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Background: Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. Objectives: Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. Methods: A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. Results: At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. Conclusion: Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used. Trial Registration: Pan African Clinical Trials Registry [ABSTRACT FROM AUTHOR]

Introduction: The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators. Methods: This was a mixed methods study that used both quantitative and qualitative data collection methods. It was implemented in five sub-counties and one town council in Kibuku district in Uganda. Data was collected through 17 key informant interviews and 10 focus group discussions as well as CSC scoring and stakeholder meeting reports. The repeated measures ANOVA test was used to test for statistical significance. Qualitative data was analyzed manually using content analysis. The analysis about the change pathways was guided by the Wild and Harris dimensions of change framework. Results: There was an overall improvement in the common indicators across sub-counties in the project area between the 1st and 5th round scores. Almost all the red scores had changed to green or yellow by round five except for availability of drugs and mothers attending Antenatal care (ANC) in the first trimester. There were statistically significant differences in mean scores for men escorting their wives for ante natal care (ANC) (F(4,20) = 5.45, P = 0.01), availability of midwives (F(4,16) =5.77, P < 0.01), availability of delivery beds (F(4,12) =9.00, P < 0.01) and mothers delivering from traditional birth attendants (TBAs), F(4,16) = 3.86, p = 0.02). The qualitative findings suggest that strengthening of citizens' demand, availability of resources through collaborative problem solving, increased awareness about targeted maternal health services and increased top down performance pressure contributed to positive changes as perceived by community members and their leaders. Conclusions and recommendations: The community score cards created opportunities for community leaders and communities to work together to identify innovative ways of dealing with the health service delivery and utilization challenges that they face. Local leaders should encourage the availability of safe spaces for dialogue between communities, health workers and leaders where performance and utilization challenges can be identified and solutions proposed and implemented jointly. [ABSTRACT FROM AUTHOR]

Aims: To describe nurses' perceptions of family nursing practice and to explore the influence of their perceptions of the benefits, barriers and activities of family engagement in care on family nursing practice. Design: A cross‐sectional correlational study. Methods: In total, 460 nurses from two tertiary hospitals in the central region of Uganda participated. Quantitative and qualitative data were collected between August 2020 and January 2021 using the Family Nursing Practice Scale. Analyses included descriptive statistics, t‐test, Pearson correlation, analysis of variance and ordinal logistics regression. Quantitative content analysis was carried out on the textual data. Results: Nurses who perceived that family engagement in care improves patient and family outcomes were more likely to rate family nursing practice highly. Perceived barriers to family engagement in care particularly time constraints, work overload and family‐related conflicts have a negative and significant influence on family nursing practice. Nurse characteristics such as education, usual shift pattern and personal experience of having a family member in hospital are significantly associated with family nursing practice; nurses who work morning shifts were likely to report higher family nursing practice. Conclusion: The study reveals that several parameters (perceived barriers, perceived benefits and nurse characteristics) influence nursing practice with families. Thus, bearing in mind the diversity of healthcare contexts, the findings show that multiple interacting factors are important for advancing family nursing interventions and practice. Impact: Probabilistic factor‐specific predictions of nursing practice with families are provided in this study – this addresses a gap in the evidence regarding the elements that should be optimized when designing well‐informed policies and interventions to advance family nursing practice. A comparison of results in the literature with the present study's findings suggests a need to broaden the scope and context perspective in future research and broaden the understanding of how nurses´ perceptions influence family engagement in care. Reporting method: The study adheres to the STROBE reporting guidelines. Patient or public contribution: Family members/caregivers were involved in the design of the study particularly in assessment of validation of the tools used in the study. [ABSTRACT FROM AUTHOR]

