Ghanaians with perinatally acquired human immunodeficiency virus (HIV) infection now live into adulthood. It is known that adolescents and young adults living with HIV have a high risk of mental health comorbidity. Despite increasing global attention on HIV-mental health interactions, the field remains understudied in Ghana, with an attendant lack of national integrated care solutions. This study aimed to measure the burden and explore the context of depression, anxiety and stress symptoms among young people living with HIV receiving care at a tertiary care hospital in Ghana. This was an explanatory sequential mixed-methods study. Depression, anxiety and stress symptoms were measured using the Depression, Anxiety and Stress Scale, and their associations with quality of life (QoL), socioeconomic status, internalised stigma, disease stage and HIV-related risk-taking behaviours were explored. After preliminary quantitative data analysis, semi-structured interviews were conducted for those who screened positive for depression and/or anxiety to explore their experience with this comorbidity. This study found a low prevalence of depression and anxiety symptoms, which were associated with higher stigma scores and lower QoL. We believe this low prevalence to be attributable to the effect of several psychosocial interventional programmes, which were previously piloted with the study cohort that have gradually normalised mental health discussions. Participants also showed marked resilience and knowledge about their condition. The results of this study present an opportunity to advocate and scale up effective locally adapted and strength-based solutions to address the mental illness-HIV syndemic in Ghanaian young people living with HIV.

Low HIV testing among men, particularly highly mobile fishermen, is a persistent challenge. The Owete study (NCT#04772469) used social network-central men (Promoters) to promote testing and linkage to HIV services among social networks of fishermen in western Kenya. The Promoters and fishermen networks were randomised to intervention or control arms. We describe Owete's interactive training approach and Promoters' training experiences for implementation insights. The 146 Promoters trained (balanced across arms) were highly engaged, eager learners, and supportive of targeted health training sessions for men. Promoters felt the knowledge gained improved their understanding of health matters and elevated their social status. Promoters felt empowered knowing how to interpret self-testing results and how to address pre-exposure prophylaxis use questions and correct misconceptions. Offering capacity building for social network-central men to spearhead campaigns on health issues affecting fishermen can leverage established relationships and trust, expand knowledge, and help increase health-seeking practices among underserved, highly mobile men.

Mozambique has the sixth highest prevalence of HIV in the world and ranks fourth in new infections. The government-owned print press has played an important role in the social construction of HIV and AIDS in the country as it was entrusted with the role of disseminating HIV and AIDS information to the public since the outbreak of the pandemic in the country in 1986. Using ' articles and frame analysis perspective, the article analyses the way has framed HIV and AIDS in the country since the late 1980s. The choice of media results from the fact that the way a phenomenon is constructed influences the way it is understood, as well as the way people may behave before it. The study found that frames on HIV and AIDS have suffered from a threefold tension: the need to maintain the Frelimo government's former centralised and grassroots-orientated socialist ideology of health services in the context of the liberal market; the need to balance the influence of the global multilateral and bilateral actors and the Frelimo government's political interest of translating HIV and AIDS response to the Mozambican context; and the need to portray a nationalist and positive image of the government's performance in HIV and AIDS response before Mozambique's non-fully plausible societal practices for an effective HIV and AIDS response. In a top-down approach, ' frames reflect not only the African post-independence ancillary and nationalist role of government-owned print press but also the power of global actors. Less is done from the societal bottom-up perspective.

Depression is a significant concern for people living with HIV and AIDS as it is associated with negative health outcomes and suboptimal adherence to antiretroviral therapy (ART). To this extent, screening for depression is essential for early detection. The CESD-R-20 is a revised four-factor questionnaire developed to assess depressive symptoms in adults. This study explored the factor structure and psychometric properties of the CESD-R-20 among 685 individuals receiving ART. Data were collected at the Infectious Diseases Clinic of a large public hospital outside Cape Town from participants who had been receiving ART for at least six months. Exploratory factor analysis (EFA) of the CESD-R-20 was performed to identify its underlying factor structure. The EFA revealed a one-factor solution termed "depressive affect," comprising 19 items that encompassed the original factors. This finding suggests that depression is a cohesive construct rather than a collection of interconnected dimensions. The scale exhibited high internal consistency (Cronbach's alpha = 0.95) among the sample of persons living with HIV and AIDS. Our findings indicate that the CESD-R-20 can effectively measure depressive affect as a one-factor scale in South Africans receiving ART. The scale demonstrated strong internal consistency and is suitable for screening for depressive symptoms among persons living with HIV and AIDS.

