#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Persistence of traditional and emergence of new structural drivers and factors for the HIV epidemic in rural Uganda; A qualitative study


Autoři: Francis Bajunirwe aff001;  Denis Akakimpa aff002;  Flora P. Tumwebaze aff002;  George Abongomera aff002;  Peter N. Mugyenyi aff002;  Cissy M. Kityo aff002
Působiště autorů: Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda aff001;  Joint Clinical Research Center, Kampala, Uganda aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0211084

Souhrn

Background

In Uganda, the HIV epidemic is now mature and generalized. Recently, there have been reports of resurgence in the incidence of HIV after several years of successful control. The causes for this resurgence are not clear but suspected to be driven by structural factors that influence large groups of people rather than individuals. The aim of this study was to describe the structural drivers of the HIV epidemic in high prevalence regions and inform the next generation of interventions.

Methodology

We conducted a total of 35 focus group discussions in 11 districts in Uganda. Due to their high HIV prevalence, the districts had been selected to implement a donor supported program to scale up HIV prevention, care and treatment. Focus groups consisted of men and women including opinion leaders, civil servants including teachers, police officers, religious, political leaders, shop keepers, local residents and other ordinary persons from all walks of life. The qualitative data were transcribed and analyzed manually. Texts were coded using a coding scheme which was prepared ahead of time but emerging themes and codes were also allowed.

Results

Our data indicated there is persistence of several structural drivers and factors for HIV in rural Uganda. The structural drivers of HIV were divided into three categories: Gender issues, socio-cultural, and economic drivers. The specific drivers included several gender issues, stigma surrounding illness, traditional medical practices, urbanization, alcohol and substance abuse and poverty. New drivers arising from urbanization, easy access to mobile phone, internet and technological advancement have emerged. These drivers are intertwined within an existing culture, lifestyle and the mixture is influenced by modernization.

Conclusion

The traditional structural drivers of HIV have persisted since the emergence of the HIV epidemic in Uganda and new ones have emerged. All these drivers may require combined structural interventions that are culturally and locally adapted in order to tackle the resurgence in incidence of HIV in Uganda.

Klíčová slova:

Domestic violence – HIV epidemiology – HIV infections – HIV prevention – Sexual and gender issues – Traditional medicine – Uganda


Zdroje

1. Asiimwe-Okiror G, Opio AA, Musinguzi J, Madraa E, Tembo G, Carael M. Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda. AIDS. 1997;11(14):1757–63. Epub 1997/12/05. doi: 10.1097/00002030-199714000-00013 9386811.

2. Kirungi WL, Musinguzi J, Madraa E, Mulumba N, Callejja T, Ghys P, et al. Trends in antenatal HIV prevalence in urban Uganda associated with uptake of preventive sexual behaviour. Sex Transm Infect. 2006;82 Suppl 1:i36–41. Epub 2006/04/04. doi: 10.1136/sti.2005.017111 16581758; PubMed Central PMCID: PMC2593075.

3. Kilian AH, Gregson S, Ndyanabangi B, Walusaga K, Kipp W, Sahlmuller G, et al. Reductions in risk behaviour provide the most consistent explanation for declining HIV-1 prevalence in Uganda. AIDS. 1999;13(3):391–8. Epub 1999/04/13. doi: 10.1097/00002030-199902250-00012 10199230.

4. Kamali A, Carpenter LM, Whitworth JA, Pool R, Ruberantwari A, Ojwiya A. Seven-year trends in HIV-1 infection rates, and changes in sexual behaviour, among adults in rural Uganda. AIDS (London, England). 2000;14(4):427–34. Epub 2000/04/19. doi: 10.1097/00002030-200003100-00017 10770546.

5. Shafer LA, Biraro S, Nakiyingi-Miiro J, Kamali A, Ssematimba D, Ouma J, et al. HIV prevalence and incidence are no longer falling in southwest Uganda: evidence from a rural population cohort 1989–2005. AIDS (London, England). 2008;22(13):1641–9. Epub 2008/08/02. doi: 10.1097/QAD.0b013e32830a7502 18670225.

