RESUMO
BACKGROUND: Home based HIV testing and counseling (HBTC) increases access to services and is associated with high testing uptake. Alongside testing, individuals are offered HIV prevention messages with an aim of helping them reduce HIV high risk sexual behaviors. This study explored the level of provision and subsequent utilization of HIV prevention messages and associated change in behavior among individuals who had received HBTC previously in an informal settlement. METHODS: In a mixed method cross sectional study, we interviewed 1257 individuals and conducted 6 focus group discussions (FGD). Multiple correspondence analysis (MCA) was used to construct provision of prevention messages and behavior change indices using STATA 3.0. Pearson's chi-square statistics was used to test for bivariate association between the outcomes and logistic regression analysis was carried out with the behavior change index as the outcome of interest and the predictors considered significant (p<0.1). Thematic content analysis for qualitative data was done using Atlas 3.0. RESULTS: Out of the 1257participants, 1078 (85.8%) had ever tested for HIV, with 74.2% having tested in the Kibera HBTC program. Nearly all (97.4%) rated HBTC experience as either excellent (62.4%) or good (37%) and would recommend it to a friend. Provision of prevention messages was high among HBTC clients compared to clients from other testing sites; partner reduction counselling (64% versus 52%) and faithfulness (78.3% versus 67%); p=0.001. Self-reported behavior change after HBTC was generally low with condom use at 10.7% and men more likely to practice safer sex (p = 0.002). Trust of the sexual partners and fear of suspicion were the main reasons given for not using condoms. Clients testing HIV positive after previous negative result were 3.4%. The focus group discussions reported multiple sexual partnerships among both HIV negative and positive residents alike. CONCLUSION: Although prevention messages delivered during HBTC are accepted and appreciated in this community, their utilization is low in both HIV negative and positive individuals. Innovative strategies for change of normative beliefs about sexual behavior are urgently needed.
RESUMO
Maize (Zea mays) is a major staple food in Africa. However, maize production is severely reduced by damage caused by feeding lepidopteran pests. In East and Southern Africa, Chilo partellus is one of the most damaging cereal stem borers mainly found in the warmer lowland areas. In this study, it was hypothesized that the future distribution and abundance of C. partellus may be affected greatly by the current global warming. The temperature-dependent population growth potential of C. partellus was studied on artificial diet under laboratory conditions at six constant temperatures (15, 18, 20, 25, 28, 30, 32 and 35 °C), relative humidity of 75±5% and a photoperiod of L12:L12 h. Several non-linear models were fitted to the data to model development time, mortality and reproduction of the insect species. Cohort updating algorithm and rate summation approach were stochastically used for simulating age and stage structure populations and generate life-table parameters. For spatial analysis of the pest risk, three generic risk indices (index of establishment, generation number and activity index) were visualized in the geographical information system component of the advanced Insect Life Cycle modeling (ILCYM) software. To predict the future distribution of C. partellus we used the climate change scenario A1B obtained from WorldClim and CCAFS databases. The maps were compared with available data on the current distribution of C. partellus in Kenya. The results show that the development times of the different stages decreased with increasing temperatures ranging from 18 to 35 °C; at the extreme temperatures, 15 and 38 °C, no egg could hatch and no larvae completed development. The study concludes that C. partellus may potentially expands its range into higher altitude areas, highland tropics and moist transitional regions, with the highest maize potential where the species has not been recorded yet. This has serious implication in terms of food security since these areas produce approximately 80% of the total maize in East Africa.