HIV testing services (HTS) enable early linkage to HIV prevention, treatment and care. A review of Chegutu District Health Information System 2 sexually transmitted infection (STI)/HIV data revealed HIV testing rates among those infected with STIs were 41%, 48%, 50%, 51% and 68%, respectively, for the period 2016-2020 against a target of 100%. We investigated factors associated with the uptake of HTS among STI clients.

This paper focused on the prevention of HIV transmission for adolescent girls and young women (AGYW), through a layered approach which included economic strengthening as a core strategy, especially for the most vulnerable. Based on multi-year data in KwaZulu-Natal, South Africa, we assessed the outcomes of an economic strengthening model developed by TB HIV Care (THC) in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) HIV prevention programme. The methods used are primarily qualitative. In 2021, 2022, and 2024 DREAMS implementation staff ( = 72) and economic strengthening beneficiaries ( = 73) from four districts were interviewed on the dynamics of the model and its emerging outcomes. The qualitative data were supplemented by monitoring data. The study results showed that, while longer-term outcomes for the beneficiaries were unclear, the short and medium-term benefits of economic strengthening activities for vulnerable AGYW were highly promising. Not only did beneficiaries gain valuable technical and life skills through training, but they showed increased confidence and hope for the future, and a new sense of empowerment. They also experienced social asset building and an increase in their social, economic, and emotional efficacy. Importantly, beneficiaries also showed signs of behaviour change, away from risky behaviours towards protective ones. The paper concludes that layered economic strengthening initiatives targeted towards those most at risk AGYW, is an important pillar of efforts to reduce HIV infection; however, challenges around taking such initiatives to scale and tracking long-term outcomes remain.

Following a systematic review of quality indicators employed in the evaluation of clinical care for individuals with HIV and AIDS, we performed "an exploratory study" that aims to assess the clinical significance and practical applicability of these indicators from the perspective of health care professionals (HCPs) specialising in HIV and AIDS care. Twenty-five HCPs filled out two questionnaires. From the initial list of 88 quality indicators, 50 were identified as the most relevant and useful in HIV and AIDS clinical care. Analysis was conducted on the individual indicators, and the outcomes were categorised into seven domains for clinical relevance and practical usefulness. Health care professionals deemed the functional organisational structure and the therapy domain to have the most pertinent and useful indicators among the seven different clinical domains, followed by the prevention domain.

The consequences of engaging in risky sexual behaviours (RSB) can lead to HIV infection, sexually transmitted diseases and unintended pregnancy. The relationship between neighbourhood characteristics and youth involvement in RSB such as early sexual debut and multiple sexual partnerships has been of great concern to government, researchers and policymakers. However, there are very few empirical studies using demographic and health surveys to unpack the nature of this relationship in Rwanda, Ghana and South Africa. The objective of this study was to estimate the prevalence and determinants of early sexual debut and condom use, and to explore the neighbourhood factors associated with early sexual debut and condom use in Rwanda, Ghana and South Africa.

Adherence to antiretroviral therapy (ART) is crucial for preventing vertical transmission of HIV and maternal deaths. While the literature is replete with studies on ART adherence, the role of social capital in adherence to ART is less studied. Drawing from the social cognitive theory, this study examines the relationship between social capital and post-partum adherence to ART.

Lesotho has the second-highest HIV and AIDS prevalence globally and is the country's second leading cause of death. Despite increasing ART coverage, adolescents remain left behind and face high mortality because of delayed ART initiation. This study aimed to explore the experiences and challenges of nurses when initiating adolescents living with HIV on ART in Thaba-Tseka, Lesotho.