6. Kiwanuka N, Ssetaala A, Mpendo J, Wambuzi M, Nanvubya A, Sigirenda S, et al. High HIV-1 prevalence, risk behaviours, and willingness to participate in HIV vaccine trials in fishing communities on Lake Victoria, Uganda. J Int AIDS Soc. 2013;16:18621. Epub 2013/07/25. doi: 10.7448/IAS.16.1.18621 23880102; PubMed Central PMCID: PMC3720985.

7. Kiwanuka N, Ssetaala A, Nalutaaya A, Mpendo J, Wambuzi M, Nanvubya A, et al. High incidence of HIV-1 infection in a general population of fishing communities around Lake Victoria, Uganda. PLoS One. 2014;9(5):e94932. Epub 2014/05/29. doi: 10.1371/journal.pone.0094932 24866840; PubMed Central PMCID: PMC4035272.

8. Kamali A, Nsubuga RN, Ruzagira E, Bahemuka U, Asiki G, Price MA, et al. Heterogeneity of HIV incidence: a comparative analysis between fishing communities and in a neighbouring rural general population, Uganda, and implications for HIV control. Sex Transm Infect. 2016;92(6):447–54. Epub 2016/03/05. doi: 10.1136/sextrans-2015-052179 26933046; PubMed Central PMCID: PMC5013105.

9. Marshall BD, Kerr T, Shoveller JA, Montaner JS, Wood E. Structural factors associated with an increased risk of HIV and sexually transmitted infection transmission among street-involved youth. BMC Public Health. 2009;9:7. Epub 2009/01/13. doi: 10.1186/1471-2458-9-7 19134203; PubMed Central PMCID: PMC2630937.

10. Parkhurst JO. Structural approaches for prevention of sexually transmitted HIV in general populations: definitions and an operational approach. J Int AIDS Soc. 2014;17:19052. Epub 2014/09/11. doi: 10.7448/IAS.17.1.19052 25204872; PubMed Central PMCID: PMC4159948.

11. Wight D, Plummer ML, Mshana G, Wamoyi J, Shigongo ZS, Ross DA. Contradictory sexual norms and expectations for young people in rural Northern Tanzania. Soc Sci Med. 2006;62(4):987–97. Epub 2005/09/06. doi: 10.1016/j.socscimed.2005.06.052 16139937.

12. Brawner BM, Reason JL, Goodman BA, Schensul JJ, Guthrie B. Multilevel drivers of human immunodeficiency virus/acquired immune deficiency syndrome among Black Philadelphians: exploration using community ethnography and geographic information systems. Nurs Res. 2015;64(2):100–10. Epub 2015/03/05. doi: 10.1097/NNR.0000000000000076 25738621; PubMed Central PMCID: PMC4352720.

13. Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372(9640):764–75. Epub 2008/08/09. doi: 10.1016/S0140-6736(08)60887-9 18687460.

14. Auerbach JD, Parkhurst JO, Caceres CF. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Glob Public Health. 2011;6 Suppl 3:S293–309. Epub 2011/07/13. doi: 10.1080/17441692.2011.594451 21745027.

15. Okeyo TM, Allen AK. Influence of widow inheritance on the epidemiology of AIDS in Africa. African journal of medical practice. 1994;1(1):20–5. Epub 1994/03/01. 12287807.

16. Abimanyi-Ochom J. The better the worse: risk factors for HIV infection among women in Kenya and Uganda: demographic and health survey. AIDS Care. 2011;23(12):1545–50. Epub 2011/11/26. doi: 10.1080/09540121.2011.582477 22117124.

17. Mabumba ED, Mugyenyi P, Batwala V, Mulogo EM, Mirembe J, Khan FA, et al. Widow inheritance and HIV/AIDS in rural Uganda. Trop Doct. 2007;37(4):229–31. Epub 2007/11/09. doi: 10.1258/004947507782332955 17988488.

