Browsing by Author "Venkataramani, Atheendar S"

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    Accuracy and determinants of perceived HIV risk among young women in South Africa
    (2018) Venkataramani, Atheendar S
    Abstract Background HIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDS-free generation – including reaching the UNAIDS 90–90-90 target – thus depends critically on the content of these perceptions. We examined the accuracy of HIV-risk perceptions and their correlates among young black women in South Africa, a group with one of the highest HIV incidence rates worldwide. Methods We used individual-level longitudinal data from the Cape Area Panel Study (CAPS) from 2005 to 2009 on black African women (20–30 years old in 2009) to assess the association between perceived HIV-risk in 2005 and the probability of testing HIV-positive four years later. We then estimated multivariable logistic regressions using cross-sectional data from the 2009 CAPS wave to assess the relationship between risk perceptions and a wide range of demographic, sexual behaviour and psychosocial covariates of perceived HIV-risk. Results We found that the proportion testing HIV-positive in 2009 was almost identical across perceived risk categories in 2005 (no, small, moderate, great) (χ 2 = 1.43, p = 0.85). Consistent with epidemiologic risk factors, the likelihood of reporting moderate or great HIV-risk perceptions was associated with condom-use (aOR: 0.57; 95% CI: 0.36, 0.89; p < 0.01); having ≥3 lifetime partners (aOR: 2.38, 95% CI: 1.53, 3.73; p < 0.01); knowledge of one’s partner’s HIV status (aOR: 0.67; 95% CI: 0.43, 1.07; p = 0.09); and being in an age-disparate partnerships (aOR: 1.73; 95% CI: 1.09, 2.76; p = 0.02). However, the likelihood of reporting moderate or great self-perceived risk did not vary with sexually transmitted disease history and respondent age, both strong predictors of HIV risk in the study setting. Risk perceptions were associated with stigmatising attitudes (aOR: 0.53; 95% CI: 0.26, 1.09; p = 0.09); prior HIV testing (aOR: 0.21; 95% CI: 0.13, 0.35; p < 0.01); and having heard that male circumcision is protective (aOR: 0.38; 95% CI: 0.22, 0.64; p < 0.01). Conclusions Results indicate that HIV-risk perceptions are inaccurate. Our findings suggest that this inaccuracy stems from HIV-risk perceptions being driven by an incomplete understanding of epidemiological risk and being influenced by a range of psycho-social factors not directly related to sexual behaviour. Consequently, new interventions are needed to align perceived and actual HIV risk.
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    Concurrent sexual partnerships among individuals on HAART in South Africa: an opportunity for HIV prevention
    (2009) Maughan-Brown, Brendan; Venkataramani, Atheendar S; Mah, Timothy L
    Concurrent sexual partnerships, a common form of sexual partnering in much of southern Africa, play an important role in HIV transmission dynamics. This study examines the prevalence of concurrency and condom use among the general population and a sample of HAART patients in Cape Town, South Africa. The prevalence of reported concurrency was relatively high among a sample of HAART patients and in the general population (24% and 18% respectively) and reported consistent condom use was significantly higher among HAART patients compared to the general population (58% versus 20%);? perceived concurrency among the study populations' sexual partners was higher among HAART patients (35% versus 20%). Individuals on HAART report higher and more consistent use of condoms than the general population but the prevalence of concurrent relationships remains worryingly high. Greater programmatic attention should be given to promoting risk awareness of and behaviour change around concurrency both in the general population and amongst people living with HIV.
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    A cut above the rest: Traditional Male Circumcision and HIV Risk Among Xhosa men in Cape Town, South Africa
    (Lippincot Williams and Wilkins, 2011) Maughan-Brown, Brendan; Venkataramani, Atheendar S; Nattrass, Nicoli; Seekings, Jeremy; Whiteside, Alan W
    Randomized clinical trials have shown that medical male circumcision substantially reduces the risk of contracting HIV. However, relatively little is known about the relationship between traditional male circumcision and HIV risk. This article examines variations in traditional circumcision practices and their relationship to HIV status. We used data from the fifth wave of the Cape Area Panel Study (n = 473) of young adults in Cape Town, South Africa, to determine attitudes towards circumcision, whether men were circumcised, at what age, and whether their foreskin had been fully or partially removed. Probit models were estimated to determine the association between extent and age of circumcision and HIV status. RESULTS: There was strong support for traditional male circumcision. 92.5% of the men reported being circumcised, with 10.5% partially circumcised. Partially circumcised men had a 7% point greater risk of being HIV positive than fully circumcised men (P < 0.05) and equal risk compared with uncircumcised men. Most (91%) men were circumcised between the ages of 17 and 22 years (mean 19.2 years), and HIV risk increased with age of circumcision (P < 0.10). CONCLUSIONS: Efforts should be made to encourage earlier circumcisions and to work with traditional surgeons to reduce the number of partial circumcisions. Data on the extent and age of circumcision are necessary for meaningful conclusions to be drawn from survey data about the relationship between circumcision and HIV status.
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    Social grants, welfare, and the incentive to trade-off health for income among Individuals on HAART in South Africa
    (Springer Verlag, 2009) Venkataramani, Atheendar S; Maughan-Brown, Brendan; Nattrass, Nicoli; Prah Ruger, Jennifer
    South Africa’s government disability grants are considered important in providing income support to low-income AIDS patients. Indeed, anecdotal evidence suggests that some individuals may opt to compromise their health by foregoing Highly Active Antiretroviral Treatment (HAART) to remain eligible for the grant. In this study, we examined the disability grant’s importance to individual and household welfare, and the impact of its loss using a unique longitudinal dataset of HAART patients in Khayelitsha, Cape Town. We found that grant loss was associated with sizeable declines in income and changes in household composition. However, we found no evidence of individuals choosing poor health over grant loss. Our analysis also suggested that though the grants officially target those too sick to work, some people were able to keep grants longer than expected, and others received grants while employed. This has helped cushion people on HAART, but other welfare measures need consideration.