This paper defines the range of sexual partners chosen by out-of-school adolescents from Masaka District in rural south-west Uganda, and implications for sexual and reproductive health discussed. Data are drawn from a sexual health needs assessment using applied anthropological techniques with 31 adolescents, their parents, guardians and community leaders. Data were analysed using inductive thematic methods. Out-of-school adolescents are exposed to risk both stable and casual sexual relationships. Young men and women want a stable relationship with one reliable partner. Young men seek a 'steady' relationship with younger schoolgirls; some also seek multiple 'casual' relationships with young women easily convinced with gifts. Young women accept 'permanent' partnerships with traders or transport workers one-three years older than themselves; some accept 'casual' relationship with age mates, others have 'casual' relationships with older men. All relationships involve the exchange of gifts and money. Older partners, or 'sugar daddies', are valued, despite the knowledge they are more likely to be HIV positive, because they offer greater financial rewards than age mates. Though far less common, some older women seek relationships with younger men, but are treated with suspicion by young men, who believe they are seeking to 'infect' them 'maliciously' with AIDS. The community sees these relationships as a source of AIDS in adolescents, and condemn older men, whom they believe to be 'killing' the younger generation. Both young men and women are exposure to sexual health risk in their primary partnerships; young men in partnerships with schoolgirls who have concurrent partnerships with older men, unlikely to use condoms and young women with partners who work, and have casual relationships in urban trading centres. Health promotion encouraging partnership with age mates, discouraging sex with older partners and 100% condom use before marriage are most appropriate for out-of-school adolescents in this context. [ABSTRACT FROM AUTHOR]

Background Increasing interest is concentrating in the investigation of whether socioeconomic interventions yield results for children in the area of protection. AVSI Foundation, in Uganda, leads a consortium implementing the “Sustainable, Comprehensive Responses for Vulnerable Children and their Families” (SCORE) Project. The project targets 25,000 moderately and critically vulnerable households in Uganda and addresses them through a multisectoral intervention package encompassing socio-economic, food security, protection and family strengthening. Data from SCORE's monitoring and evaluation system and the mid-term assessment has become available and is used to investigate the topic. Objective This paper contributes original data and analysis to the discussion of socioeconomic strategies for vulnerability reduction and protection of children. Methods Statistical analysis of Village Savings and Loan Association Management Information System (VSLA MIS) data from 741 VSLAs was supported by the SCORE Project between 2012 and 2013. Statistical analysis of SCORE Vulnerability Assessment Tool (VAT) data covering 13,327 beneficiary households enrolled by SCORE in its first phase (last quarter 2011–first quarter 2012) and corresponding second assessment (second quarter 2013). Data analysis was carried out using Statistical Package for Social Sciences (SPSS). Results Between 2011 and 2012, SCORE supported the establishment of 743 Village Savings and Loan Associations (VSLAs), with a total membership of 20,818. Total saving stands at 1,113,185,960 Uganda Shillings. Saving and loans per capita are at 53,754 and 50,093 Uganda Shillings respectively, with regional variation (ranging 33,008–83,073 for savings, and 24,005–93,280 for lending). The overall loan to saving ratio is at 84.45%, with regional variation and range 60.83%–97.97%. Vulnerability data concerning the protection for 13,326 households supported by SCORE shows a reduction by 52%, with regional variation (range 42%–71%). Conclusion Results show that the VSLA approach can be used, besides community development, for direct vulnerability reduction strategies. VSLA approach can be made more inclusive of the most disenfranchised members of the community without losing in efficiency or effectiveness. SCORE Project data is highly suggestive of a positive linkage between socioeconomic interventions and protection outcomes, thereby reinforcing the current literature. More detailed analysis of SCORE databases may allow further understanding of the pathways linking the two result dimensions. [ABSTRACT FROM AUTHOR]

