Women's Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa.

Daily oral pre-exposure prophylaxis (PrEP) offers effective HIV prevention. In South Africa, PrEP is publicly available, but use among young women remains low. We explored young women's perceptions of PrEP to inform a gender-focused intervention to promote PrEP uptake. Six focus group discussions and eight in-depth interviews exploring perceptions of PrEP were conducted with forty-six women not using PrEP, ages 18-25, from central Durban. Data were thematically analyzed using a team-based consensus approach. The study was conducted among likely PrEP users: women were highly-educated, with 84.8% enrolled in post-secondary education. Qualitative data revealed intersecting social stigmas related to HIV and women's sexuality. Women feared that daily PrEP pills would be confused with anti-retroviral treatment, creating vulnerability to misplaced HIV stigma. Women also anticipated that taking PrEP could expose them to assumptions of promiscuity from the community. To address these anticipated community-level reactions, women suggested community-facing interventions to reduce the burden on young women considering PrEP. Concerns around PrEP use in this group of urban, educated women reflects layered stigmas that may inhibit future PrEP use. Stigma-reducing strategies, such as media campaigns and educational interventions directed at communities who could benefit from PrEP, should re-frame PrEP as an empowering and responsible choice for young women.

Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24 years in South Africa: results from the 2012 national population-based household survey.

BACKGROUND: Despite a variety of contraceptives being available for women in South Africa, a considerable number of adolescent girls and young women still face challenges in using them. This paper examines socio-demographic and behavioral predictors of using contraceptives among adolescent girls and young women (AGYW) aged 15 to 24 years. METHODS: A secondary data analysis was conducted based on the 2012 population-based nationally representative multi-stage stratified cluster randomised household survey. Multivariate backward stepwise logistic regression model was used to examine socio-demographic and behavioural factors independently associated with contraceptive use amongst AGYW aged 15 to 24 years in South Africa. RESULTS: Out of 1460 AGYW, 78% (CI: 73.9-81.7) reported using some form of contraceptives. In the model, contraceptive use was significantly associated with secondary education [OR = 1.8 (1.2-2.7), p = 0.005], having a sexual partner within 5 years of their age [OR = 1.8 (1.2-2.5), p = 0.002], and sexual debut at age 15 years and older [OR = 2.5 (1.3-4.6), p = 0.006]. The likelihood of association decreased with other race groups-White, Coloured, and Indians/Asians [OR = 0.5 (0.3-0.7), p = 0.001], being married [OR = 0.4 (0.2-0.7), p = 0.001], never given birth [OR = 0.7 (0.5-0.9), p = 0.045], coming from rural informal [OR = 0.5 (0.3-0.9), p = 0.010] and rural formal settlements [OR = 0.5 (0.3-0.9), p = 0.020]. CONCLUSIONS: Evidence suggest that interventions should be tailor-made to meet the needs of AGYW in order to, promote use and access to contraceptives. The results also suggest that family planning interventions should target those who had not given birth in order to reduce unplanned and or unintended pregnancies and associated risk factors. These findings contribute to public health discourse and reproductive health planning for these age groups in the country.

An evaluation of the capillus HIV-1/HIV-2 latex agglutination test using serum and whole blood.

The capillus HIV-1/HIV-2 latex agglutination (LA) test was evaluated for its potential as an initial screening test in primary health care. For the serum study, panels totalling 289 HIV-positive sera and 323 known HIV-negative sera plus 50 individual seroconversion samples were tested by capillus. Paired blood specimens were also collected in heparinized and plain tubes from 501 consecutive patients with newly diagnosed sexually transmitted diseases (STDs) attending an STD clinic at a Transvaal hospital. Overall, an initial sensitivity of 99.3% and an initial specificity of 99.7% were obtained by visual reading of the capillus HIV-1/ HIV-2 LA tests on serum samples. Capillus also detected 40 (80%) of the 50 seroconversion samples. Of the 501 paired plain and heparinized blood specimens, serum testing by enzyme immunoassay (EIA) and indirect immunofluorescence/ Western blot (IFA/WB) showed 147 (29%) to be HIV Ab positive. Capillus testing of the paired specimens correctly identified all 147 known positive patients and 345 of the 346 negative patients, thus showing an initial sensitivity of 100% and an initial specificity of 99.7% for the testing of heparinized whole blood by a relatively unskilled health worker. It was concluded that the capillus HIV-1/HIV-2 LA test would be suitable for use as a primary screening test in small outlying laboratories or primary health care clinics.