In South Africa, the high rate of human immunodeficiency virus (HIV) infection among young people and unplanned pregnancies remains a concern. Using a qualitative approach, this study aimed to explore how young people between 18 and 24 years old perceive the risk of unplanned pregnancy and HIV, and how they give priority to and act to prevent both concerns. Fifty-four young people were recruited from three provinces in South Africa: KwaZulu-Natal, Eastern Cape, and Gauteng. Data collection took place between May and June in 2016. All data collection was carried out in person using a standardised discussion guide and a semi-structured interview guide in English. We conducted eight focus group discussions with young people and three in-depth interviews with young people who had become parents in their teens. We utilised thematic analysis grounded in a social constructionist framework to assess patterns and associations in the data. Respondents reported unplanned pregnancy and HIV as prevalent among their peers, but prioritised both concerns differently. Preventing pregnancy was a greater priority and threat than HIV. Respondents were less concerned about being infected with HIV which was perceived as invisible and not a death sentence because of the efficacy and ease of use of treatment. HIV was considered comparatively more manageable and less burdensome than other chronic illnesses and unplanned pregnancy. Our study suggests unplanned pregnancy and HIV prevention interventions should prioritise responding to young people's primary desire to control their fertility, but also encourage them to have holistic sexual and reproductive health goals that include HIV prevention. Our findings suggest a pressing need for biomedical therapies that offer combined HIV and pregnancy prevention for young people. Future programmes need to be agile and innovative in addressing young people's tendency to prioritise HIV and pregnancy differently, and they need to revive the sense of urgency to prevent HIV.

This study aimed at assessing the experiences of people living with HIV who participated in an agricultural livelihood support initiative in selected districts of Uganda. The initiative, implemented from 2017 to 2018, involved the provision of agricultural inputs such as beans, cassava cuttings, goats, chickens, and pigs to participants. In-depth interviews were conducted with 37 people (28 women and 9 men) from the districts of Kampala, Masaka and Wakiso (specifically Entebbe) in central Uganda, who had participated in the project. Data were analysed thematically focusing on facilitators, challenges and outcomes from the project. The following themes emerged as facilitators: access to land and animal feed, prior farming experience and supportive family and friends. Some participants experienced challenges including animal/poultry diseases, livestock theft, "low quality" agricultural inputs, unfavourable weather conditions, limited finance and land to support livelihood activities and difficulties working in groups. Several participants reported positive livelihood outcomes including improved food security, better nutrition, increased income and improved mental health. However, some participants reported negative outcomes which took the form of a loss of money and time invested when their livestock died from disease. Although participants in the agricultural livelihood initiative faced challenges which reduced the profitability of their projects, the initiative was regarded as beneficial and worthwhile. These findings have relevance to the broader field of livelihoods programming. Future interventions can draw from the experiences of our participants while also taking seriously into consideration the different circumstances of individuals in a targeted population so as to increase the chances of producing more positive outcomes.

For over 25 years, new programs to attempt to stem the HIV epidemic have been developed in Africa by country governments as well as external donors. These programs and activities have built and operated facilities, trained clinicians, financed drugs and commodities, supported and helped finance government health planning and operations, and contributed in other ways. Who has benefited from this massive mobilization? While some single country and narrowly focused studies have been done, the issue of equity of HIV programs for vulnerable populations has not been examined in a large set of countries. Using Population-based HIV Impact Assessment (PHIA) data, we examine equity of the HIV programs in 13 African countries to determine if vulnerable groups (such as those with low wealth, rural populations, young adults, and females) have achieved comparable levels of access to HIV program services. In contrast, we also compare the equity of the HIV response to rural and low-wealth populations with the equity of corresponding domestic health systems using Demographic and Health Survey data.This study found that in over half of the countries, the HIV response indicators were equitable for vulnerable population segments including the low-wealth population (in seven countries) and rural population segment (in nine countries). In no country was the domestic health system equitable for these two groups. However, HIV programming does show some clear patterns of inequity for low-wealth and rural populations in some countries. For gender and young adults, the HIV response indicators show that in all 13 countries men and young adults are consistently underserved relative to their counterparts.