Protected areas are employed worldwide as a means of conserving biodiversity. Unfortunately, restricting access to such areas imposes opportunity costs on local people who have traditionally relied on them to obtain resources such as fuelwood and bushmeat. We use contingent valuation to estimate the local benefits forgone from loss of access to a number of protected area types in Uganda. Methodologically, we innovate by implementing a "provision point mechanism to estimate willingness to accept compensation (WTA) for loss of access to protected areas. We show that the provision point reduces mean WTA by a significant degree. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: The study was done to establish medicinal plants used in the treatment of various diseases by the people in the Northern sector of Kibale National Park in western Uganda. It was also aimed at establishing the plant parts used and the mode of preparation of remedies. These plants create a basis for phytochemical evaluation which can lead to the discovery of biologically active compounds that can be used as starting materials in the development of new drugs targeting selected diseases such as malaria. Materials and methods: The required information was obtained using open interviews, semi-structured questionnaires, focus group discussions and transect walks. Results: Different medicinal plants (131 species) distributed over 55 families were observed to be used by the local communities around the Northern sector of Kibale National Park. The plants as reported in this paper are used to treat 43 physical illnesses/diseases. The most used parts of the plants are the leaves. Water is the main medium used for the preparation of the remedies which are mostly administered orally. Conclusion: The people in the study area have a rich heritage of traditional plants that are used in the health care system to treat diseases. These medicinal plants have contributed significantly to several disease therapies. The most common diseases treated are malaria and cough, which are mostly treated by Vernonia amygdalina Del. and Albizia coriaria Welw. respectively. The main sources of medicinal plants include bush land, home gardens, grasslands, and the forest. [Copyright &y& Elsevier]

Background.: Annona muricata and Khaya grandifoliola are ethnomedicinally used for the treatment of malaria and have been experimentally shown to have an anti-plasmodial effect, but the mechanisms involved are not fully understood. This study investigated the effect of the ethanol extracts of their leaves on parasitemia, radical scavenging and cytokines in Plasmodium berghei ANKA-infected BALB/c mice. Methods.: BALB/c mice were infected with P. berghei and treated with chloroquine, A. muricata or K. grandifoliola extract for 4 days. The percentage of parasitemia and the level of cytokine expression were determined after treatment. Trace element, phytochemical and nitric oxide (NO) scavenging activity, 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging properties assays were done to study the antioxidant effects of AN and KG in vitro. Results.: P. berghei consistently increased parasitemia in BALB/c mice. The tested doses (100-, 200-, and 400 mg/kg) of A. muricata and K. grandifoliola attenuated the P. berghei -induced elevation of parasitemia and cytokines (TNF-α, IL-5, and IL-6) in vivo during the experimental period, though not as much as chloroquine. Moreover, both extracts scavenged the DPPH and NO radicals, though A. muricata had more anti-oxidant effect than K. grandifoliola in-vitro. Conclusion.: The ethanol extracts of A. muricata and K. grandifoliola reduce parasitemia in P. berghei -treated mice BALB/c by scavenging free radicals and reducing cytokines, though the extracts were not as effective as chloroquine. [ABSTRACT FROM AUTHOR]

As global mental health research and programming proliferate, research that prioritizes women's voices and examines marginalized women's mental health outcomes in relation to exposure to violence at community and relational levels of the socioecological model is needed. In a mixed methods, transnational study, we examined armed conflict exposure, intimate partner violence (IPV), and depressive symptoms among 605 women in Northeastern Uganda. We used analysis of variance to test between groups of women who had experienced no IPV or armed conflict, IPV only, armed conflict only, and both; and linear regression to predict depressive symptoms. We used rapid ethnographic methods with a subsample (n = 21) to identify problem prioritization; and, to characterize women's mental health experiences, we conducted follow up in-depth interviews (n = 15), which we analyzed with grounded theory methods. Thirty percent of the sample met the cut-off for probable major depressive disorder; women exposed to both IPV and armed conflict had significantly higher rates of depression than all other groups. While women attributed psychological symptoms primarily to IPV exposure, both past-year IPV and exposure to armed conflict were significantly associated with depressive symptoms. Women identified socioeconomic neglect as having the most impact and described three interrelated mental health experiences that contribute to thoughts of escape, including escape through suicide. Policy efforts should be interprofessional, and specialists should collaborate to advance multi-pronged interventions and gender-informed implementation strategies for women's wellbeing. Additional online materials for this article are available on PWQ's website at http://journals.sagepub.com/doi/suppl/10.1177/0361684319864366 [ABSTRACT FROM AUTHOR]

