BACKGROUND:This study explored healthcare providers' perspectives and experiences regarding HIV status disclosure to children receiving antiretroviral therapy (ART) in the Masaka region of Uganda. Despite national and World Health Organization (WHO) recommendations to disclose HIV status by age 12 years, disclosure rates remain low in Uganda. Understanding providers' views is critical, given their central role in supporting caregivers and children throughout the process. METHODS:The study employed a qualitative design, drawing on key informant interviews (KIIs) with 18 purposively selected healthcare providers that included, medical officers, clinical officers, nurses, and counsellors. Data were analysed thematically following Braun and Clarke's approach. RESULTS:Two overarching themes emerged: HIV disclosure enablers and impediments. HIV disclosure enablers included the availability of national disclosure guidelines, integration of disclosure activities into routine ART clinic practice, provision of safe psychosocial spaces for children and caregivers, and the presence of structured peer support networks led by young people with HIV. These elements facilitated developmentally appropriate, emotionally supportive, and systematic disclosure. Conversely, HIV disclosure impediments included unstable or unsupportive home environments, domestic violence, child schooling and extended stays with relatives, prioritisation of disclosure only for children with high viral loads, lack of standardised facility-level disclosure protocols, and role ambiguity between caregivers and providers. Such barriers often delayed or undermined the process, leaving many adolescents unaware of their HIV status despite being on lifelong treatment. DISCUSSION:The findings underscore that paediatric HIV disclosure is a complex, multilevel process shaped by structural, psychosocial, and contextual factors. Strengthening health system structures through standardised guidelines, continuous provider training, and clear role delineation, combined with psychosocial interventions such as providing social and psychological spaces for clients to vent their issues and strong child peer support, can enhance disclosure practices. Tailored approaches for children in schools and extended family settings are also essential for improving adherence, retention, and long-term well-being among children with HIV.
Amidst severe aid cuts, sustaining paediatric HIV care in Africa is urgent. Children and adolescents face disproportionate risks from treatment disruptions. A youth-centred, multisectoral approach-integrating mental health, long-acting therapies, and community-based support-is essential to prevent catastrophic setbacks and protect vulnerable populations from rising infections, neurocognitive decline, and systemic exclusion.
For more than two decades, United States foreign assistance, particularly through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), has been central to Nigeria's HIV response, supporting antiretroviral therapy (ART), laboratory systems, and community-based prevention initiatives. Among these are programs for orphans and vulnerable children (OVC) and the Families Matter! Program (FMP), which equips parents and caregivers to guide adolescents away from behaviours that increase HIV risk and help reduce HIV-related stigma within families and communities.The temporary freeze on U.S. foreign aid announced in January 2025 disrupted these interventions and raised concerns about the sustainability of Nigeria's HIV response. While much attention has focused on the risk of treatment interruptions and ART stock-outs, less attention has been given to the suspension of OVC and FMP programs despite their role in prevention, psychosocial support, and household stability.This paper examines the short-and long-term implications of the aid freeze for Nigeria's HIV response, with particular focus on adolescents, vulnerable children, and family-centred prevention initiatives. It argues that disruptions to these programs may undermine prevention gains and weaken social protection systems, while also highlighting the need for stronger domestic resource mobilisation and institutionalisation of community-based HIV interventions to ensure a more sustainable and resilient response.
BACKGROUND:Accurate interpretation of survey questions about sensitive matters such as sexual practices is crucial for obtaining reliable data to inform effective public health interventions. Describing sexual practices involves reflecting on acts and contextually attributing meanings. However, participants in sexual behaviour studies may struggle to understand questions, affecting the validity of the data. AIM:We investigated factors that shape the understanding of survey questions on sexual practices in South Central Uganda using a survey instrument and a semi-structured cognitive interview guide. METHODOLOGY:Participants (n = 24), stratified by age, sex, and community type, and including persons with disabilities, were recruited. Interviews were conducted in person, and data were analysed using thematic analysis and an analytic matrix. RESULTS:A complex interaction between awareness or knowledge of the practice, memory retrieval, denial, sexual involvement, and cultural beliefs influenced participants' understanding of survey questions on sexual activities. Specifically, awareness and knowledge of the practice facilitated spontaneous and accurate responses, while a lack of familiarity led to hesitation and confusion. Memory retrieval was easier for recent experiences, and denial slowed down the process. CONCLUSION:This study highlights the importance of considering individual, interpersonal, and community-level factors to improve the accuracy and reliability of survey research on sexual practices for effective public health interventions.
