"Health regains but livelihoods lag": findings from a study with people on ART in Zambia and Kenya.

Although ART is increasingly accessible and eases some stresses, it creates other challenges including the importance of food security to enhance ART-effectiveness. This paper explores the role livelihood strategies play in achieving food security and maintaining nutritional status among ART patients in Kenya and Zambia. Ongoing quantitative studies exploring adherence to ART in Mombasa, Kenya (n=118) and in Lusaka, Zambia (n=375) were used to identify the relationship between BMI and adherence; an additional set of in-depth interviews with people on ART (n=32) and members of their livelihood networks (n=64) were undertaken.

Implementation of clinic-based modified-directly observed therapy (m-DOT) for ART; experiences in Mombasa, Kenya.

The effectiveness of modified-directly observed therapy (m-DOT), an adherence support intervention adapted from TB DOTS programmes, has been documented. Describing the implementation process and acceptability of this intervention is important for scaling up, replication in other settings and future research. In a randomised trial in Mombasa, Kenya, patients were assigned to m-DOT or standard of care for 24 weeks.

Implementing programs for the prevention of mother-to-child HIV transmission in resource-constrained settings: Horizons studies, 1999-2007.

An estimated 430,00 new human immunodeficiency virus (HIV) infections occurred among children younger than 15 years of age in 2008, most in sub-Saharan Africa and most due to mother-to-child transmission (MTCT). In marked contrast, MTCT of HIV has been virtually eliminated in well-resourced settings through the use of combinations of antiretroviral (ARV) drugs for the mother during pregnancy and labor and for the infant postpartum; cesarean delivery to reduce the infant's exposure to trauma and infection in the birth canal; and formula feeding to protect the infant from transmission from breastfeeding. While effective, these interventions are costly and require strong health-care systems.

Changes in sexual risk taking with antiretroviral treatment: influence of context and gender norms in Mombasa, Kenya.

In-depth interviews were conducted with 23 sexually-active adults receiving antiretroviral treatment (ART) in Mombasa Kenya to understand changes in sexual behaviour after treatment initiation and factors influencing condom use. Advanced HIV disease had previously led to marked decreases in sexual desire and function. After HIV testing, numbers of partners reduced and monogamous relationships began to predominate.

Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: a randomized trial.

Objectives: To determine short- and long-term efficacy of modified directly observed therapy (m-DOT) on antiretroviral adherence.

Design: Randomized controlled trial. SETTING AND ANALYTIC APPROACH: From September 2003 to November 2004, 234 HIV-infected adults were assigned m-DOT (24 weeks of twice weekly health center visits for nurse-observed pill ingestion, adherence support, and medication collection) or standard care.

Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort.

Roll-out of antiretroviral treatment (ART) raises concerns about the potential for unprotected sex if sexual activity increases with well-being, resulting in continued HIV spread. Beliefs about reduced risk for HIV transmission with ART may also influence behavior. From September 2003 to November 2004, 234 adults enrolled in a trial assessing the efficacy of modified directly observed therapy in improving adherence to ART.

Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV.

This article reviews field experiences with provision of family planning services in prevention of mother-to-child transmission (PMTCT) programs in ten countries in Africa, Asia, and Latin America. Family planning is a standard component of most antenatal care and maternal-child health programs within which PMTCT programs are offered. Yet PMTCT sites often miss opportunities to provide HIV-positive clients with family planning counseling.

Understanding perceptions of HIV risk among adolescents in KwaZulu-Natal.

Risk perception has been theorized to be an important antecedent for adopting protective behavior. It is a key construct of research applying the Health Belief Model and other behavior change models. In relation to HIV, risk perception is an indicator of perceived susceptibility to infection, a measure for one's understanding of AIDS transmission as well as willingness to consider behavioral changes.

Pregnant or positive: adolescent childbearing and HIV risk in KwaZulu Natal, South Africa.

In communities where early age of childbearing is common and HIV prevalence is high, adolescents may place themselves at risk of HIV because positive or ambivalent attitudes towards pregnancy reduce their motivation to abstain from sex, have sex less often or use condoms. In this study, we analyse cross-sectional survey data from KwaZulu Natal, South Africa, to explore whether an association exists between the desire for pregnancy and perceptions of HIV risk among 1,426 adolescents in 110 local communities. Our findings suggest that some adolescents, girls more than boys, were more concerned about a pregnancy if they lived in environments where youth were perceived to be at high risk of HIV infection.

