HIV Sero-behavioural study in Agricultural Plantations in Lake Victoria Basin, Uganda
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HIV&AIDS Baseline Sero-behavioural Study in the Agricultural Plantations in Lake Victoria Basin, Uganda
Background, aim and survey methods The survey was conducted in four agricultural plantations of the Lake Victoria Basin of Uganda between April and May 2010. The main aim was to establish HIV prevalence among plantation workers, the associated drivers of risk and vulnerability; and the effectiveness of HIV and AIDS response. The survey methods consisted of individual interviews, focus group discussions and key informants interviews. A desk-review was also conducted to document HIV service availability and utilization, as well as institutional policies and structures for the coordination and delivery of HIV services. Laboratory testing for HIV was also conducted both in the field and at central level. A total 1432 women and men aged 15-59 years were interviewed by four fieldwork teams; of these, 1,072 (75%) are men. About two thirds of the respondents are aged 20-39 years.. Each team consisted of 4 interviewers, 1 counselor, 1 laboratory technician and 1 supervisor. Before the main survey, a pretest was carried out. All respondents provided written consent before the interviews. The survey protocol was approved by the Sicience and Ethics Committee of the Uganda Virus Research Institute; and cleared by the Uganda National Council for Science and Technology. Data was captured using EPIINFO following a double data entry strategy. Main findings About seven percent of the plantation workers are infected with HIV; HIV prevalence among women is higher (13.4%) than among men (4.5%). Of the 4 plantations, Kaweri has the highest HIV prevalence (8.3%) while Tilda has the lowest (5.1%). Across all the 4 plantations, HIV prevalence is highest among widows/widowers (28.6 percent) followed by that among divorced people (14.2 percent). HIV prevalence is highest among respondents with higher number of living children. Knowledge of single HIV prevention methods is widespread among plantation workers and is similar among women and men. Over three quarters of women (79.2 percent) and more than two thirds of men (68.4 percent) know that HIV can be transmitted from a mother to her child by breastfeeding. About two thirds of the respondents know that there are special drugs (antiretroviral drugs) that a doctor or nurse can give to a pregnant woman infected with the AIDS virus to reduce the risk of transmitting the virus to the baby. Knowledge of at least one source of a condom is widespread; ranging from 77 percent in Tilda to 91 percent in Kaweri. Misconception about HIV/AIDS is low. About 90% of both women and men know that a healthy-looking person can have the virus that causes AIDS. Much fewer respondents understand that the AIDS virus cannot be transmitted by mosquito bites: 56 percent of women and 60 percent of men know that AIDS cannot be transmitted by mosquito bites. The proportions of women and men who know that people cannot get the AIDS virus by sharing food with a person who has AIDS are 68.6 and 65.2 percent, respectively. The vast majority of plantation workers say that witchcraft is not a means of transmission of HIV, with 81.1 percent of women and 84.4 percent of men saying so. The majority of respondents have a caring attitude. Over ninety percent of women and men say they would be willing to care for a relative who is sick with AIDS in their own household. About 77% of respondents agree that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching in the school. Equally, about 77% of women and men say they would buy sugar or fresh vegetables from a vendor if they knew that he/she is HIV positive. Furthermore, about 48% of women and 63% of men say that if a member of their family got infected with the AIDS virus, they would not necessarily want it to remain a secret. The proportion of women and men who express positive attitudes on all four indicators are 31.5 and 40.4 percent, respectively Over 96 percent of the respondents said that they have ever had sex. The median ages at first sex for women and men were 16 and 18 years, respectively. Overall, 37 percent of women and 24.5 percent of men initiated sex before the age of 15 years. Primary abstinence was more common among men (12.9%) than in women (3%). There is a widespread acceptance of the ability of women to negotiate safer sex with their husbands. About 96 percent of women and 92 percent of men agree that a wife is justified in refusing to have sex with her husband if she knows he has a sexually transmitted disease and/or believe that a wife is justified in asking that he uses a condom if she knows that her husband has a sexually transmitted infection. Additionally, some of the respondents who were sexually active in the 12 months preceding the survey engaged in multiple sexual relationships (27.1% of men and 9.1% of women). The mean number of lifetime sexual partners was 6.3 in men compared to 3.2 in women. Higher risk sex is more common in men than in women. Similarly, condom use during the last higher risk sexual encounter is higher in men than in women. Women are more likely than men to undergo HIV counseling and testing; about 71 of women and 58 percent of men reported that they have ever had HIV tests. Fifty seven percent of pregnant women who gave birth in the last two years were counseled during antenatal care. Among those women who were offered and accepted HIV test during antenatal care, 27.2 percent received their results. The key factors cited by the key informants to be influencing the spread of HIV infection included: poverty; low female-to-male ratio, inadequate information on HIV/AIDS among plantation workers, low risk perceptions, the practice of commercial sex work as a means of supplementing income, seeking for favours, widow inheritance, negative beliefs on condoms and negative cultures/values. On policy, only two plantations (Kakira and Kaweri) have written workplace policies; although the one for Kaweri is still in draft form. The other two have unwritten policies. Never-the-less, all the surveyed plantations are implementing workplace policies and programmes. Among others, emphasis is being put on ensuring non-discrimination of HIV infected workers, gender sensitivity, safer work environment and confidentiality in handling HIV information. HIV related services that are being offered include awareness creation, health education, HCT, general HIV care and ART services. Conclusion Some action is required to address the key issues emerging from the survey. For instance, Tilda, Kaweri and Wilmar plantations should develop their HIV/AIDS work place policies; and the coordination structures for HIV prevention and control should be strengthened in the plantation sector. The range of HIV services in Ti lda, Kaweri and Tilda should be expanded to make them comprehensive. To increase the levels of HIV-related knowledge, there is need to strengthen the programmes for information-education-communication (IEC) in the plantations and surrounding areas. Programmes for behavior change communication also need to be strengthened. HIV counseling and testing should be promoted among the general population. Pregnant women should be particularly targeted with HCT. Finally, strategies consider the key emerging issues should be designed to address the high level of HIV infection among the plantation workers.