Background: While pelvic floor ultrasound is commonly utilised in high‐resource locations, our understanding of pelvic floor characteristics in women suffering with obstetric fistula and unrepaired fourth degree obstetric tears in low‐resource areas is limited. Aims: This study aimed to assess the pelvic floor ultrasound characteristics of Ugandan women suffering with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse, and determine whether obstructed labour resulting in obstetric fistula causes more levator muscle defects compared to parous women without a history of obstructed labour. Materials and Methods: This was a prospective study in western Uganda assessing 82 women with obstetric fistula, unrepaired fourth degree obstetric tears and pelvic organ prolapse with a pelvic floor ultrasound scan. Results: Demographic characteristics were significantly different, with women suffering pelvic organ prolapse being older and more parous. Hiatal area on Valsalva was significantly smaller in the obstetric fistula group (mean 21.45 cm2) compared to non‐obstetric fistula group (unrepaired fourth degree obstetric tears and pelvic organ prolapse; mean 30.44 cm2); a mean difference of 9.0 cm2 (95% CI: 5.4–12.6 cm2, P < 0.001). Overall, levator muscle defects were significantly more common in women with obstetric fistula (66.7%) compared to the non‐obstetric fistula group (44.7%) with P = 0.048; however, there were no significant differences in complete levator muscle defects between obstetric fistula (28.6%) and non‐obstetric fistula (23.7%). Conclusions: Increased hiatal area on Valsalva was noted in the non‐obstetric fistula group compared to women with obstetric fistula; however, there were no differences in proportions of complete levator muscle defects. [ABSTRACT FROM AUTHOR]

Background: Despite the conventional approaches to HIV prevention being the bedrock for early reductions in HIV infections in Uganda, innovations that demonstrate reduction in risk to infection in vulnerable populations need to be embraced urgently. In the past 2 years, a USAID-funded project tested a quality improvement for behavior change model (QBC) to address barriers to behavioral change among adolescent girls and young women (AGYW) at high risk of HIV infection. The model comprised skills building to improve ability of AGYW to stop risky behavior; setting up and empowering community quality improvement (QI) teams to mobilize community resources to support AGYW to stop risky behavior; and service delivery camps to provide HIV prevention services and commodities to AGYW and other community members. Methods: We recruited and followed a cohort of 409 AGYW at high risk of HIV infection over a 2-year period to examine the effect of the QBC model on risky behaviors. High-risk behavior was defined to include transactional sex, having multiple sexual partners, and non-use of condoms in high-risk sex. We documented unique experiences over the period to assess the effect of QBC model in reducing risky behavior. We analyzed for variances in risk factors over time using repeated measures ANOVA. Results: There were statistically significant declines in high-risk behavior among AGYW over the QBC roll-out period (p < 0.05). Univariate analysis indicated reduction in AGYW reporting multiple sexual partners from 16.6% at baseline to 3.2% at follow up and transactional sex from 13.2 to 3.6%. The proportion of AGYW experiencing sexual and other forms of gender based violence reduced from 49% a baseline to 19.5% at follow up due to the complementary targeting of parents and partners by QI teams. Conclusion: The QBC model is appropriate for the context of northern Uganda because it provides a framework for the community to successfully drive HIV prevention efforts and therefore is recommended as a model for HIV prevention in high-risk groups. [ABSTRACT FROM AUTHOR]

HIV disclosure is a gateway to HIV prevention – particularly among couples living in regions severely affected by the HIV epidemic. This cross-sectional study utilizes data collected from 862 people living with HIV across three countries (Ethiopia, Mozambique, and Uganda) in 2011 to determine the role of partner disclosure on self-reported health perceptions and changes in sexual risk behavior. The study's secondary aims are to understand whether or not internalized stigma mediates this relationship and if there is a different pattern of results by gender. The multivariate analysis reveals that the three key HIV-related independent variables, belonging to a support group, doing volunteer work, and disclosing to one's spouse or partner, were significantly associated with lower levels of internalized stigma. Internalized stigma was associated with self-perceptions of poorer health for both women and men, with women reporting higher levels of internalized stigma than men. Disclosure to spouse was positively associated with perceptions of better health for women but not for men. For men, doing HIV-related volunteer work and disclosing their status to their spouse were positively associated with self-reported changes in sexual risk behavior, although stigma was not found to mediate this relationship. Findings from this study suggest that disclosure and stigma have gender-specific effects on individual well-being and changes in sexual risk behaviors. As such, programs must address gender inequity in disclosure patterns and stigma to enhance prevention efforts. [ABSTRACT FROM AUTHOR]

