Hurdles and Stumbling Blocks on Efforts of Prevention and Halting New HIV Infections by 2030: A Review of Southern Africa Region

Since the discovery of Human Immunodeficiency Virus (HIV) an infection that causes Acquired Immune Deficiency Syndrome (AIDS) four decades ago, there have been numerous global conferences where governments and heads of states made commitments to end the spread and provide mechanisms to mitigate the socioeconomic effects of advanced HIV [1]. However, these commitments have not been fully implemented as by 2019, the advanced HIV continued to be the leading cause of death among young women of reproductive age of 15-49 years globally. Despite political commitments, an estimated 6000 new HIV infections per week continue to occur among the age group of 15 and 24. These new incidences of HIV makes it near impossible for the international community to meet its commitment of fewer than 500,000 new HIV infections by 2020 [1]. On the positive side, there has been recognition that advanced HIV is not only a health issue but a development phenomenon. To this end, there have been multifaceted interventions such as increased number of girls enrolled in primary and secondary schools globally. Other development relates to more numbers of women in political leadership, improvement on pieces of legislation, increased investment in vaccines and noticeable uptake of antiretroviral treatment (ART) for people infected with HIV. By end of 2019, there were over 24 million people globally that were on treatment, of which more than 13 million were women aged 15 years and over [1]. However, there are formidable hurdles that make halting new HIV infections by 2030 as per the Sustainable Development Goals (SDGs) a difficult task. In the midst of progress and difficult challenges, the international community ought to reflect on Mandela's assertion that “…I have discovered the secret that after climbing a great hill, one only finds that there are many more hills to climb”[2]. These daunting hurdles include lack of political will, multiple concurrent sexual partnerships, transactional sexual relations, stigma, isolation and exclusion as well as poverty-migration and HIV, co-infection of Tuberculosis (TB) and HIV. The combination of these hurdles make the possibility of meeting the internationally agreed upon SDGs target of having zero new HIV infections a greater challenge to achieve, unless complacency is addressed head-on and the issues raised in this review are reprioritized.

Social Capital and Risk of Concurrent Sexual Partners Among African Americans in Jackson, Mississippi

Concurrent sexual partnerships (i.e., relationships that overlap in time) contribute to higher HIV acquisition risk. Social capital, defined as resources and connections available to individuals is hypothesized to reduce sexual HIV risk behavior, including sexual concurrency. Additionally, we do not know whether any association between social capital and sexual concurrency is moderated by gender. Multivariable logistic regression tested the association between social capital and sexual concurrency and effect modification by gender. Among 1445 African Americans presenting for care at an urban STI clinic in Jackson, Mississippi, mean social capital was 2.85 (range 1–5), mean age was 25 (SD = 6), and 62% were women. Sexual concurrency in the current year was lower for women compared to men (45% vs. 55%, χ2(df = 1) = 11.07, p = .001). Higher social capital was associated with lower adjusted odds of sexual concurrency for women compared to men (adjusted Odds Ratio [aOR] = 0.62 (95% CI 0.39–0.97), p = 0.034), controlling for sociodemographic and psychosocial covariates. Interventions that add social capital components may be important for lowering sexual risk among African Americans in Mississippi.

Partner faithfulness and sexual reproductive health practices in Botswana: does perception of partner infidelity influence sexual risk behaviours of people aged 10–34 years?

The main aim of this study was to test whether perception of partner infidelity prompts people to adopt behaviour that is meant to compensate for the increased risk of infection posed by their partner’s infidelity; or whether it prompts people to engage in behaviour that magnifies the risk associated with partner infidelity. Data used were derived from the fourth and latest Botswana AIDS Impact Survey (BAIS IV) conducted in 2013. The sample consisted of 6985 people aged 10–34 years. Logistic regression analysis was used to identify factors associated with perception of partner infidelity and sexual risk behaviours. Perception of partner infidelity with the current and most recent partner was 39.6% while perception of partner infidelity with other previous sexual partners was 79.9%. The main socio-demographic factors associated with perception of partner infidelity were being a man, being single and having secondary education, while sexual risk behaviours associated with perception of partner infidelity were having multiple sexual partners and being involved in multiple concurrent sexual partnerships. These relationships were statistically significant at the 5% level. Botswana’s HIV prevention strategies should seek to improve partner communication within relationships in order to enhance people’s confidence and skills so as to minimize perceptions of infidelity.

Development and Validation of the Masculine Attributes Questionnaire

The present study describes the development and validation of the Masculine Attributes Questionnaire (MAQ). The purpose of this study was to develop a theoretically and empirically grounded measure of masculine attributes for sexual health research with African American young men. Consistent with Whitehead’s theory, the MAQ items were hypothesized to comprise two components representing reputation-based and respect-based attributes. The sample included 505 African American men aged 19 to 22 years ( M = 20.29, SD = 1.10) living in resource-poor communities in the rural South. Convergent and discriminant validity of the MAQ were assessed by examining the associations of masculinity attributes with psychosocial factors. Criterion validity was assessed by examining the extent to which the MAQ subscales predicted sexual risk behavior outcomes. Consistent with study hypotheses, the MAQ was composed of (a) reputation-based attributes oriented toward sexual prowess, toughness, and authority-defying behavior and (b) respect-based attributes oriented toward economic independence, socially approved levels of hard work and education, and committed romantic relationships. Reputation-based attributes were associated positively with street code and negatively related to academic orientation, vocational engagement, and self-regulation, whereas respect-based attributes were associated positively with academic and vocational orientations and self-regulation. Finally, reputation-based attributes predicted sexual risk behaviors including concurrent sexual partnerships, multiple sexual partners, marijuana use, and incarceration, net of the influence of respect-based attributes. The development of the MAQ provides a new measure that permits systematic quantitative investigation of the associations between African American men’s masculinity ideology and sexual risk behavior.

African American Women and Sexually Transmitted Infections: The Contextual Influence of Unbalanced Sex Ratios and Individual Risk Behaviors

This study uses data from 564 African American women to examine the correlates of lifetime prevalence of a sexually transmitted infection (STI). Specifically, we test the effects of perceptions about the availability of African American males, five partner characteristics, and drug history. At the bivariate level, women with an STI diagnosis were significantly more likely to have dated a man who was married, older, had sex with another man, involved in concurrent partnerships, and had been incarcerated. About half of the participants stated it was difficult to find an eligible African American male and attributed the limited pool of same-race partners to drug trafficking, a lack of monogamy, and high rates of incarceration. Multivariate analyses revealed having dated a man who had concurrent sexual partnerships or had been incarcerated, as well as drug use during sex were positively associated with ever having an STI. Individual and contextual implications are addressed.