hiv-survey-analysis

HIV Survey Analysis


Desmond Tutu HIV Foundation, University of Cape Town, South Africa


The primary objective of South Africa’s National Strategic Plan for 2012-2016 was to improve the accessibility and coverage for HIV testing and treatment. As a result of HIV testing and counselling (HTC) campaign of 2010 and its revitalization strategy in 2013 which focused upon the inclusion of a diverse range of populations in these services, 86% of South African citizens are now aware of their HIV status. This awareness of HIV status has also likely contributed to the marked reductions in mother-to-child transmission, which dropped from 3.6% in 2011 to 1.5% in 2016 (SANAC, 2016). Overall, incident cases of HIV decreased from 367,946 to 266,618 in the same time. Despite a 27.5% reduction in new HIV infections this figure falls significantly short of the 2012-2016 NSP goal of 50%. In response to this shortcoming, a revision of HIV reduction strategies has occurred within both the scientific community and South African government and municipalities.

In recent years the South African government has been responsive and acted in accordance with the scientific community, which is made evident by recent policy changes and the objectives outlined by the 2017-2022 NSP; among these indicators for social program success stories are a large scale-up of condom distribution, a successful male circumcision campaign, the approval of pre-exposure prophlaxis (PrEP) in 2015, the national sex worker HIV plan and ‘she conquers campaign’ for empowering young women in 2016, and the successful negotiations for low ART prices followed by the implementation of the national LGBT HIV strategy of 2017 (Auvert et al., 2005; Lachapelle & Barton-Knott, n.d.; SANAC, 2017; South & National, 2019; “The South African National LGBTI HIV Framework,” 2016). In January 2018, the first South African led study with regards to HIV in transgender women was announced by the Human Sciences Research Council (HSRC) (Human Sciences Research Council, n.d.).

In order to ensure a continued and accelerated success in attenuating the HIV epidemic in South Africa the inclusion of these historically overlooked populations must be ensured; in order to successfully ensure access to PrEP for populations such as sex workers, men who have sex with men (MSM), transgender individuals, childbearing mothers, and adolescent women, their unique behavioral and cultural factors must be considered and integrated. Such barriers might include an adolescents undesired self-identification of sexual behavior (whether perceived by the parents or real), legality issues with sex workers identifying themselves or their occupational pressures which discourage safe sex practices, or a fear of disclosing one’s sexual identity by participating in a particular study or clinical trial.

In addition to historically overlooking high risk populations such as MSM and sex workers, the South African government has not made significant progress with respect to two overarching issues; comprehensive HIV education and social stigmatization of HIV positive individuals remain key issues which are central to prevention - the primary objective of the national strategic plan for 2017-2022. Only 5% of schools offered comprehensive sexuality education in 2016 (SANAC, 2017). Media and community focused education HIV education programs can in part fill this void of curriculum based education, however recent studies indicate that only 59% of young South Africans had knowledge of ways to prevent HIV compared to the adjacent Swaziland where this knowledge was far greater at 85% (UNFPA, n.d.).

The present study titled Target User Product Preferences (TUPP) is a mixed methods analysis which aims to better understand general comprehension of HIV and preventative measures, the degree to which this knowledge is translated into sexual behaviors, and the factors promoting or discouraging the use and access of prevention medicines and products such as Oral PrEP, Microbicide gel, and vaccines. These products are an integral component of the 2017-2022 national strategic plan for South Africa, and the efficacy of Oral PrEP in a controlled environment has been proven in several clinical trials, while a great deal of hope rests in the feasibility of vaccine uptake and its efficacy.

Understanding the barriers to consumer access points for PrEP products are a vital component of ensuring the success of the prevention scale up in South Africa. Although the TUPP survey aimed to quantify a broader range of HIV prevention knowledge and attitudes towards health care and social structures affecting the use and access of PrEP products, the present analysis focuses specifically on the preferred access points for obtaining these medications. Due to the attributed stigma and attitudes which homosexual, transgender, and youth are subjected to in their interface with health care systems it was anticipated that preferred access points for prevention medications would differ with respect to sexuality, age and gender.

The raw data set was cleaned and prepared for statistical tests in SAS 9.4. Of the initial 863 survey respondents, those that had errors during data entry or missing values for essential demographic indicators were deleted, resulting in a final sample of 737 individuals. Cross-tabulations using a chi square test were conducted on survey questions pertinent to preferred PrEP products and access points for these products, in order to identify themes predominating within particular groups.

A multinomial, nominal logistic regression was used to understand how preferred access points for PrEP differed by sexuality, age, and gender. The outcome modeled was based on a survey question which all survey participants responded to; the responses for preferred access point included traditional HIV clinics, hospitals, pharmacies, private doctors, and other access points not part of the traditional health care structure. These alternate locations included taverns, clubs, grocery stores, and MSM sensitized clinics. For the entire study population, traditional clinics were the most common choice for access. After stratification by gender, sexuality, and age groups HIV clinics remained the top choice in all groups although the proportion of MSM, and adolescents indicating this as their choice was far lower than heterosexual adults. For this reason, traditional clinics were modeled as the reference category for the regression.

With regards to the study population as a whole, response levels for taverns, grocery stores, and clubs were quite low although preferences among the MSM community surveyed for a MSM sensitized clinic were quite high. Additionally, MSM preferred other alternate locations to a higher degree than the rest of the study population.

Results from the regression indicate that younger age and homo-sexuality strongly increased the odds of preferring an access point other than the traditional HIV clinic

References