In recent years, discussion about the financial capability of rural households has increased. Although studies have conceptualized what financial capability means, there is a dearth of empirical evidence that addresses how the different components of financial capability interact to improve savings outcomes, especially in rural households in sub-Saharan Africa. In this article, the authors use data from an asset-building project in Masindi, Uganda, and a multilevel logistic regression approach to model the likelihood of households contributing to a savings account in a bank. The advantage of a multilevel modeling approach is that it will allow for understanding how contextual factors, such as proximity to the bank and the presence of informal savings mechanisms, affect how households save. Findings suggest that community characteristics affect rural households' financial capability. The study also shows that financial education and the existence of informal savings groups are associated with the households' saving behaviors and that internal and external factors are important in shaping them. The implications of the findings and the importance of using the correct method of analysis are discussed. [ABSTRACT FROM PUBLISHER]

Task shifting to community health workers (CHW) has received recognition. We examined the performance of community antiretroviral therapy and tuberculosis treatment supporters (CATTS) in scaling up antiretroviral therapy (ART) in Reach Out, a community-based ART program in Uganda. Retrospective data on home visits made by CATTS were analyzed to examine the CATTS ability to perform home visits to patients based on the model's standard procedures. Qualitative interviews conducted with 347 randomly selected patients and 47 CATTS explored their satisfaction with the model. The CATTS ability to follow-up with patients worsened from patients requiring daily, weekly, monthly, to three-monthly home visits. Only 26% and 15% of them correctly home visited patients with drug side effects and a missed clinic appointment, respectively. Additionally, 83% visited stable pre-ART and ART patients (96%) more frequently than required. Six hundred eighty of the 3650 (18%) patients were lost to follow-up (LTFU) during the study period. The mean number of patients LTFU per CATTS was 40.5. Male ( p=0.005), worked for longer durations ( p=0.02), and had lower education ( p=0.005). An increased number of patients ( p=0.01) were associated with increased LTFU. Ninety-two percent of the CATTS felt the model could be improved by reducing the workload. CATTS who were HIV positive, female, not residing in the same village as their patients, more educated, married, on ART, and spent less time with the patients were rated better by their patients. The Reach-Out CHW model is labor-intensive. Triaged home visits could improve performance and allow CATTS time to focus on patients requiring more intensive follow-up. [ABSTRACT FROM AUTHOR]

The increase in cell phone use has manifested a growing interest in using this technology for health promotion. The portability and ‘always on’ features of the cell phone, along with increasing capability for the devices to carry and transfer data suggest that they will reach more people than computers and the Internet in coming years. Self-reported quantitative survey data from 1503 secondary school students in Mbarara, Uganda collected in 2008–2009 suggest that 27% currently have cell phones and about half (51%) of all students and 61% of those who owned a cell phone believe that they would access a text messaging-based HIV prevention program if it were available. Other forms of program delivery modality (e.g. Internet, religious organizations, schools) were preferred to text messaging however. We are in need of effective HIV prevention programs that can reach large audiences at low cost and are culturally relevant for the East African context. Researchers are encouraged to consider translation of effective HIV prevention programs for cell phone delivery in Africa. [ABSTRACT FROM PUBLISHER]

