Browsing by Author "Buvé, Anne"

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    Factors influencing social self-disclosure among adolescents living with HIV in Eastern Africa
    (Taylor & Francis., 2015) Nöstlinger, Christiana; Bakeera-Kitaka, Sabrina; Buyze, Jozefien; Loos, Jasna; Buvé, Anne
    Adolescents living with HIV (ALHIV) face many psychosocial challenges, including HIV disclosure to others. Given the importance of socialization during the adolescent transition process, this study investigated the psychological and social factors influencing self-disclosure of own HIV status to peers. We examined social HIV self-disclosure to peers, and its relationship to perceived HIV-related stigma, self-efficacy to disclose, self-esteem, and social support among a sample of n = 582 ALHIV aged 13–17 years in Kampala, Uganda, and Western Kenya. Data were collected between February and April 2011. Among them, 39% were double orphans. We conducted a secondary data analysis to assess the degree of social disclosure, reactions received, and influencing factors. Interviewer-administered questionnaires assessed medical, socio-demographic, and psychological variables (Rosenberg self-esteem scale; self-efficacy to disclose to peers), HIV-related stigma (10-item stigma scale), and social support (family–life and friends). Descriptive, bivariate, and logistic regression analyses were performed with social self-disclosure to peers with gender as covariates. Almost half of ALHIV had told nobody (except health-care providers) about their HIV status, and about 18% had disclosed to either one of their friends, schoolmates, or a boy- or girlfriend. Logistic regression models revealed that having disclosed to peers was significantly related to being older, being a paternal orphan, contributing to family income, regular visits to the HIV clinic, and greater social support through peers. Low self-efficacy to disclose was negatively associated to the outcome variable. While social self-disclosure was linked to individual factors such as self-efficacy, factors relating to the social context and adolescents’ access to psychosocial resources play an important role. ALHIV need safe environments to practice disclosure skills. Interventions should enable them to make optimal use of available psychosocial resources even under constraining conditions such as disruptive family structures.
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    Having sex, becoming somebody: A qualitative study assessing (sexual) identity development of adolescents living with HIV/AIDS
    (Routledge, 2012) Loos, Jasna; Nöstlinger, Christiana; Murungi, Irene; Adipo, Daniel; Amimo, Brenda; Bakeera-Kitaka, Sabrina; Oluoch, Dorothy; Mboi, Phyllis; Wobudeya, Eric; Vandenhoudt, Hilde; Buvé, Anne
    A growing number of adolescents are living with HIV/AIDS. For their well-being and for prevention, age- and culturally appropriate interventions become increasingly important. This qualitative study was conducted as the first step to develop a sexual and reproductive health (SRH) intervention. The study’s objective was to assess the impact of HIV and related contextual conditions on identity formation of adolescents living with HIV/AIDS (ALH) in the domains of physical, cognitive, social, and sexual development. Data were collected using focus group discussions (FGDs). Through HIV care centers in western Kenya and Greater Kampala, Uganda, we recruited 119 ALH aged 10–19 years, 54 of their caregivers, and 55 service providers for 28 FGDs. Following analytic induction principles, data analysis showed that many ALH had grown up in HIV-affected families in poverty. They reported experiencing long histories of illness and HIV-related stigma and discrimination, affecting their self-esteem. The physical changes of puberty, fueled by effective HIV treatment, symbolized a new start in life. The cognitive changes typical for adolescence enhanced their self-esteem, resilience, and belief in the future, particularly among older adolescents. In discovering their new social identity, ALH experimented with behaviors and norms, especially related to sexuality. ALH carefully examined the contrasting sexual norms of their peers, caregivers, and service providers and balanced them when developing their own sexual identity. For many ALH, sex is the way to become a social “somebody.” For some, having sex served to cope with the emotional pains of growing up with HIV. Sexual relationships also enabled some ALH to gain financial and emotional independence. This study shows how ALH’s identity development is influenced by the individual and social consequences of HIV. Multiple factors contribute to the importance that ALH attribute to sexuality, which calls for comprehensive interventions addressing the broader context of positive living and SRH rights.
