Background: Reaching all people with HIV services, including traders in the informal economy, is critical to meeting UNAIDS’ 95-95-95 goals. However, traders prioritise their business over attendance at health facilities. This limits their access to health services. This study explores market traders’ preferences for the potential type and delivery methods of HIV services at Lilongwe Central market. Method: The study used an exploratory qualitative study design in Lilongwe, Malawi. Sixteen in-depth interviews were conducted among traders at Lilongwe Central market between June and September 2022. In the same period, we also conducted four key informant interviews involving three officers responsible for HIV services at the district and council levels, and the market chairman. Results: HIV services preferred by market traders include HIV testing, antiretroviral therapy, condom dispensation, voluntary medical male circumcision and HIV awareness campaigns. These services should be offered daily or when the market is less crowded, and they could be delivered either in the market or a health facility setting. These services can be provided by both lay and health workers, depending on traders’ preferences, and must be integrated with other health services to mitigate unintended HIV status disclosure concerns. Conclusion: The achievement of UNAIDS’ 95-95-95 goals by 2030 requires that HIV services should be available to all those who require them at times and locations that are convenient for them, through providers they have chosen, and provided as either integrated or standalone services depending on the target group's perception of the role of these two models in mitigating stigma. This will necessitate the development of new approaches targeting underserved groups, such as traders in markets.

Objectives: In 2018, the KwaZulu-Natal Department of Health launched the ward-based primary health care outreach teams policy framework which sought to expand the community health worker (CHW) programme’s provision of longitudinal patient support, including human immunodeficiency virus (HIV) services in communities. This study sought to explore the perceptions of outreach team leaders who supervise CHWs on their experiences of providing HIV services in the province. Study design: This was a qualitative, phenomenology study. Methods: Convenience sampling was done to select one outreach team leader from each of the 11 KwaZulu-Natal health districts to be interviewed using an interview guide. Thematic analysis, guided by the Ritchie and Spencer framework analysis, was used to analyse the data. Results: The challenges faced by CHWs in delivering HIV services were: the absence of individuals when CHWs visited their homes, self-HIV stigma, rejection of CHWs’ HIV services due to traditional beliefs, CHW shortages, lack of other resources, low levels of CWH education and a lack of training. On the other hand, the provision of HIV services was fascilitated by: supportive supervision, training, having cell phones and having a positive attitude towards providing HIV services by CHWs that were HIV-positive. Conclusion: The CHWs in KwaZulu-Natal face more challenges than enablers in the provision of HIV services. The delegation of HIV services to CHWs should be aligned with their holistic empowerment by eliminating barriers to the provision of HIV services.

The HIV infection rate is higher among adolescent girls and young women (AGYW) in Africa than men in the same age range. Pre-exposure prophylaxis (PrEP) can be used by women discreetly; however, for most AGYW, male partner approval is desired. We explored PrEP use in the context of relationship violence and power dynamics through focus group discussions and support club sessions with AGYW, in-depth interviews and male sensitisation sessions with male partners of AGYW, and joint sessions with AGYW and their male partners. Many male partners reported hesitancy in supporting partner’s PrEP use without sufficient information; most of these became supportive following their engagement in study activities; and most preferred participation in decisions around PrEP use. For AGYW, male involvement minimised partner violence around their PrEP use. The findings support the need for correct PrEP information to be provided to male partners of AGYW and to involve them early on, in decision-making about PrEP use. This is likely to improve uptake of and adherence to PrEP.

Aim: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors. Methods: This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between june and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis. Results: Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19–5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28–8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47–32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services. Conclusions: The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.

Initial and subsequent waves of COVID-19 in Uganda disrupted the delivery of HIV care. In rural areas, village health teams and organisations on the ground had to develop strategies to ensure that people living with HIV could continue their treatment. It was necessary to take evolving circumstances into account, including dealing with movement restrictions, constrained access to food and stigma due to anonymity being lost as a result of a shift from health facility-based services to community-level support. Uganda has a long history of community-driven response to HIV, although health systems and response programming have become more centralised through government and donors to address political commitments to HIV treatment and other targets. The delivery system for antiretroviral therapy was vulnerable to the impacts of COVID-19 restrictions and related circumstances. To understand the continuum of challenges, and to inform ongoing and future support of treatment for people living with HIV, interviews were conducted with HIV organisation implementers, health workers, village health team members and people living with HIV. It was found that stigma was a central challenge, which led to nuanced adaptations for delivering antiretroviral treatment. There is a need to strengthen support to households of people living with HIV through improving community capacity to manage crises through improving household food gardens and savings, as well as capacity to organise and interact with support systems such as the village health teams. In communities, there is a need to evoke dialogue on stigma and to support community leadership on pressing issues that affect communities as a whole and their vulnerable groups. There are opportunities to reawaken the grassroots civic response systems that were evident in Uganda’s early response to HIV yet were lacking in the COVID-19 context.

Aim: Even though Eswatini was the first country in Africa to achieve the UNAIDS 95-95-95 targets among people living with HIV nationally, youth aged 15–24 years lag behind in HIV testing. This study determined the overall prevalence of HIV testing among the youth and the factors associated with HIV testing. Methods: Data were analysed for 1 834 young people from the 2016–2017 Swaziland HIV Incidence Measurement Survey (SHIMS2) using multivariable logistic regression. Results: Overall, 66% of the young people had tested for HIV in the past 12 months before SHIMS2. Lower odds of HIV testing were observed among males, among those aged 15–17 years, the never married/cohabited, those with primary and secondary education, and among those who had high perceived stigma towards people living with HIV and AIDS. Youth from households classified in the poor and middle quintiles had higher odds of testing for HIV compared to those from rich households. Conclusion: Efforts to increase HIV testing should consider the sociodemographic and behavioural factors identified as determinants of HIV non-testing in this age group.