Ecological sanitation (Ecosan) is a relatively new concept being promoted in many developing countries to improve sanitation coverage and recycle nutrients in excreta for agricultural production. We conducted a cross-sectional study in Kabale municipality, western Uganda to determine the coverage of Ecosan and factors affecting its uptake. A total of 806 respondents were interviewed, randomly selected from 32 of 77 (42%) villages in Kabale municipality. We held six focus group discussions and 10 key informant interviews. Ecosan coverage was found to be 20% (163/806). The factors that were significantly associated with Ecosan coverage included education, occupation, religion and age. Our study found a relatively high Ecosan coverage in Kabale municipality compared to the targeted national coverage of 15% by 2018. Policy-makers and organizations in Ecosan development ought to take into consideration the influence of education and socio-economic factors for successful uptake of ecological sanitation. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the social networks of people living with HIV/AIDS (PLHA) and explore the implications social network characteristics might have for mobilizing PLHA as prevention agents. Thirty-nine PLHA attending an HIV clinic in Kampala, Uganda provided information on themselves and on 20 network members. Based on these data, descriptive statistics for social network composition and structure were calculated. Research questions relating these network characteristics to treatment-related variables such as time since diagnosis, ART status, and time on ART were investigated. Analyses reveal that, in general, network members know the PLHA's status, are trusted, provide advice and support, and are well-connected to each other. Network features (e.g., proportion of individuals who know the PLHA's status) are related to the previously mentioned treatment variables. Findings suggest that PLHA surround themselves with a social context that enables PLHA to feel fairly protected and supported if they choose to discuss HIV and prevention. With respect to treatment, those on ART may be better prepared to act as prevention advocates. [ABSTRACT FROM AUTHOR]

Background Gender-based violence is viewed as a significant problem in conflict-affected regions throughout the world. However, humanitarian organizations typically have been unable to reliably estimate the incidence of rape, intimate partner violence and other forms of sexual abuse in such settings. Such estimates are required to inform programming in contexts such as northern Uganda. Methods We sought to establish incidence rates for gender-based violence in internally-displaced-persons camps in northern Uganda. The assessments involved a "neighbourhood methodology," in which adult female heads of household reported about their own, their sisters' and their neighbours' experiences. 299 households were selected for interview across four camps by using systematic random sampling. Findings Interviews were completed by 204 respondents (5 women having declined interview and 90 not having been successfully contacted). These respondents reported on themselves, a total of 268 sisters and 1206 neighbours. Reports with respect to these alternative populations produced estimates of overall incidence of intimate partner violence in the past year of 51.7% (95% CI 44.8 to 58.7; respondents), 44.0% (95% CI 41.2 to 46.9; respondents' sisters) and 36.5% (95% CI 30.7 to 42.3; respondents' neighbours). In the same period, estimates of incidence of forced sex by husbands were 41.0% (95% CI 34.2% to 47.8%), 22.1% (95% CI 17.0 to 27.2) and 25.1% (95% CI 22.5 to 27.6), respectively, with incidence of rape by a perpetrator other than an intimate partner estimated at 5.0% (95% CI 2.0% to 8.0%), 4.2% (95% CI 1.8 to 6.6) and 4.3% (95% CI 3.1 to 5.5), respectively. Interpretation Gender-based violence-particularly intimate partner violence-is commonplace in postconflict Uganda. The neighbourhood method provides a promising approach to estimating human right violations in humanitarian settings. [ABSTRACT FROM AUTHOR]

In Africa, HIV infections occur mostly in stable relationships, yet little is known about the determinants of condom use in this context. We examined condom use among 272 coupled HIV clients in Uganda who had just screened for ART eligibility; 128 had an HIV-positive partner, 47 HIV-negative, and 97 a partner with unknown HIV status. Sixty-six percent reported unprotected sex with their partner over the past 6 months (57-70% across the three subgroups). Multiple variables among socioeconomic characteristics, physical health, social support, and psychosocial adjustment were correlated with condom use in bivariate analysis, but in multivariate analysis, condom use self-efficacy was the only predictor of condom use in the total sample and subgroups; church attendance and physical functioning were also predictors among unknown status couples. This analysis reveals high rates of unprotected sex among coupled HIV clients, regardless of partner's HIV status, and suggests multiple targets for prevention. [ABSTRACT FROM AUTHOR]