Adolescents and young adults living with HIV (AYA) are faced with the challenge of living with a life-long chronic condition. We investigated the influences on the decisions by AYA to disclose their HIV status to family, intimate partners and friends. Twenty AYA aged between 15 and 24 years were purposely selected through local community-based organisations in eThekwini municipality and uMkhanyakude district in KwaZulu-Natal Province, South Africa. Virtual in-depth interviews were conducted between September 2020 to October 2021 using a topic guide focusing on HIV-status disclosure and the impact of stigma on decision-making capacity. An iterative thematic process was used for analysis. Findings revealed the challenges that AYA experience for disclosure because of stigma and how this impacts their decision-making capacity. Family and friends influenced AYA in processing their discovery of their HIV status offering support needed to manage living with HIV. However, for some AYA disclosing to relatives, friends and intimate partners was difficult because of fears of rejection and recrimination. The act of disclosure was influenced by both internalised and external stigma and the type of relationships and interactions that AYA had with relatives, friends and caregivers. The decision to disclose is challenging for AYA because of the fear of rejection, along with internal and external stigma. The provision of support, whether from family or peers, is important. Enhancing the decision-making capacity of AYA is essential for developing their self-esteem as well as supporting future healthcare choices.

HIV-testing services (HTS) are an important point of entry to prevention and treatment of HIV in South Africa. Despite the availability of HTS across the region and in SA, the uptake among men remains low, especially young men residing in rural and peri-urban communities. This study aimed to explore interventions that could improve the uptake of HTS among young men in KwaZulu-Natal. A descriptive exploratory qualitative study was conducted in which 17 young men and two health care providers in Ladysmith were purposively and conveniently sampled. Data were collected through semi-structured interviews using WhatsApp and landline audio calls between September and December 2021 and thematically analysed. An improvement in the health care provider attitudes and service delivery, establishment of adherence clubs for young people living with HIV, ensuring a diverse and balanced health care provider staff composition at primary health care facilities, and increased demand creation in spaces frequented by men are vital for enhancing access and utilisation of HTS among young men. Additionally, health care providers believe that the presence of male health care providers, investment in health education, prioritising men in the morning at the primary health care facilities, and the establishment of male clinics within communities as key factors in improving the uptake of HTS among young men. To attract and retain young men in HTS and in HIV treatment and care, several improvements at primary health care facilities need to be implemented. These should focus on addressing the specific needs and preferences of young men, ensuring their comfort and engagement in health care.

According to Transparency International, of the US$7.5 trillion spent globally on health each year, US$500 billion is lost to corruption.1 This article deals with the topic of corruption in the health sector in sub-Saharan Africa with a focus on how it affects persons living with HIV and their families. It begins with a definition of corruption and outlines the types of activities, people and institutions that fall within that definition in the context of HIV/AIDS. Examples are provided of what happens in practice and the types of persons (in terms of their societal roles) who yield to corruption, and how and why they commit it. The effects of corruption in health and in the fight against HIV/AIDS are then considered, drawing on published research on the costs to institutions and society. For example, HIV prevalence among women is higher than men, yet their reliance on health services plagued by corruption makes them vulnerable to abuse, blocking access to vital contraceptive, HIV testing, and reproductive and child health services. Attention is then focused on the factors that encourage the adoption of corrupt practices and what approaches have been taken to try to counter them. This includes a review and analysis of the steps that have been taken to strengthen compliance, governance and accountability and why attempts to deal with corruption have met with little success. This article suggests a new approach - harnessing digitalisation - to combat corruption more quickly and effectively, pointing out that corruption is both a major factor contributing to inefficiency and is harming peoples' health. This article aims to raise interest and renew efforts in fighting corruption in health.

