs to determine factors influence engagement in positive prevention. Knowledge and education, feelings of responsibility and positive prevention practices were identified as the primary domains of engagement. These domains were found to be influenced by feelings of ostracism and frustration, poverty, barriers to disclosure of HIV status, access to and utilization of drug abuse treatment services and antiretroviral thera...

Background Young adults with perinatally acquired HIV (PAH) face several challenges, including adhering to antiretroviral therapy (ART), managing the risk of onward HIV transmission and maintaining positive well-being. Sharing one’s HIV status with others (onward HIV disclosure) may assist with these challenges by facilitating emotional and practical support. Rates of HIV status sharing are, however, low in this population. There are no existing interventions focused on sharing one’s HIV status for young adults living with PAH. The HEADS-UP study is designed to develop and test the feasibility of an intervention to help the sharing of HIV status for young adults with PAH. Methods The study is a 30-month multi-site randomised feasibility study across both a high-income/low-HIV prevalence country (UK) and a low-income/high-HIV prevalence country (Uganda). Phase 1 (12 months) will involve developing the intervention using qualitative interviews with 20 young people living with PAH (ten...

Background: Several studies have reported on factors influencing adolescent pregnancies and the associated outcomes, but evidence from a systematic review is limited, especially in sub-Saharan Africa where the greater burden lies. Establishment of accurate epidemiological data on the rates of adolescent pregnancy, its predictors, and adverse outcomes (maternal and neonatal) may have important implications towards attainment of the Sustainable Development Goals. Methods: This will be a systematic review of studies reporting predictors of adolescent pregnancy and adverse outcomes in sub-Saharan Africa published between January 2000 and December 2017. The following databases will be searched: