The abstracts of the HIV/AIDS research grant winners

Ethiopia

The Challenges and Opportunities of Mainstreaming HIV/AIDS in Higher Education System: What Roles for Tertiary Education?

By Abebe Haile Gabriel

Abstract

Mainstreaming is about integrating a social message into an organization's daily activities. In such endeavor, higher education institutions play a strategic role because: the institutions are centers where future policy makers and advisors are generated; the students are more susceptible; the institutions are situated at a comparative advantage to effectively and systematically respond to the challenges through mainstreaming of HIV/AIDS: Teaching, Research, Outreach programs; the stock of knowledge, skills, networks, resources at the institutions is by far better; and the impacts could be far-reaching. The general objective of the study is to explore the potentials, constraints, and options for mainstreaming HIV/AIDS in higher education institutions. Specifically, the study aims to investigate: the various ways, if any, by which the higher learning institutions have responded or hope to respond to the demands set by the pandemic and their effectiveness; the extent to which HIV/AIDS has been incorporated into the institutions’ curricula and its rationale; the nature of problems faced by the institutions for a comprehensive and proactive mainstreaming of HIV/AIDS into their activities; and alternative options for a systematic mainstreaming of HIV/AIDS in HE systems and implications on: Legal framework, Systems, Structures, and Resources. The methodology consists of data generation techniques, coverage, sampling design and data analysis. The findings are expected to help HEIs and policy makers take proactive stances with regard to HIV/AIDS mainstreaming in Higher Education. 

Viability of Antiretroviral Drug Therapy in Ethiopia

By Abdulhamid Bedri Kello

Abstract

The major hypothesis of this study is that the cost of ARV therapy is prohibitive to be viable as a public health service. The problem is organized around the following issues: HIV/AIDS is perhaps the most serious health threat following the threat of famine, it also complicates the effect of other diseases, reduce viral loads, but expensive drugs, and issues such as possibility of introducing ARV. The objective of the study is to conduct an economic analysis of the possible costs and benefits of triple combination therapy (TCT) with antiretroviral drugs to determine the viability of such a therapy in Ethiopia. The study employs economic and medical variables in a cost/benefit analysis. 

 Social Responses to HIV-Aids in Addis Ababa: Case Studies of Commercial Sex Workers (Csws), People Living With HIV-AIDS (Plwha), and Aids Orphans and Community-Based Burial Associations

By Andargatchew Tesfaye, Ayalew Gebre, Alula Pankhurst

Abstract

HIV-AIDS is the foremost medical problem in Ethiopia (Ethiopia 3rd globally, 3 Million affected 1999). The research growth in the field, however, has mainly been medical, with little social research being done. Yet, the problem is primarily a social problem. Little has been known on local level responses. Thus, the research addresses this gap from three angles: those with highest prevalence (CSWs); those most affected (PLWHA) + AIDS orphans; most concerned CBOS (burial associations), the focus being the synergy between these areas.

The general objective of the study is to develop a better understanding of how the HIV-AIDS epidemic is responded to in Addis Ababa at a local level by four key categories of actors: commercial sex workers, people living with HIV-AIDS, AIDS orphans and community-based burial associations with a view to suggest appropriate strategies and interventions.

Regarding commercial sex workers, the study set out to: understand the changing attitudes and responses of commercial sex workers to the epidemic, in terms of changing behavior patterns; investigate the evidence of the changing ability of commercial sex workers to negotiate for safer sex through the use of condoms; and assess the attempts of commercial sex workers to seek alternative sources of income.

Regarding people living with HIV-AIDS and AIDS orphans, the study sets out to: understand changing attitudes and responses of people living with HIV-AIDS and AIDS orphans and how they come to terms with the epidemic; assess the extent of care and support networks, and evaluate their effectiveness from the point of view of the beneficiaries themselves; and investigate the attempts by PLWHA to resist stigma, assert their rights and form associations to provide mutual assistance to one another

Regarding Iddir Burial Associations, the study sets out to: understand responses of iddir in terms of coping with increased deaths; assess iddirs’ attempts and constraints on providing assistance to people infected and affected by the illness, notably people living with HIV-AIDS and AIDS orphans; and investigate attempts by iddir to form umbrella associations and thereby address the epidemic together.

Regarding Cross-cutting interlinkages, the study sets out to: To assess the opportunities for and constraints on CSW joining associations of PLWHA and burial associations; investigate the extent to which associations of PLWHA and AIDS orphans collaborate with burial associations; and understand attitudes of burial associations towards CSWs, PLWHAs and AIDS orphans and the extent to which they are aware of their special needs.

The study will use SPSS for quantitative and Focus Group Discussions and Case studies for qualitative data analysis. It is expected to provide the policy-makers with evidence about the responses of the above-mentioned key groups.

The Role of Gender Relations and Sexual Negotiation on HIV Risk Awareness and Risky Sexual Behaviors in Ethiopia

By Yared Mekonen, Tsehaynesh Messele, Yetnayet Asfaw, Gugsa Yimer, and Ambaye Degefa

Abstract

In Ethiopia there is in general limited information on the relationship between gender and HIV. In particular, information is lacking on gender relations, discussion and negotiations regarding sex and the term under which sex occurs. In addition, the influence of gender relations and sexual negotiation on the spread of HIV/AIDS is not well established.

The study’s general objective is to systematically investigate the influence of gender relations, power, sexual communication and negotiation on the spread of HIV in Ethiopia.

Specifically, the study sets out to investigate how: men and women communicate about the terms under which sex occurs; this communication varies in different kinds of relationships; and women negotiate the terms of sexual encounters specifically in relation to protective behavior.

Regarding HIV risk awareness and sexual behavior, the study aims at investigating: the general level of men and women’s awareness about HIV/AIDS and STDs; HIV risk awareness in men and women across socio-cultural contexts; and the magnitude of risky sexual behavior in men and women.

With regard to the link between gender relations, sexual negotiations and HIV risk awareness and sexual behavior, the study aims at investigating how: gender relations influence HIV risk awareness and risky sexual behaviors in men and women; and sexual negotiation influences such risks. Cross-sectionally designed, the research method includes Structured Individual Interviews, Focus Group Discussions, and In-depth Key Informant Interviews.   Policy relevance and academic significance of the study lie on generating relevant information that improves the understanding of how gender-related factors influence vulnerability to HIV/AIDS and filling critical gap existing in the design of prevention programmes that can more effectively address the role of gender relations in the spread of HIV/AIDS in the country.

Kenya 

The Challenges of Fosterage of HIV/AIDS Orphans in Nyanza Province, Kenya

By Joram Kareithi , Maurice Kong’ong’o, and Omar Egesah

Abstract

The high HIV/AIDS mortality in Nyanza has resulted into high rate of orphanhood. This calls for the need to systematically understand burden of HIV/AIDS orphan fosterage, and for the need of designing appropriate intervention for orphans and foster institutions. To this end, the study proposes to fill the existing gap in knowledge in coping mechanisms of Kenyan families on the face of burden of HIV/AIDS orphanhood. The study sets out to: examine the socio-cultural and economic situation of AIDS orphans in Nyanza province of Kenya; examine the impact of HIV/AIDS orphan hood on the education of the orphans; and identify the nature and kinds of challenges families/institutions which foster orphans face and the implication on the welfare of the children. Sampling, data collection and analysis include documentary research, focus group discussions, key informant interviews, structured questionnaires, projective techniques, informal discussions, and data analysis using SPSS and QARNUD*IST for quantitative and qualitative data, respectively.

The Magnitude and Impact of HIV/AIDS on the Sugarcane Sub-Sector: A Case of Western Kenya

By Elizabeth Bukusi, Chris Shisanya, Zachary Kwena, and Constance Ambasa 

Abstract

The study’s general objective is to enable an assessment of the magnitude and impact of HIV/AIDS on the sugarcane sub-sector. To this end, it is hoped that the results may provide a basis for formulating a sound policy framework to confront HIV/AIDS in sugarcane sub-sector. Specifically, the study sets out top: assess the magnitude of HIV/AIDS on sugarcane sub-sector; analyze the socio-economic impact of HIV/AIDS-related morbidity and mortality on sugarcane sub-sector; examine the response of sugarcane sub-sector to dysfunctions caused by HIV/AIDS pandemic; and evaluate intervention measure designed to cushion the sub-sector against the impact of HIV/AIDS. The data collection tools will include questionnaire schedules, key informant interviews, and focus group discussions.  Data processing and analysis comprise SPSS and ATLAS.ti to analyse quantitative and qualitative data, respectively. 

Emotional Care of AIDS-Orphaned Children in Kenya

By Hezborn M. N. Kodero 

Abstract

Little is known about emotional care of AIDS Orphans in Africa, and in Kenya. It is hoped that the study will provide information about how well Love and Affection needs of AIDS Orphans are being met by Caregivers in the three types of Residential Destinations.

Thus, the study proposes to fill in the existing gap in knowledge by providing data about the quality of caregiver-orphan relationship in orphanage care in Kenya which will confirm or refute claim that most children face harsh discipline in orphanages. In addition, the study will provide data about the effect of separation of AIDS-orphaned siblings on emotional well-being of AIDS orphans in their residential destinations. Finally, the study will provide data that could be used by policy-makers to enhance the quality of intervention programs geared towards improving emotional well-being of AIDS orphans in their residential destinations.

The study sets out to: investigate how well AIDS orphans meet love and affection needs in residential destinations; examine the relationship between gender and the satisfaction of love and affection needs by AIDS orphans in the residential destinations; and determine whether or not separation of AIDS orphans from siblings during adoption has effect on love and affection the orphans received from caregivers. Both qualitative (interview) and quantitative (ANOVA) research methods will be used in the study.   

HIV Assessment Study in the Private Sector in Kenya

By Philomena Muiruri          

Abstract

The economy is being severely affected by HIV/AIDS because it tends to affect sexually active employees in their prime ages (20-45) and this reduces work performance and productivity.  HIV/AIDS poses a serious economic and social burden for the family and society through greater health costs and loss of incomes as family members engaged in economic activities become less productive and eventually die. The HIV/AIDS epidemic is affecting commercial enterprises productivity and profits. This is through disruption of production due to sick leave, absenteeism, funeral attendance while business costs rise through replacing workers lost to AIDS, medical and funeral expenses. HIV/AIDS is affecting all industries as the epidemic claims some of the best business leaders, managers and a great number of workers at all levels of the production system. National efforts to prevent the spread of HIV/AIDS must be multi-sectoral in nature and include the involvement of private sector businesses. As managers of workplaces, the business community has a critical role to play and can use company resources, creativity, organizational structures, access to communities and investment decisions to aid national AIDS prevention initiatives (UNAIDS, 1999). Many business managers, however, are concerned about the financial cost of HIV/AIDS to their operations and the cost of investing in HIV/AIDS prevention and care programs. The Kenya HIV/AIDS Business Council has taken the lead in promoting the involvement of business communities in the fight against HIV/AIDS. The council, however, is hampered by lack of data on types of responses that can enable it develop a strategy to suit the HIV/AIDS situation in the business sector. The rationale for this study is to come up with a sustainable workplace policy that will enable companies to obtain guidance on how to develop prevention programs and policies that will serve their employees while also assuring the profitable continuation of business.

The general objective of the study is to undertake a situational analysis on the Private Sector’s response to HIV/AIDS challenges in the workplace. Specifically, the study proposes to: measure the responses in the private sector to HIV/AIDS challenges in the workplace in key areas of policy, prevention, care and support; assess the business motivation for investing resources in HIV/AIDS programs; assess the private sector’s involvement in community based programs in the fight against HIV/AIDS; and explore ways of making HIV/AIDS prevention and care a more integral part of companies operations. Because of the diverse nature of business activities, a survey design approach will be employed in the study. The data collection techniques will include a questionnaire, interview guide and focus group discussions (FGDs), and the data analysis procedure will consist of both qualitative and quantitative approaches.

South Africa

Investigating the Impact of the HIV/AIDS Epidemic on Clinics Staff in Two Rural Districts in South Africa

By Uta Lehmann  and Jabulisiwe Victoria Zulu

Abstract

HIV/AIDS has hit health sector human resources in many ways. For instance, it has reduced the sector’s workforce through resignations and attrition resulting from deaths, absenteeism through sickness, or funeral arrangements and attendances. Another impact is through increased workloads due to changing disease patterns, staff attrition and absenteeism, leading to staff demotivation, stress, absenteeism and burn-out syndrome.  The study has three objectives. Firstly, it sets out to describe and examine the impact of the HIVAIDS epidemic on the health workforce in terms of morale through morbidity, mortality, turnover/attrition  and absenteeism, stress, burnout, motivation and, staff numbers and new treatment regimes. Secondly, the study proposes to provide planning data for staffing needs emanating from the introduction of new interventions and strategies. Finally, it sets out to identify skills required and training needs for successful HIV/AIDS management at primary level. Qualitative tools (focus group discussions, in-depth interviews, self-reflection, observations, workshops, document reviews) will be used to investigate staff morale, reasons for absenteeism and attrition, qualitative aspects of workload, tasks and skills profiles, availability of support, supervision and training. The policy relevance of the study lies in the consideration and inclusion of human resources before implementation of any amendment or creation of new policy involving health human resources.

 Living with an HIV+ Caregiver:
An Exploratory Study of the Factors That Impact on Caregiving & Young Children’s Developmental Outcomes

 By Leslie Swartz, Andy Dawes, Greg Hussey, and René Brandt 

Abstract

Research is required to underpin sound psychosocial interventions for young children whose caregivers are infected with HIV/AIDS. The reasons may be that being HIV+ compromises care giving capacity; poor care poses a risk to young children’s psychosocial development; and large numbers of southern African children are at risk resulting in a need for effective low cost interventions to support caregivers. The study sets out to: explore factors that impact on quality of care giving (in poverty environments); determine impact of quality of care giving on developmental outcome; and inform the design of appropriate psychosocial interventions for infected caregivers and other household members. Data analysis involves descriptive statistics, multiple regression analysis and t-test. The study is expected, among other things, to produce an evidence base to design and implement effective psychological interventions for children and caregivers in households affected by HIV/AIDS. Interventions include psychological support for caregivers and other household members. The study is expected to contribute to policy and psychological programming for HIV/AIDS affected households. 

Aids, Poverty and Inequality in South Africa

By  Newman Kwaswo Kusi and E. Nkema Abonta 

Abstract

HIV/AIDS may possibly be the main cause of death in South Africa. Currently, there is a decisive shift in debate from demographic to socio-economic impact of this issue. The government contends with substantial inequality and poverty: economic policies and legislative measures have been used to alleviate poverty and inequality as a post-1994 priority but is yet to devise a coherent strategy in response to HIV/AIDS. The objectives of the study are to: investigate and quantify the link between HIV/AIDS prevalence and poverty and inequality; and determine and quantify precise impact of HIV/AIDS on income inequality given following considerations. This may be warranted because:  infection rates differ by skills class; high-unemployment unskilled category associated with greater morbidity; and anticipated effects of HIV AIDS:  inertia in unemployment rate; increase in poverty and inequality level, and decrease in growth of per capita GDP. 

A Pilot Study of the Impact of HIV/Aids on Income-Earning Urban Household Economies in South Africa: A Township Case Study of Households Where Women Utilize Health Services

By  Veni Naidu 

Abstract

A study of the effects of HIV/AIDS at household level is crucial to an understanding of the impact at the macro economic level.  Individuals who are part of households carry the cost of HIV/AIDS that is not borne by the government, business or other aid organisations.  Households either survive this extra burden or dissolve depending on their economic behaviour.  Women will be vulnerable if one or more of the primary income-earners become infected since the loss of income may lead to reorganisation of the household. 

The central argument of this study is that in order to understand the relationship between adult morbidity and mortality on urban households, it is necessary to analyze the production, consumption, investment and borrowings of household economies. The study conceptualizes the household as a unit of production, consumption, investment and debt.  The overall aim of the study is to develop an economic model of an income-earning South African urban household which contains at least one woman that has utilized a health service and who is infected with HIV/AIDS.  Specifically, the study proposes to: develop a methodology to investigate the impact of HIV/AIDS on such urban household economies; develop an economic model of such an urban household; and contribute to theory and policy debates on the impact of HIV/AIDS on households, specifically urban households where Women utilize health services in South Africa. The research design includes six qualitative focus groups in prime-age adults. Data analysis involves taping interviews, translation and use of Microsoft Excel.  One of the policy implications of the study is that it informs policy decision-makers about the content of HIV/AIDS and reproductive health education including condom usage. 