Multicentre study on factors determining differences in rate of spread of HIV in sub-Saharan Africa: methods and prevalence of HIV infection.

Objective: The objective of this study was to explore whether the differences in rate of spread of HIV in different regions in sub-Saharan Africa could be explained by differences in sexual behaviour and/or factors influencing the probability of HIV transmission during sexual intercourse.

Methods: A cross-sectional, population-based study was conducted in two cities with a high HIV prevalence (Kisumu in Kenya and Ndola in Zambia) and two cities with a relatively low HIV prevalence (Cotonou in Benin and Yaoundé in Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population.

Male circumcision and HIV infection in four cities in sub-Saharan Africa.

Objectives: To explore the role of male circumcision in the spread of HIV infection in four urban populations in sub-Saharan Africa.

Design And Methods: A cross-sectional population based study was conducted in four cities in sub-Saharan Africa with different levels of HIV infection. HIV prevalence among adults was relatively low in Cotonou (Benin) and in Yaoundé (Cameroon), and exceeded 25% in Kisumu (Kenya) and in Ndola (Zambia).

Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection.

Objective: To identify factors that could explain differences in rate of spread of HIV between different regions in sub-Saharan Africa.

Design: Cross-sectional study.

Methods: The study took place in two cities with a relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon), and two cities with a high HIV prevalence (Kisumu, Kenya and Ndola, Zambia).

Interpreting sexual behaviour data: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities.

Background: The main conclusion of the multicentre study on factors determining the differential spread of HIV in four African cities was that differences in sexual behaviour could not, by themselves, explain the differences in HIV prevalence between the four cities. The present paper examines three potential sources of bias that could invalidate this conclusion: (1) changes in sexual behaviour since the start of the HIV epidemics; (2) bias due to the low response rates of men; and (3) bias in reported sexual behaviour.

Methods: To assess whether there have been any changes in sexual behaviour over time, selected parameters of sexual behaviour were compared between different age groups in the four cities.

The buzz outside the clinics: conversations and contraception in Nyanza Province, Kenya.

When women talk with each other about family planning outside the clinic, are they really only spreading myths and rumors? If nurses give good information about family planning, why do women go and talk with other women? Why would a woman instructed by a nurse at a workshop want to talk to the workshop cleaner as well? To answer these questions, findings are used from a household survey and in-depth interviews that examine the role of informal social interaction in influencing the use of contraceptives in rural Kenya. The women in the study area are found to be ambivalent about family planing, and they supplement providers' instructions with the experiences of women whose bodies and circumstances are similar to their own. Family planning programs could improve their effectiveness by viewing clients and providers not only as individuals but also as members of informal networks that are meaningful to them.

Detecting induced abortions from reports of pregnancy terminations in DHS calendar data.

This study considers whether pregnancy terminations reported in Demographic and Health Survey (DHS) calendar data can be classified accurately as having been spontaneous or induced based upon other information collected in the survey interview. A classification scheme is proposed that is an adaptation of the method developed by the World Health Organization for categorizing cases in which women admitted to hospitals experienced complications of pregnancy termination. The scheme is evaluated using data from the 1993 Turkey DHS.

Fertility in Botswana: the recent decline and future prospects.

Recent estimates of fertility in Botswana suggest a rapid decline of more than two births per woman between 1981 and 1988. This paper proposes that the baseline fertility was overestimated but that nonetheless fertility declined by about one birth per woman during the 1980s. The decline in fertility was linked to a deterioration in social and economic conditions caused by a major drought in the early 1980s and to the increased availability of family planning services in the same period.

Coitus and contraception: the utility of data on sexual intercourse for family planning programs.

The Demographic and Health Surveys (DHS) program has included several questions on sexual intercourse in its model questionnaires that have been used in more than 25 surveys in Latin America, Africa, and Asia over the last five years. This article assesses the quality of the data on sexual intercourse for 12 DHS surveys and shows how these data may be useful for understanding contraceptive use dynamics and for organizing the management of family planning programs. The data show that there is considerable variation among countries in exposure to pregnancy prior to first marriage.