As HIV unfolded in the 1980s, HIV and AIDS were heard and seen through the lives of those whom it touched directly. Personal histories were foregrounded, centred by the inevitable mortality attached to HIV infection, the courage of circumstance in the face of illness, and the activism necessary to make a difference. In the later part of the decade, the impacts of HIV were most apparent in East Africa, where community responses and political leadership coalesced to reduce new HIV infections. The 1990s marked a turn towards centralised policy, funding, and the reification of biomedically oriented approaches and systems that are intrinsically top-down. This biomedical turn centred on foregrounding the widespread availability of low-cost antiretroviral therapy and was articulated in the 90-90-90 and subsequent targets. Biomedicalisation reinforces individualised approaches to health primarily focused on biomedical technologies and health service provision that do not rely on community or social organisation formats. Emphasis on HIV treatment, along with the promise of reduced HIV transmission through viral load suppression, contributed to limiting socio-behavioural approaches to HIV prevention. While the importance of community-led response was highlighted in the 2016 United Nations Political Declaration on Ending AIDS, community-led response has devolved towards concepts such as community-led monitoring and community-led response that frame responses in direct relation to the dominant biomedical paradigm. There are lessons in the history of the AIDS response that demonstrate that communities formulate responses to AIDS differently when there have been opportunities for community members to determine the pathways for action to address HIV independently. Older research studies offer retrospective insights into moments in the history of HIV when communities were foregrounded and highlighted the need to reconsider the current trajectory of the HIV response. Not only for history's sake but to acknowledge that community leadership remains overwhelmed by elites. While lofty targets and goals drive the contemporary HIV response, the way forward is mired by uncertainty. HIV prevention efforts remain uneven, and millions of people living with HIV depend on access to treatment for decades to come in the context of budgetary uncertainties. Changing the course of AIDS will not be achieved if we fail to ensure that communities occupy a genuine and unambiguous place in shaping HIV response.

South Africa's 2016 medical male circumcision (MMC) guidelines ("the guidelines") provide direction for the MMC programme's implementation in South Africa. The aim of our document analysis was to assess the guidelines, particularly in lieu of changing guidance from WHO and PEPFAR. We then assessed how the guidelines might be applied to infant and child male circumcision (ICMC). The analysis was performed by reviewing South Africa's guidelines, along with international documents used in developing those guidelines, to identify the historical development of the guidelines, as well as the implications for MMC and ICMC decision-making within the South African context. The following principles were analysed within the context of South Africa's guidelines: (1) quality and safety; (2) informed consent; (3) confidentiality; (4) human rights; and (5) accessibility of services. Tthe document analysis also identified ambiguities that exist in the guidelines, particularly regarding consent, recognising religious or cultural exemptions, and guaranteeing the best interests of the child. South Africa's MMC guidelines could benefit from incorporating common definitions to assist with interpretation and understanding, thus preventing confusion and controversy among programme planners, parents and boys. The guidelines were made available in 2016 and recommendations for circumcision have evolved as new research and information has become available. South Africa's National Department of Health should review and update these guidelines, with a focus on both MMC and ICMC issues, so that they reflect the most up-to-date, accurate information available, to avoid inconsistent practices, risks, and litigation in the management of the programme. This study was situated within a qualitative paradigm and applied a social choice theory perspective to make sense of the MMC guidelines. The study concludes that future policy revisions should develop a broader understanding of the complex medical male circumcision decision-making process, particularly faced by parents.

The COVID-19 pandemic, particularly from 2020 to mid-2022, debilitated the management of the HIV epidemic in Africa. The multiple effects included well-documented HIV service interruptions, curtailment of HIV prevention programmes, the associated marked increase in both the risk for HIV infection among key populations and vulnerability of sub-populations (e.g. adolescent girls and young women) who are the focus of these programmes and - as importantly but less well-documented - the diverse negative socio-economic effects that accentuate HIV risk and vulnerability generally (e.g. loss of earnings, gender-based violence, stigma, police harassment of people during "lockdowns"). The global biomedical response to COVID-19 was necessary and remarkable for mitigating the bio-physical impacts of the pandemic (e.g. wide-spread surveillance coupled with rapid updates on the epidemiology of infections, rapid development of vaccines and revisions of treatment). However, drawing upon the widespread criticisms of state responses to the socio-economic effects of the COVID-19 pandemic and of "lockdowns" themselves, this article elaborates a core argument within those criticisms, namely that key lessons learnt during the HIV and AIDS and other pandemics were ignored, at least during the early stages of COVID-19. Our critique is that better integration of the social sciences and humanities in responses to pandemics can counter the reflex tendency to uncritically adopt a biomedical paradigm and, more importantly, to enable consideration of the social determinants of health in pandemic responses. At root, we re-assert a key value of 'integrated' interventions, namely the accommodation of context-sensitive considerations in the formulation of strategies, policies, plans and programme designs.