BACKGROUND:In Nigeria, HIV prevalence among men who have sex with men (MSM) continues to rise due to sociocultural barriers hindering prevention efforts. AIM:This study investigated the barriers MSM face in HIV prevention. METHODS:Informed by the social ecological model (SEM), a qualitative study was conducted with 12 participants via online semi-structured interviews. Participants were men over the age of 18 years who were HIV negative and recruited from a non-governmental organisation (NGO) in Lagos, Nigeria. RESULTS:Using a thematic analysis approach, six themes appeared as common barriers to HIV prevention, including (i) adult violence and extortion, (ii) perceptions of HIV biomedical approaches, (iii) condom attitudes, (iv) access to HIV and sexually transmitted infection services and education, (v) internalised stigma, and (vi) externalised stigma. These themes reflected the systemic and multipart sociocultural environment that inhibits MSM from seeking HIV prevention resources. CONCLUSION:There is a need to improve access to community-based NGOs and trauma-informed mental health resources. Furthermore, until policy reforms are implemented and homophobia is significantly reduced, the development of intersectional, community-informed interventions is particularly important for addressing inadequacies in healthcare for MSM.
INTRODUCTION:Health equity is a central objective of global health, requiring the removal of barriers to ensure equitable access and use of services for all. Monitoring inequalities in health service use is critical to evaluate progress toward this goal. This study analyses longitudinal trends in condom use, a key HIV prevention service and the associated socioeconomic inequalities among men in Sierra Leone to assess whether access and use are becoming more equitable. METHODS:We conducted a secondary analysis of data from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys. The sample included 9 375 men aged 15 to 59 years who reported sex with a non-marital, non-cohabiting partner in the past 12 months. Using the World Health Organization's Health Equity Assessment Toolkit (HEAT), we calculated absolute (Difference, Slope Index of Inequality) and relative (Ratio, Relative Index of Inequality) measures to quantify inequalities across economic status, education, age, marital status, residence, and region. RESULTS:National condom use at last higher-risk sex remained stable at 23.0% in 2008, 21.4% in 2013, and 22.5% in 2019. However, disaggregated analysis revealed persistent absolute inequalities. In 2019, the absolute gap (D) by economic status was 12.4 percentage points and by education was 18.0 percentage points. A notable finding was the decline in condom use among the richest (40.4% to 31.7%) and most educated (53.6% to 34.2%) men, even as use increased among the poorest (4.7% to 19.3%) and least educated (10.2% to 16.2%). CONCLUSION:While improvements among the most disadvantaged men are encouraging, persistent absolute inequalities and declining use among more privileged groups highlight a complex landscape for HIV prevention. Achieving health equity requires targeted interventions that address the specific barriers faced by disadvantaged groups while countering risk compensation in higher socioeconomic strata. Longitudinal inequality monitoring is vital for guiding these efforts.