18. Perry B, Oluoch L, Agot K, Taylor J, Onyango J, Ouma L, et al. Widow cleansing and inheritance among the Luo in Kenya: the need for additional women-centred HIV prevention options. J Int AIDS Soc. 2014;17:19010. Epub 2014/06/29. doi: 10.7448/IAS.17.1.19010 24973041; PubMed Central PMCID: PMC4074366.

19. Rujumba J, Kwiringira J. Interface of culture, insecurity and HIV and AIDS: Lessons from displaced communities in Pader District, Northern Uganda. Conflict and health. 2010;4:18. Epub 2010/11/26. doi: 10.1186/1752-1505-4-18 21092165; PubMed Central PMCID: PMC2995777.

20. Mall S, Middelkoop K, Mark D, Wood R, Bekker LG. Changing patterns in HIV/AIDS stigma and uptake of voluntary counselling and testing services: the results of two consecutive community surveys conducted in the Western Cape, South Africa. AIDS Care. 2013;25(2):194–201. Epub 2012/06/15. doi: 10.1080/09540121.2012.689810 22694602.

21. Chan BT, Tsai AC. HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003–2013. Journal of acquired immune deficiency syndromes (1999). 2016;72(5):558–64. Epub 2016/04/02. doi: 10.1097/qai.0000000000001011 27035888; PubMed Central PMCID: PMC4942369.

22. Uganda AIDS Indicator Survey 2011, Demographic and Health Surveys, ICF International. 2012.

23. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405. Epub 2013/03/14. doi: 10.1111/nhs.12048 23480423.

24. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care: journal of the International Society for Quality in Health Care. 2007;19(6):349–57. Epub 2007/09/18. doi: 10.1093/intqhc/mzm042 17872937.

25. Mwanga JR, Mshana G, Kaatano G, Changalucha J. "Half plate of rice to a male casual sexual partner, full plate belongs to the husband": findings from a qualitative study on sexual behaviour in relation to HIV and AIDS in northern Tanzania. BMC Public Health. 2011;11:957. Epub 2011/12/29. doi: 10.1186/1471-2458-11-957 22202562; PubMed Central PMCID: PMC3296677.

26. Thamattoor U, Thomas T, Banandur P, Rajaram S, Duchesne T, Abdous B, et al. Multilevel Analysis of the Predictors of HIV Prevalence among Pregnant Women Enrolled in Annual HIV Sentinel Surveillance in Four States in Southern India. PLoS One. 2015;10(7):e0131629. Epub 2015/07/07. doi: 10.1371/journal.pone.0131629 26147208; PubMed Central PMCID: PMC4492681.

27. Russell S, Zalwango F, Namukwaya S, Katongole J, Muhumuza R, Nalugya R, et al. Antiretroviral therapy and changing patterns of HIV stigmatisation in Entebbe, Uganda. Sociol Health Illn. 2015. Epub 2015/09/19. doi: 10.1111/1467-9566.12341 26382288.

28. Chan BT, Weiser SD, Boum Y, Siedner MJ, Mocello AR, Haberer JE, et al. Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion. AIDS (London, England). 2015;29(1):83–90. Epub 2014/10/01. doi: 10.1097/qad.0000000000000495 25268886; PubMed Central PMCID: PMC4286463.

29. Kamndaya M, Vearey J, Thomas L, Kabiru CW, Kazembe LN. The role of material deprivation and consumerism in the decisions to engage in transactional sex among young people in the urban slums of Blantyre, Malawi. Glob Public Health. 2015:1–14. Epub 2015/03/06. doi: 10.1080/17441692.2015.1014393 25741631.

30. Kamndaya M, Kazembe LN, Vearey J, Kabiru CW, Thomas L. Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre, Malawi: A multi-level approach. Health Place. 2015;33:90–100. Epub 2015/03/31. doi: 10.1016/j.healthplace.2015.03.001 25814337; PubMed Central PMCID: PMC4415138.