An Investigation into HIV/AIDS Conditions in South African Informal Settlement Communities: Cases from the Limpopo and Northwest Provinces

By Nana C. Kirk and Hassan Omari Kaya

Abstract

The proposed study seeks to make a comparative assessment of the socio-demographic characteristics of the HIV infected people in the informal sector settlements in two provinces in South Africa: the Limpopo and Northwest Provinces. A sample of 120 males and females will be interviewed; these will be supplemented with qualitative data from FGDs and key informant interviews.

Zimbabwe 

The Social and Economic Impact of HIV/AIDS on Rural Households in Zimbabwe: The Case of Masvingo and Manicaland Provinces

 By Marvellous M. Mhloyi 

Abstract 

Since the first AIDS case in Zimbabwe was reported 1985, the progression of the HIV epidemic has been very rapid, in terms of prevalence and incidence. By 1987, 119 cases had been diagnosed as AIDS, increasing to 202 in 1988 and 1311 by 1989. By 1995, the cumulative number of AIDS since the beginning of the epidemic was estimated to be around 110,000, which rose 320,000 by 1997. On the other had, in 1990, the seroprevalence among the population aged 15 years and over was estimated to be 9.2%.  in 1994, it was 18% and in 1995% it was 19.4%. At present Zimbabwe has the second highest HIV/AIDS prevalence rate in the world, with an estimated 33.7 percent of the adult population reported to be HIV positive (UNAIDS, 2002). Already AIDS claims between 2000 and 6000 lives a week and has left more than 900,000 children orphaned (Maveneka, 2002). It is in this context that this paper proposes to carry to research into the social and economic impact of HIV/AIDS on rural communities in Zimbabwe. 

A lot of HIV/AIDS related research has been undertaken in Zimbabwe main in the areas of prevention, diagnosis and management, with relatively little research on the impact of AIDS at household and community levels. These researches over the past decade or so have taught us a great deal about the epidemiology of HIV/AIDS, especially the extent of the problem in different population groups as well as the contextual and behavioural risk factors that continue to drive the epidemic. it has, however, been commented that while there has been a surfeit on non-intervention linked KABP studies in Zimbabwe, there still remains a need for research focusing on impact of HIV/AIDS on the affected and infected communities. This particular study will help in providing insights in the survival strategies of household infected and affected by HIV/AIDS epidemic. 

The overall objective of this study is to improve the understanding of social and economic consequences of the HIV/AIDS epidemic on family composition, living conditions and coping strategies, with a view to mitigating the impact at household level. Specifically, the study proposes to: examine the impact of increasing morbidity and mortality on production (resource availability and allocation) and consumption patterns (food security, education, health status) in rural communities; examine the mechanisms adopted by households to mitigate these impacts, i.e. identify the nature of a household responses and examination of both their sustainability and potentially adverse knock-on effects (in the medium and long term); identify and characterise households highly vulnerable to the adverse impacts of HIV/AIDS in rural areas; and provide information to generate policy recommendations on form and level of assistance required by seriously affected (and vulnerable households. This would then facilitate effective channelling of available assistance or aid packages by targeting the needy households. 

 The Impact of HIV/AIDS on the Health Sector in Zimbabwe 

By  M.Chimbari and. J.F. Mangoma 

Abstract

Zimbabwe, like most countries in Southern Africa, has one of the devastating HIV epidemics seen to date. According to available information, HIV is thought to have begun to spread rapidly within Zimbabwe in the mid-1980’s with adult HIV prevalence reaching approximately 9% by 1990. The most recent published surveillance figure for Zimbabwe suggest that the national level of HIV prevalence among women attending antenatal clinics increased from 29% in 1997 to 3% in 2000 (Ministry of Health and Child Welfare 2002). Even after adjusting for likely selection bias in sentinel sites, it was estimated that HIV prevalence among adults in Zimbabwe had increased from 25% to 30% during the intervening three year period.

The costs of the epidemic and of the secondary infections exacerbated by HIV infection have overwhelmed health systems in many developing countries, which may find themselves using a major portion of their national health budgets to care for those suffering from AIDS or related opportunistic infections, including tuberculosis. This financial burden on struggling health care systems too often means that other pressing health concerns – infectious diseases, malnutrition, maternal health, child survival, and many more – are neglected. The impact of the HIV epidemic in developing countries on the health systems must be understood in the contest of the critical social and economic problems already experienced by these countries.