Background:HIV self-testing (HIVST) enables individuals to test privately and can serve as an important tool to mitigate stigma and fear of HIV testing and unintended disclosure, especially among men, who have lower voluntary testing rates than women.Aim:Within an intervention study involving distribution of HIVST kits by fishermen to their peers [NCT 04772469], we explore the experiences and the motivations of men who chose to self-test for HIV in the presence of their female partners.Method:We conducted in-depth interviews (n = 32) with fishermen from three fishing communities along Lake Victoria, Kenya. Interviews were conducted at three months post-intervention and explored fishermen's experiences with HIVST and the context under which they tested. Interviews were analysed using a framework analysis approach.Results:Though they were not prompted by the study to do so, 17 participants described testing for HIV at home in the presence of partners. Fishermen who used HIVST kits in front of partners expressed feelings of comfort and closeness, felt the experience strengthened their relationships, helped garner partner support, and facilitated partner disclosure of their HIV status and subsequent couples' HIV testing.Conclusion:Building awareness of the benefits of HIVST for promoting knowledge of HIV status, as a starting point for discussions about HIV, and to promote disclosure in relationships, may increase rates of voluntary HIV testing among men.
Background: The COVID-19 pandemic disrupted essential health services globally, including sexual and reproductive health (SRH).Aim: This study examines the impact of lockdown measures on sexual and reproductive health services in Ekurhuleni Health District, South Africa.Methods: An interrupted time series design was utilised to analyse the impact of COVID-19 restrictions on SRH indicators in the Ekurhuleni Health District, Gauteng Province, South Africa. Monthly data (January 2018 to December 2023) from the web-District Health Information System were used. Indicators included primary health utilisation (PHC), couple-year protection (CYP), antenatal care visits (ANC), maternal mortality ratio (MMR), medical male circumcision (MC), male urethritis syndrome (MUS), female and male condom distributions, and cervical cancer screening. Descriptive statistics and segmented linear regression models were conducted using Stata version 17.Results: PHC utilisation declined significantly during the COVID-19 lockdown (Coef: -0.3%, 95% CI: -0.4 to -0.2) with gradual recovery after the lockdown. ANC first visits before 20 weeks decreased by 5.7% during lockdown (Coef: -5.7%, 95%CI: - 2.8 to -8.5). Cervical cancer screening coverage significantly declined during lockdown with no recovery afterwards (Coef: -29.4%, 95% CI: -37.4 to -21.3). In contrast to these declining trends, the CYP rate remained stable and increased significantly by 18.2% during lockdown (Coef: 18.2%, 95% CI: 3.4 to 32.9). MUS declined by 3.3% during the lockdown period (Coef: -3.3%, 95% CI: -5.7 to -1.0).Conclusion: This study revealed a remarkable impact of the COVID-19 lockdown on sexual and reproductive health services indicators. While primary health care utilisation experienced a moderate decline and gradual recovery, other indicators, such as ANC, cervical cancer, and MUS, showed persistent negative disruptions.
Background: In Libya, the HIV/AIDS epidemic has worsened over the past 10 years because of political instability, dilapidated health infrastructure, social stigma, and limited access to testing and treatment. While public health has a growing interest in addressing HIV issues, there is limited and uncoordinated national-level research on HIV in Libya.Objective: This study aimed to analyse trends and risk factors of HIV/AIDS in Libya from 2011 to 2025.Methods: This study utilised a retrospective descriptive epidemiological design to describe HIV/AIDS trends in Libya over 15 years (2011-2025). Data were obtained from national health records, the World Health Organization, Libyan public reports, and UNAIDS. Variables of interest included incidence, prevalence, sex, age, geographic distributions, modes of transmission, and displacement status.Results: By 2025, an estimated 8 200 people will be living with HIV in Libya. Males made up 77.3% of confirmed cases, injection drug use was the most common transmission route at 45.2%, and the impacts were primarily in the 30 to 39-year age group. Displaced populations made up 34% of the cases. The large increase in cases was preceded by a government indication program for testing, and cases were then identified that had previously gone undiagnosed.Conclusions: While the patterns of HIV spread in Libya are alarming, we recommend an urgent scale-up of interventions similar to those in Rwanda. Mobile testing units, harm reduction programs, peer outreach, and community-based anti-stigma programs in high-risk communities all require immediate scale-up.
