Sexual and Reproductive Health and HIV/AIDS

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• Growing old with AIDS

  Brief Description: Despite the important consequences that HIV/AIDS is likely to have for older people in South Africa, very little empirical work has focused directly on this issue. The overall aim of this study is to provide insights into the perspectives and behaviours of older men and women, both infected and affected by HIV/AIDS.  The impact of HIV/AIDS is likely to be substantial and unique and is likely to be compounded by gender.
  Funder: SANPAD

  Staff Members

  • Pranitha Maharaj

• Stalling Contraception

  South Africa has a population of approximately 50 million people and has been one of the first countries in sub-Saharan Africa to experience an overall fertility decline. The total fertility rate declined from 6.0 in the mid-1950s to about 4.3 in the 1980s and is now reported to be 2.4. The decline in fertility is strongly related to rising contraceptive use in South Africa. Contraceptive use in South Africa is relatively high compared to the other sub Saharan African countries. Despite the impressive progress in raising contraceptive use, there are some concerns that use of contraception has either declined or remained stagnant over the past few years especially as much of the focus is now concentrated on reducing the impact of the AIDS epidemic. A study was commission by the Department of Health and UNFPA to better understand the reasons preventing women from using contraception consistently and correctly, or even at all.

  Staff Members

  • Pranitha Maharaj

• Health in a rapidly changing SA

  More than ten years after the end of apartheid in South Africa, some evidence seems to suggest that the health situation of the majority of the population is deteriorating. The overall aim of the study is to offer more insights into the health and perceptions of health of South Africans using a combination of quantitative and qualitative methods. Nationally representative surveys on their own are not able to establish an association between social transformation and health status. As such, it is suggested that combining quantitative and qualitative data allows for an in-depth investigation of social change and health from a variety of angles.
  This research is funded by Medical Research Council and is done in partnership with Linköping University.

  Staff Members

  • Pranitha Maharaj

• The intro of a universal dual prophylaxis PMCT

  Concomitant with the national introduction of the combined Zidovudine (AZT) and Nevirapine (NVP) regimen for pregnant HIV positive women, the KwaZulu Natal Department of Health launched a surveillance of HIV infection rates. A dried blood spot for DNA/RNA PCR was obtained to determine HIV infection among 8030 infants 4 – 8 weeks, brought for first immunization at fixed public primary health care clinics in six districts. This was done with the consent of the parent or legal guardian bringing the infant. 
  While HIV prevalence has been found to be consistently higher in urban areas than in rural areas (UNAIDS 2006) reviews of studies in Africa have highlighted diverse findings in the relationship between HIV and socioeconomic status (Buve, Bishikwabo-Nsarhaza et al. 2002; Mosley 2004; Nyindo 2005; Gillespie, Kadiyala et al. 2007). A recent analysis of DHS data from eight sub-Saharan African countries reporting that women in the wealthiest quintile of households were more likely to be HIV infected than those from the poorest quintile (Mishra, Assche et al. 2007). 
  Despite the differential HIV infection rates among women from districts with varying urban rural populations and socioeconomic profiles, preliminary analysis of this surveillance data showed no differences between these districts in HIV infection rates among infants. In the context of universal availability of free PMTCT services through the public health system in South Africa (Wilkinson, Gouws et al. 2001), other barriers to PMTCT to PMTCT need to be identified. However, most published studies on barriers to PMTCT have been conducted as part of clinical trials or pilot programs, or limited to a small number of purposively selected PMTCT sites rather than operational settings (Delvaux, Elul et al. 2009).   The few conducted in operational settings were for the single dose NVP regimen (Colvin, Chopra et al. 2007; Rollins, Little et al. 2007; Delvaux, Elul et al. 2009).
  The new regimen is more complicated, requiring mothers to take HAART or AZT, ideally from 12 weeks before the birth, and to administer AZT to the baby for at least 7 days. This necessitates that the women return on at least two other occasions to collect their medication, and allow opportunities to monitor for adverse side effects or toxicity (National Department of Health 2008). Given the distance to the clinic and the cost of returning, the geographic area of residence and the economic conditions experienced by the mother are thought to have a greater impact on program implementation than the single drug regimen. Further, the mother’s education may impact on her understanding of the importance of taking and administering the drugs as instructed, while her living conditions may influence her ability to take her medication as a result of a lack of privacy.
  
  This study aims to investigate the impact of geographical area of residence and socioeconomic status on maternal HIV infection, PMTCT services and ultimately on infant HIV infection.
         

  Publications: 

  • Horwood, C., Butler, Lisa M., Vermaak, K., Rollins, N. Haskins,L., Nkosi, L., Neilands, T.B. and Qazi, S. (2010). Disease profile of children under 5 years attending primary health care clinics in a high HIV prevalence setting in South Africa. Tropical Medicine and International Health, 16(1), 42-52
  • Horwood,C.,  Haskins, L., Vermaak, K., Phakathi, S., Subbaye, R. and T. Doherty (2010). Prevention of mother to child transmission of HIV (PMTCT) programme in KwaZulu-Natal, South Africa: an evaluation of PMTCT implementation and integration into routine maternal, child and women’s health services. Tropical Medicine and International Health, 15(9), 992-999

  Staff Members

  • Kerry Vermaak

• Understanding the dynamics of condom negotiation

  In mature generalised HIV epidemics, the majority of new infections occur within marital or cohabiting relationships due to prior infection or infidelity, and the proportion of HIV-discordant couples - where one partner is infected but not the other - can be as high as 20%. However, in contrast to the huge body of research on condom use among young unmarried men and women, the topic of protective behaviour among married couples has been badly neglected by researchers.  The overall aim of the study is to inform policy makers and programme managers by providing insights into the process of behaviour change and guidance for better services and information for married and cohabiting couples. This study is grounded in a conceptual framework that examines the pathways to adopting condom use in stable relationships and builds on the previous study on family planning and sexual behaviour in the era of HIV and STIs, conducted in six east and southern African countries with severe HIV epidemics.  It considers individual, couple, and community level characteristics and condom use and integrates population based quantitative survey with qualitative in-depth interviews to better document the condom use and its determinants in different settings and to shed light on strategies effective for behaviour change.  The project is funded by the World Health Organization.

  Publications: 

  • Maharaj P, Neema S, Cleland J, Busza J, Shah I.(2012) Condom use within marriage: An assessment of changes in South Africa and Uganda. AIDS Care 24(3-4): 444-450.

  Staff Members

  • Pranitha Maharaj