The side effects of antiretroviral (ARV) medications negatively impact patients' quality of life and adherence to treatment. This study describes the burden of side effects from ARV treatment as experienced by a sample of HIV/AIDS patients and identifies the personal strategies they used to cope with the side effects. A total of 166 participants were recruited from a non-governmental HIV/AIDS clinic in Entebbe, Uganda. Most of the participants (76%) were females and the mean age of the sample was 38 years. Although the participants had taken ARV medications for an average period of nine months, a large proportion (76%) could not name the medications they were taking. The mean side-effects burden for the participants was five side effects. The most common adverse effects reported were tiredness, nightmares, mood swings, nausea, poor appetite, insomnia, vomiting and dizziness. The main strategies the patients used for coping with the side effects were those categorised under information-seeking, social-support seeking and positive-emotion-focused coping. However, 27% of the participants reported non-adherence to their ARV medications as a strategy to cope with the side effects. The findings show a significant relationship between the side-effects burden and a patient's age (r = 0.530, p ≤ 0.01) and level of education (r = 0.394, p ≤ 0.01). The findings indicate that in the short term after initiating ARV treatment most patients are able to cope with the high burden of side effects through appropriate strategies, but a sizable portion will fail to cope appropriately and thus resort to non-adherence. Clinicians should assist patients with continuous health education and counselling that focuses on appropriate strategies to cope with the side effects of ARVs in order to buffer the negative impact of HIV treatment on patients' adherence and quality of life. [ABSTRACT FROM AUTHOR]

Most studies of HIV disclosure in Africa have focused on disclosure to spouses and sexual partners, and particularly among women. Few have examined disclosure to family, friends, and others. Understanding the reasons for disclosure and nondisclosure and how these reasons differ by disclosure target is needed for effective prevention interventions. Using a case study design and content analysis, this study explored whether the reasons for disclosure decisions differ by the nature of the relationship to the disclosure target. Semistructured interviews were conducted with 40 HIV clients in Kampala, with even stratification by gender and age. Most (95%) respondents reported disclosing to someone; among these, 84% disclosed to family members, 63% to friends, 21% to workplace colleagues, and 18% to others. Of the 24 participants who had a spouse, 13 (54%) reported disclosing to a spouse. The most common reasons for disclosure were to receive support (76%), associated with disclosure to family members; relationship ties (76%), associated with disclosure to all target types; explaining change in behavior or appearance (61%), associated with disclosing to family and friends; and HIV prevention (50%), associated with disclosure to spouse/partner and friends. The most common reasons for nondisclosure were: fear of abandonment, particularly among young women disclosing to spouse/partner; inaccessibility to the disclosure target; and not wanting to worry/upset the disclosure target. This exploratory analysis suggests that reasons for disclosure and nondisclosure differ depending on the targets of disclosure, highlighting the need for tailoring interventions for improving disclosure decisions making and outcomes. [ABSTRACT FROM AUTHOR]

Disclosure of HIV sero-positive results among HIV-discordant couples in sub-Saharan Africa is generally low. We describe a facilitated couple counselling approach to enhance disclosure among HIV-discordant couples. Using unique identifiers, 293 HIV-discordant couples were identified through retrospective linkage of married or cohabiting consenting adults individually enrolled into a cohort study and into two randomised trials of male circumcision in Rakai, Uganda. HIV-discordant couples and a random sample of HIV-infected concordant and HIV-negative concordant couples (to mask HIV status) were invited to sensitisation meetings to discuss the benefits of disclosure and couple counselling. HIV-infected partners were subsequently contacted to encourage HIV disclosure to their HIV-uninfected partners. If the index positive partner agreed, the counsellor facilitated the disclosure of HIV results, and provided ongoing support. The proportion of disclosure was determined. Eighty-one per cent of HIV-positive partners in discordant relationships disclosed their status to their HIV-uninfected partners in the presence of the counsellor. The rates of disclosure were 81.3% in male HIV-positive and 80.2% in female HIV-positive discordant couples. Disclosure did not vary by age, education or occupation. In summary, disclosure of HIV-positive results in discordant couples using facilitated couple counselling approach is high, but requires a stepwise process of sensitisation and agreement by the infected partner. [ABSTRACT FROM AUTHOR]