INTRODUCTION:Despite global strides in HIV testing strategies in recent years, such as home testing and non-medical testing sites, HIV testing uptake and access to treatment, care, and support remain at very low access levels amongst key and priority populations, such as adolescent girls and young women (AGYW). The study assessed the barriers and facilitators influencing the use of HIV self-testing (HIVST) among AGYW in Sekhukhune Technical Vocational Education and Training college, South Africa. METHODS:An institution-based descriptive exploratory qualitative study was employed in which 22 AGYW were purposively sampled. Data were collected through four focus group discussions with an average of six participants between February and April 2024. The data were analysed thematically. RESULTS:The participants were enrolled on levels 2 to 6 of training (age range = 19 to 24 years). Fear, doubt, and anxiety regarding HIVST results, mental health concerns after self-testing, and concerns over the accuracy and the interpretation of results were barriers linked to HIVST use. Convenience, privacy, and ease of use made HIVST appealing to AGYW. CONCLUSION:To ensure the successful implementation of HIVST interventions, there is a need to implement a tailored modality that is appealing to AGYW. This should focus on addressing current HIVST barriers and leveraging facilitators to enhance HIVST uptake among AGYW.
Background: Significant advancements have been made in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) diagnosis and treatment, yet progress in quality care remains limited. To address this gap, 88 quality indicators for clinical HIV/AIDS care were evaluated. This study aimed to assess and compare adherence to these quality indicators and to analyse their impact on treatment outcomes in the Democratic Republic of Congo (DRC) and South Africa (SA).Methods: A retrospective cohort study was conducted at Panzi Hospital (DRC) and King Edward VIII Hospital (SA) among adult HIV and AIDS (PLWHA) patients who began antiretroviral treatment between January 2018 and December 2022. Descriptive analysis and logistic regression were used to assess the association between indicators and treatment outcomes.Results: Compliance with indicators was 65.75% in the DRC and 69.86% in SA. Multivariate analysis identified 10 indicators in DRC and four in SA linked to negative immunological responses, while eight in the DRC and seven in SA were associated with viral load suppression failure. Additionally, 12 indicators in the DRC and 14 in SA were linked to an increased risk of death.Conclusion: The level of compliance with the indicators was suboptimal in both countries, indicating the need for improvement. Several indicators were associated with treatment outcomes.
Introduction: While the effects of the US government's sudden pause of foreign aid on the global HIV response have been well documented, little is known about the likely impact on universal health coverage (UHC) in recipient countries. This study assesses the association between PEPFAR funding and the universal health service coverage index.Methods: Using data on PEPFAR investments in 24 countries between 2004 and 2020, the study applied fixed and time effects panel data regression on the main UHC index and its sub-indices for non-communicable diseases (NCDs), reproductive, maternal, newborn and child healthcare (RMNCH); and service capacity and access. Gross domestic product (GDP) per capita, government health expenditure as a percentage of current health expenditure (CHE), private health expenditure as a percentage of CHE, and government efficiency were included as control variables.Results: The UHC index tripled in some countries over the study period, coinciding with PEPFAR investments, which prioritised HIV treatment. However, GDP per capita doubled, government health spending increased marginally, while out-of-pocket payments declined in the same time period. The study found positive associations between PEPFAR funding and the UHC index (0.11, p < 0.01), RMNCH (0.036, p < 0.1), and NCDs (0.038, p < 0.05). GDP per capita, government health expenditure, and government efficiency were also positively associated with UHC indexes. Time effects were established for the main UHC index and the NCDs sub-index.Conclusions: We conclude that PEPFAR funding for HIV was instrumental in driving UHC in recipient countries. The abruptness of the funding cuts was destabilising to HIV programs across the globe and threatened to upend hard-won gains in ending AIDS as a public health threat. Without renewed PEPFAR support, continued global solidarity, and greater domestic financing, health systems risk setbacks threatening the health of current and future generations, as well as global health security. Safeguarding current progress requires PEPFAR funding restoration, host governments' commitment to growth-oriented policies, efficient use of available resources, integration of HIV into UHC, stronger South-South cooperation to reduce aid reliance, and donor alignment with national health goals.