The study seeks to assess the impact of HIV/AIDS on the health sector in Zimbabwe. Specifically, the study proposes to: assess the impact of HIV/AIDS on the performance of the health sector; explore the responses of the health systems to the HIV/AIDS challenge; identify the problems and challenges being encountered by the various health system in light of the HIV/AIDS epidemic; explore the impact of the HIV/AIDS epidemic on the health personnel; assess the impact of the National AIDS Trust Fund both at the macro and micro level; assess the experiences and perceptions of the communities about the different health systems in light of the HIV/AIDS epidemic; and make recommendations to the various stakeholders in terms of policies and solutions in tackling the HIV/AIDS epidemic. The study employs both quantitative as well as qualitative methods and critical analysis, and interpretation, statistical analysis, frequencies, means, tests of significance for data analysis. Expected results are to assess the impact of HIV/AIDS on human and resources within the sector and as well as availability of essential hospital materials.  The study will provide useful information for planning human resource development amid HIV/AIDS pandemic, which has and policy relevance.

Girls’ Susceptibility and Vulnerability to HIV/AIDS: The Zimbabwean Case

By Naomi Wekwete and  Nyasha Madzingira 

Abstract

Young people aged 15-24 are particularly vulnerable to HIV infection. UNAIDS estimates that about 11.8 million young people aged 15-24 are living with HIV/AIDS and the United Nations Children’s Fund (UNICEF 2002), estimates that half of the new cases of HIV occur in young people within the ages 15-24. Adolescents are at greater risk of HIV infection because they often practise high-risk sexual behaviours such as having short-term sexual relationships, and it is well documented that they are reluctant to use contraceptives, including condoms. They also tend to have insufficient knowledge and understanding of HIV/AIDS, i.e. their vulnerability to it, how to prevent it and the self–confidence necessary to prevent from such infections. They also face obstacles such as adult related factors (e.g. the negative provider attitudes to access contraceptives) and socio-economic issues, which influence their decision-making with respect to sexual behaviour.

Young women are particularly more vulnerable to HIV than their male counterparts. HIV infection in females is almost five times that found in males in the age group 15-19 years. Female adolescents have a high risk of HIV infection because of early sexual activity, as well as sexual engagement with older men. The 1999 Zimbabwe Demographic and Health Survey shows that 21% of teenagers were mothers or pregnant with their first child, indicating that young women engage in sex early ages. Young women are also at greater risk to HIV infection due to biological and cultural reasons. Gils’ vulnerability to sexual violence and exploitation, lack of access to contraception and reproductive health services, and the inability to negotiate with partners about safe sex compound each other to put young women at risk.

This study is aimed at contributing to an understanding of the complex socio-economic, cultural and psychological contexts in which adolescent girls expose themselves to the risks of HIV/AIDS. These issues will be investigated in a survey of in-and out of schoolgirls and boys aged 10-19 years, in selected rural and urban areas of Zimbabwe.

The general objective of this study is to generate information on girls’ perceptions of susceptibility and vulnerability to HIV/AIDS. This information useful in the formulation of reproductive health policies related to reduction of HIV/AIDS among adolescents.

Specifically, the study sets out to: investigate how adolescent girls perceive the severity of HIV/AIDA, their risk assessment, and their vulnerability to HIV/AIDS; investigate socio-cultural and economic motives of engaging in premarital sexual activity; explore adolescents’ attitudes towards premarital sexual activity, including attitudes towards condoms; asses the relationship between knowledge of HIV/AIDS and sexual behaviour; determine the socio-cultural barriers to adolescent girls’ sexual behaviour, including practising safe sex; and determine adolescent girls’ self-efficacy to effectively perform the required behaviour. The study employs semi-structured interviews, FGDs and key informant interviews. It uses SPSS for quantitative data and DT search for qualitative data.  The expected results include girls’ perceptions of risks of HIV infection and risk assessment from key informants.  This information is useful in the formulation of reproductive health policies aimed at reducing girls’ vulnerability to HIV/AIDS.