Studies show that increased knowledge of the human immunodeficiency virus (HIV) is achieved through exposure to mass media, which then contributes to positive attitudes and behaviours towards people living with HIV and acquired immune deficiency syndrome (AIDS). This study examined the relationship between the frequency of exposure to the media and the level of HIV-related knowledge and stigmatising attitudes towards HIV and AIDS among adults in Ghana. A weighted sample of 13 484 men and women 15 to 59 years old took part in the study. The main outcome variable was the HIV-related knowledge score, calculated based on responses to eight questions about general HIV concepts and HIV transmission modes. The frequency of exposure to the media was the primary explanatory variable. The relationship between the frequency of media exposure and the level of HIV-related knowledge was investigated using Poisson regression methods in Stata 13.0. Of the 13 484 respondents analysed, 25%, 88.2% and 79.7% reported reading print media, listening to the radio and watching TV at least once a week respectively. The average HIV-related knowledge score was 4.9 (SD 1.6), with 22.9% of respondents correctly answering five questions and about 2.0% correctly answering all eight questions. The frequency of exposure to the media, particularly print media and television, was associated with an increase in the level of HIV-related knowledge. When compared to having a low level of HIV-related knowledge, having a moderate and high level of HIV-related knowledge reduced the score of stigmatising attitude by 0.065 and 0.277 points, respectively. The adult population in Ghana has a very low level of HIV or AIDS knowledge, as well as a significant level of stigma associated with HIV or AIDS, which could stymie HIV prevention efforts. The media, on the other hand, provide a platform for these issues to be addressed.

HIV and AIDS has developed as one of the urgent problems affecting many youths in Africa. Yet many of the knowledge and awareness programmes aimed at young people do not target high schools where the majority of young people are found. As a result, many youths do not have accurate information on HIV and AIDS that they can use to protect themselves from the disease. The objectives of this study were to determine the knowledge and awareness of Sixth Form students regarding the spread of HIV and AIDS among young people. A study was carried out among Sixth Form students in three schools in Harare from October 2017 to November 2017. A total of 156 students participated in the survey. Results showed that most students (74%) obtained their information on HIV and AIDS from television and radio programmes. Most students (92%) were able to identify unprotected sexual intercourse as the major mode of HIV transmission, while 89% said that HIV could be transmitted through sharing injections. Some students had misconceptions about HIV and AIDS which might negatively influence their behaviour and attitude towards HIV and AIDS, for example, 11% of students said HIV and AIDS could be cured. The study concludes that programmes on awareness and knowledge application in schools are limited, and efforts should be increased to help students effectively apply the knowledge they have about HIV and AIDS in everyday life situations, and protect themselves from the disease.

Barriers to treatment faced by people living with HIV (PLWH) have been well explored in the literature. Despite the importance of antiretroviral therapy (ART) in the treatment of HIV and prevention of AIDS, in the Ghanaian context only about 32% of infected persons have access to treatment. This underscores a need to understand the experiences of PLWH receiving ART to provide baseline information for policymakers’ efforts to increase access to treatment. This study captures the voices of PLWH who were receiving ART in Ghana. A total of 35 participants receiving treatment in a hospital setting (11 males, 24 females; mean age 38 years, age range 21–60 years) took part in semi-structured face-to-face interviews to discuss their opinions about the cause of their HIV infection and its impact on their lives. The study found that the participants were susceptible to discrimination in their communities and at health care facilities. Some participants experienced marriage breakdowns, unemployment, social isolation, and were unable to perform everyday chores and responsibilities. Concerted efforts to address the barriers to treatment faced by PLWH are needed.

Aim: Alcohol consumption contributes to a significant burden of illnesses, health conditions and premature deaths globally. There is limited knowledge of alcohol consumption among people living with HIV (PLWH) in Eswatini. This study sought to determine the prevalence, and examine the sociodemographic determinants of alcohol consumption among adult people living with HIV in Eswatini. Methods: Using the Swaziland HIV Incidence Measurement Survey 2, a recent national representative cross-sectional survey conducted in Eswatini between August 2016 and March 2017, a subsample of 2 832 adults (aged 18 and older) living with HIV was extracted. Multinomial logistic regression was used to assess the sociodemographic factors associated with alcohol consumption (i.e. use or misuse). Results: The prevalence of alcohol misuse (hazardous drinking) was 10.9% (23% male v 4.5% female), whereas alcohol use (moderate drinking) was estimated at 8.5% (14.7% male v 5.2% female). Men were more likely to engage in alcohol use (adjusted relative risk ratio [aRRR] = 3.46 [95% CI 3.46–6.62]) and misuse (aRRR = 6.12 [95% CI 6.12–11.47]) than females. Those who reported HIV stigma had a higher likelihood of alcohol misuse compared to those who did not report HIV stigma (aRRR = 1.43 [95% CI 1.04–1.98]). Conclusion: Our findings highlight a notable prevalence of alcohol use or misuse among PLWH in Eswatini. Males, those with no education, never married and those who reported HIV stigma were more likely to report alcohol misuse. The study thus recommends innovative policies and strategies to curb alcohol-related harm in the Eswatini population, specifically among PLWH.