Introduction: In Tanzania, nearly 1.6 million adults were living with HIV in 2022, with an HIV prevalence rate of 4.4%. We piloted community health worker-managed adherence clubs in two clinics in Shinyanga, Tanzania. We previously demonstrated better stability in care and improved treatment adherence following the establishment of clubs. This study evaluated referral back to the facility, feasibility, and challenges to inform potential scale-up.Method: The study included clubs from two clinics between July 2018 and September 2019, Ngokolo (13 clubs) and Bugisi (33 clubs), all located in the Shinyanga region. Clinicians invited stable clients to join an AC if they met eligibility criteria. Logistic regression models identified factors associated with the likelihood of clients' referral back to the facilitiesResults: The setup of the adherence clubs was feasible and successful. In one year, 46 clubs with 617 clients were established. Thirty-eight clients (6.3 %) were referred back to the clinics. Factors associated with being referred back were lower age (below 25 compared to above), having ever missed AC visits, and a rural site. Challenges included start-up problems with wrongful enrolments, the need for additional staff to facilitate the club model, the duplication of data collection tools, and the need for youth-friendly adherence clubs.Conclusion: Task shifting to community health workers to manage the clubs was successful. Despite its success, it required a higher level of organisation, particularly during the setup phase. These findings support the revision of the National HIV guideline to formally integrate community health worker-led adherence clubs, ensuring scalability and sustainability.
Background: The psychosocial vulnerability of adolescents living with HIV, particularly in sub-Saharan Africa, where structural and psychosocial stressors are prevalent, is an important public health concern. While several studies have investigated some psychosocial factors as they predict mental well-being among adults living with HIV, little is known about the role of psychosocial (depression, personality traits and social support) predictors and sex differences in the mental well-being of adolescents living with HIV in Ibadan, Nigeria.Aim: This study aims to examine the psychosocial predictors and gender differences in the mental well-being of adolescents living with HIV in Ibadan, Nigeria.Methods: A cross-sectional design using purposive sampling was employed, with data collected from 144 adolescents (aged 13 to 19 years, M = 16.04 years, SD = 2.02 years). Instruments included the Warwick-Edinburgh Mental Well-being Scale, the Perceived Social Support in HIV (PSS-HIV) scale, the Centre for Epidemiologic Studies Depression Scale (CESD-R) Scale, and the Big Five Personality Traits inventory. Five hypotheses were tested using hierarchical multiple regression and an independent sample t-test at a significance level of 0.05.Results: Results showed that depression, personality traits, and social support jointly predicted mental well-being [F(12, 122) = 13.77, R = 0.60, R2 = 0.36, p < 0.01]. Independent predictors included agreeableness (β = 0.23, t = 2.54, p < 0.01), openness (β = -0.19, t = -2.05, p < 0.05), belonging (β = 0.22, t = 2.56, p < 0.01), and esteem (β = 0.38, t = 3.31, p < 0.001). Results also showed that there were no significant sex differences in mental well-being [t(141) = -1.39, p > 0.05].Conclusion: Psychosocial factors significantly influenced mental well-being, and interventions should focus on strengthening social support networks and promoting adaptive personality traits to improve mental well-being.