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    Natural history of Mycoplasma genitalium Infection in a Cohort of Female Sex Workers in Kampala, Uganda
    (Sexually transmitted diseases, 2013) Vandepitte, Judith; Vandepitte, Judith; Weiss, Helen A.; Kyakuwa, Nassim; Nakubulwa, Susan; Muller, Etienne; Buvé, Anne; Van der Stuyft, Patrick; Hayes, Richard; Grosskurth, Heiner
    There have been few studies of the natural history of Mycoplasma genitalium in women. We investigated patterns of clearance and recurrence of untreated M. genitalium infection in a cohort of female sex workers in Uganda. Methods—Women diagnosed as having M. genitalium infection at enrollment were retested for the infection at 3-month intervals. Clearance of infection was defined as testing negative after having a previous positive result: persistence was defined as testing positive after a preceding positive test result, and recurrence as testing positive after a preceding negative test result. Adjusted hazard ratios for M. genitalium clearance were estimated using Cox proportional hazards regression. Results—Among 119 participants infected with M. genitalium at enrollment (prevalence, 14%), 55% had spontaneously cleared the infection within 3 months; 83%, within 6; and 93%, within 12 months. The overall clearance rate was 25.7/100 person-years (pyr; 95% confidence interval, 21.4–31.0). HIV-positive women cleared M. genitalium infection more slowly than did HIVnegative women (20.6/100 pyr vs. 31.3/100 pyr, P = 0.03). The clearance rate was slower among HIV-positive women with CD4 counts less than 350/mL3 than among those with higher CD4 counts (9.88/100 pyr vs. 29.5/100 pyr, P < 0.001). After clearing the infection, M. genitalium infection recurred in 39% women. Conclusions—M. genitalium is likely to persist and recur in the female genital tract. Because of the urogenital tract morbidity caused by the infection and the observed association with HIV acquisition, further research is needed to define screening modalities, especially in populations at high risk for HIV, and to optimize effective and affordable treatment options.
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    Translating primary into ‘positive’ prevention for adolescents in Eastern Africa
    (Oxford, 2015) Nöstlinger, Christiana; Jasna, Loos; Bakeera-kitaka, Sabrina; Obong’o, Christopher; Buvé, Anne; Wobudeya, Eric
    There is an urgent need to develop positive prevention interventions for adolescents living with HIV in high endemic regions. Adapting existing evidence-based interventions for resource-constrained settings is effective when the intervention’s theoretical core elements are preserved while achieving cultural relevance. We describe the process of adapting a primary prevention to a secondary/positive prevention programme for adolescents living with HIV in Kenya and Uganda. The systematic adaptation was guided by the Centers for Diseases Control’s map for the adaptation process, describing an iterative process. The procedure included: assessing the target positive prevention group’s needs (safer sex; fertility-related issues), identifying the potential interventions through a literature review, conducting qualitative adaptation research to identify areas for adaptation by ensuring cultural relevance (revising the intervention logic by adding topics such as adherence; HIV-related stigma; HIVdisclosure; safer sex), pilot-testing the adapted programme and conducting a process evaluation of its first implementation.Areasaddedonto theoriginal intervention’slogicframework,basedonsocialcognitivetheory,thetheoriesofreasonedactionandplannedbehaviourwereinformationandskillsbuilding onsexualrelationshipsandprotectionbehaviour,preventionofverticalHIVtransmission,contraception, HIV-disclosure, HIV-related stigma, HIV-treatment and adherence. The process evaluation using mixed methods showed that we delivered a feasible and acceptable intervention for HIV-positive adolescents aged13–17years. The systematic approach adopted facilitated the development ofacontextualized and developmentally appropriate (i.e. age-specific) intervention for adolescents living with HIV.