31. Kamndaya M, Thomas L, Vearey J, Sartorius B, Kazembe L. Material deprivation affects high sexual risk behavior among young people in urban slums, South Africa. Journal of urban health: bulletin of the New York Academy of Medicine. 2014;91(3):581–91. Epub 2014/02/01. doi: 10.1007/s11524-013-9856-1 24481587; PubMed Central PMCID: PMC4074323.

32. Kunnuji M. Basic deprivation and involvement in risky sexual behaviour among out-of-school young people in a Lagos slum. Cult Health Sex. 2014;16(7):727–40. Epub 2014/04/05. doi: 10.1080/13691058.2014.894206 24697531.

33. Greif MJ. Housing, medical, and food deprivation in poor urban contexts: implications for multiple sexual partnerships and transactional sex in Nairobi's slums. Health Place. 2012;18(2):400–7. Epub 2012/01/20. doi: 10.1016/j.healthplace.2011.12.008 22257740.

34. Seeley J, Watts CH, Kippax S, Russell S, Heise L, Whiteside A. Addressing the structural drivers of HIV: a luxury or necessity for programmes? J Int AIDS Soc. 2012;15 Suppl 1:1–4. Epub 2012/08/21. doi: org/10.7448/IAS.15.3.17397 22905346.

35. Schuyler AC, Edelstein ZR, Mathur S, Sekasanvu J, Nalugoda F, Gray R, et al. Mobility among youth in Rakai, Uganda: Trends, characteristics, and associations with behavioural risk factors for HIV. Glob Public Health. 2015:1–18. Epub 2015/08/28. doi: 10.1080/17441692.2015.1074715 26313708.

36. Beattie TS, Bhattacharjee P, Isac S, Davey C, Javalkar P, Nair S, et al. Supporting adolescent girls to stay in school, reduce child marriage and reduce entry into sex work as HIV risk prevention in north Karnataka, India: protocol for a cluster randomised controlled trial. BMC Public Health. 2015;15:292. Epub 2015/04/17. doi: 10.1186/s12889-015-1623-7 25881037; PubMed Central PMCID: PMC4391662.

37. Wagman JA, King EJ, Namatovu F, Kiwanuka D, Kairania R, Semanda JB, et al. Combined Intimate Partner Violence and HIV/AIDS Prevention in Rural Uganda: Design of the SHARE Intervention Strategy. Health Care Women Int. 2015:1–24. Epub 2015/06/19. doi: 10.1080/07399332.2015.1000129 26086189.

38. Wagman JA, Gray RH, Campbell JC, Thoma M, Ndyanabo A, Ssekasanvu J, et al. Effectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort. The Lancet Global health. 2015;3(1):e23–33. Epub 2014/12/30. doi: 10.1016/S2214-109X(14)70344-4 25539966; PubMed Central PMCID: PMC4370228.

39. Kyegombe N, Abramsky T, Devries KM, Starmann E, Michau L, Nakuti J, et al. The impact of SASA!, a community mobilization intervention, on reported HIV-related risk behaviours and relationship dynamics in Kampala, Uganda. J Int AIDS Soc. 2014;17:19232. Epub 2014/11/08. doi: 10.7448/IAS.17.1.19232 25377588; PubMed Central PMCID: PMC4223282.

40. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med. 2014;12:122. Epub 2014/09/25. doi: 10.1186/s12916-014-0122-5 25248996; PubMed Central PMCID: PMC4243194.

41. Kyegombe N, Starmann E, Devries KM, Michau L, Nakuti J, Musuya T, et al. 'SASA! is the medicine that treats violence'. Qualitative findings on how a community mobilisation intervention to prevent violence against women created change in Kampala, Uganda. Global health action. 2014;7:25082. Epub 2014/09/17. doi: 10.3402/gha.v7.25082 25226421; PubMed Central PMCID: PMC4165071.

42. Santelli JS, Edelstein ZR, Wei Y, Mathur S, Song X, Schuyler A, et al. Trends in HIV acquisition, risk factors and prevention policies among youth in Uganda, 1999–2011. AIDS. 2015;29(2):211–9. Epub 2014/12/24. doi: 10.1097/QAD.0000000000000533 25535753.


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#