Background: Stigma and discrimination against people living with HIV (PLHIV) in healthcare settings are significant barriers to achieving Egypt's 95-95-95 targets and ending AIDS as a public health threat by 2030. Misconceptions among healthcare professionals (HCPs) can negatively affect testing, treatment, and care outcomes. This study aimed to assess the knowledge, attitudes, and practices (KAP) of HCPs toward PLHIV at Cairo University Hospitals.Methods: A cross-sectional study was conducted between March and June 2021 (n = 344 HCPs, mean age = 31.1 years, female = 52%), including physicians, nurses, and house officers, using an online, self-administered questionnaire adapted from the UNAIDS standardised tool for measuring HIV-related stigma and discrimination. The survey covered five domains: sociodemographic characteristics, knowledge, attitudes, practices, and institutional policies.Results: Only 30.3% of participants (n = 104) had received HIV/AIDS training in the past year. The training received had a median training duration of 12 hours (IQR: 7-21). While 86.6% (n = 298) correctly identified that a healthy-looking person can have HIV, misinformation was prevalent in other areas. Furthermore, 77.3% were unaware of the "undetectable = untransmittable" ("U=U") concept. Discriminatory attitudes and stigmatising behaviour driven by illiteracy of HIV/AIDS issues were evident. More than half of the participants strongly agreed that their facility had adequate supplies and standardised procedures to reduce HIV transmission risk, and 31.4% stated that their facility lacked written guidelines to protect patients with HIV from discrimination.Conclusion: Persistent knowledge gaps, fear of occupational exposure, and moral judgments toward PLHIV were evident among HCP. Targeted stigma-reduction interventions through continuous professional education, enforcement of institutional anti-discrimination policies, and incorporation of HIV prevention principles into healthcare curricula are urgently needed.
Background: South Africa has the world's highest HIV prevalence rate (12.7%), with university students disproportionately affected. While HIV Pre-Exposure Prophylaxis (PrEP) is an effective preventive measure for high-risk individuals, its uptake among university students remains low, which hinders progress toward national and global targets to end the AIDS epidemic by 2030. This study aimed to identify the factors influencing PrEP uptake in this vulnerable population, specifically among university students in Gauteng province, using Pender's Health Promotion Model.Methods: A quantitative, descriptive cross-sectional survey was conducted among 537 university students across six universities in Gauteng province. Data were analysed using Partial Least Squares Structural Equation Modelling to identify significant predictors of PrEP use.Results: The study revealed a low PrEP uptake rate among students at risk of contracting HIV. The analysis identified several factors that directly influenced PrEP uptake, including knowledge (β = 0.122, p = 0.001), interpersonal influence (β = 0.082, p = 0.038), situational influence (β = 0.145, p = 0.001), and perceived benefits (β = 0.121, p = 0.003). Significant interactions were also found between condom use and knowledge (β = 0.098, p = 0.004) and between condom use and perceived benefits (β = 0.127, p = 0.013).Conclusion: PrEP uptake is a complex process influenced by the dynamic interplay of factors consistent with Pender's Health Promotion Model, particularly interpersonal, cognitive, and situational factors. These results provide valuable evidence for developing multifaceted, youth-friendly interventions, such as a mobile health application, to promote PrEP use, reduce HIV incidence, and help achieve national and global HIV prevention targets.
Background: HIV treatment, adherence, and retention in care are fundamental in achieving viral load suppression (VLS) and fighting the HIV pandemic. The Government of Eswatini has decentralised antiretroviral treatment (ART) services and introduced differentiated HIV service delivery models to improve treatment outcomes for all people living with HIV, including young people. It is imperative to investigate the success of these initiatives in improving VLS in young people living with HIV (YPLHIV) in Eswatini.Objective: To determine the factors associated with VLS amongst YPLHIV (15 to 24 years) who are on ART in Eswatini.Methodology: A retrospective cohort analysis of 4 334 YPLHIV on ART in Eswatini between January 2018 and December 2021 was conducted. The Statistical Package for Social Scientists version 25 was used to determine the factors associated with viral suppression through bivariate and logistic regression analysis.Results: The prevalence of viral suppression (< 1 000 copies/mL) was 92.9%. After adjusting for all covariates, the likelihood of viral suppression remained significantly higher among YPLHIV who were female (AOR = 2.06; CI 1.04-4.11), had enrolled on the fast-track ART care model (AOR = 2.14; CI 1.09-4.20), and were receiving 4 to 5 months' (AOR = 5.88; CI 3.14-11.02) and 6+ months' (AOR = 3.55; CI 1.67-7.53) of medication.Conclusion: The national HIV treatment program in Eswatini exceeded the UNAIDS target of 90% virologic suppression for YPLHIV who are enrolled for ART for more than six months. However, to meet the revised 95% target, tailored interventions are required to strengthen long-term adherence and retention in care for YPLHIV on ART.
Background: Pre-exposure prophylaxis (PrEP) is recommended as part of a comprehensive HIV prevention approach, but its uptake among women, particularly those in key populations, remains limited.Methods: A mixed-methods community-based study was conducted in Mali, Mauritius, and Morocco to assess barriers and facilitators to PrEP implementation among cis and transgender women at high risk of HIV infection. Quantitative data collected included demographic information, awareness, willingness to use PrEP, and perceived barriers. The qualitative component included in-depth interviews with key populations, policymakers, healthcare workers, and community stakeholders to better determine the barriers to PrEP implementation and scale-up for women. Data analysis and processing were performed using software adapted to the respondent-driven sampling technique.Results: Between 15 February and 15 March, 2020, a survey was conducted involving 1 003 female participants. The results indicated varying levels of awareness of PrEP across different populations, with transgender women in Mauritius exhibiting the highest awareness (54%). Moreover, there was generally a high willingness to use PrEP among participants, with rates of 77% and 84% among female sex workers in Morocco and Mali, respectively, and 71% among female partners of people who inject drugs, as well as 50% among transgender women in Mauritius. Additionally, qualitative insights revealed prevailing barriers such as issues related to accessibility, stigma, and the legal frameworks in the respective countries.Conclusion: This study provides critical insights into the challenges and opportunities for PrEP implementation among women in Mali, Mauritius, and Morocco. The findings underscore the importance of community-based research and the need for tailored interventions to improve PrEP awareness and uptake among women, particularly those in key populations. The results may inform advocacy efforts and the provision of adapted services within comprehensive HIV prevention programs to better address the needs of these populations.
Female university students engaging in high-risk sexual behaviours, such as transactional sex or unprotected sex, are eligible for HIV pre- and post-exposure prophylaxis (PrEP/PEP). This study aimed to determine the uptake and correlates of PEP and PrEP use among female students at a public university in Uganda. We conducted an online survey among 483 female students at Makerere University and found that 53% had ever engaged in sexual intercourse, with a median debut of 20 years (interquartile range 18 to 22 years). Overall, 20% had sex with a person with HIV or of unknown status, and 9% experienced sexual assault. Despite 32% being eligible for PEP and 20% for PrEP, uptake remained low (9% and 2%, respectively). PEP use was associated with being married/cohabiting and perceived HIV risk. Low uptake of PrEP and PEP among eligible female students highlights the need for targeted awareness and accessibility efforts in academic institutions.
Background: HIV self-testing has been introduced as a secondary mode of testing in most countries as a way of counteracting the barriers associated with the traditional clinic-based method of testing. As the entry point into the HIV care cascade, testing signifies a unique contribution in the fight to end HIV by 2030. However, in Uganda, the uptake of self-testing services remains contested, especially in low-skilled communities. Using the health beliefs model constructs of individual beliefs (perceived susceptibility, benefits, and barriers), the current study examined the effect of individual beliefs as a mediating factor between HIV self-testing knowledge and use.Methods: A cross-sectional survey was conducted (July to September of 2023), with a systematic and random sample of 453 unskilled workers from Darling, Wakiso district, Uganda. The data were collected using a structured, validated, self-administered questionnaire. Data were analysed using regression mediation analysis in Process Macro Model 4 in SPSS v27.Results: Perceived susceptibility (β = 0.06, Boot 95% [0.03, 0.10]) and benefits (β = 0.06, Boot 95% [0.24, 0.39]) mediated HIV self-testing knowledge and HIV self-testing use. Perceived barriers (β = 0.01, Boot 95% [0.00, 0.03]) did not mediate HIV self-testing knowledge and HIV self-testing use.Conclusion: In addition to delivering knowledge about self-testing, the benefits of using HIV self-testing and the susceptibility nature of individuals in low-skilled employment should be given more attention as a means to increase HIV self-testing.
