social drivers of the hiv and aids epidemic_ekpo
TRANSCRIPT
Social Drivers of HIV Epidemic Among Public Sector Workers
Gloria Ekpo, MD, FMCOG, MPH Senior Technical Advisor, HIV & AIDS, Health and Hope, International Programs
Group, World Vision
CORE Group Global Health Practitioner Conference April 14, 2015
Experience from SPEAR Project, Uganda
Supporting Public Sector Workplace to Expand Actions and Responses Against HIV and AIDS (SPEAR)
• A six-year USAID/PEPFAR funded HIV and AIDS intervention
• Targeting Uganda public sector: • Ministries of Local Government, Education
and Sports and • Ministry of Internal Affairs (Uganda Police
force (UPF), Uganda Prison Services (UPS) and Immigration Services
• Implemented by World Vision, RTI and
local partners
Main Interventions under the SPEAR Project
• Strengthen institutional capacity of the target ministries through HIV Policy Development.
• Scale up HIV Prevention Initiatives (Behavior Change, HIV testing,
Voluntary Medical Male Circumcision, PMTCT) • Provide wrap around services for people living with HIV
• Strengthen linkages to care and support program in a continuum of care
for beneficiaries
Assessment sought to provide answers to three main questions: • What were the most common drivers of the HIV epidemic in the target population? • Were there unique enablers of the social drivers peculiar to the population assessed? • What were the level of access and utilization of HIV related services for public sector
workers
• Cross sectional survey of 20 out of the 83 SPEAR implementing districts (Jinja, Busia, Gulu, Kampala, Mbale, Hoima, Mbarara, Oyam and others)
• Respondents were 18 years and older
• 1700 participated in the survey
Assessment Findings • Level of Participation: -Ministry of Internal Affairs: 58.8% - Ministry of Local Government: 20% - Ministry of Education and Sports: 21%
• Sex: Male: 63% and Female: 37%
• Mean Age: Male - 36 years; Female - 33years • Marital status: Married: Male - 74%; Female - 57% • Educational Level: Secondary School: Male - 53%; Female - 46% University: Male - 43%; Female - 49%
Common drivers of HIV Epidemic among public sector workers
• Multiple sexual partners
• Behavioral disinhibition/Risk perception
• Limited Condom use
• Non-disclosure of HIV status
• Cross-generational and Transactional sex
• Alcohol and Drug use
• Unique social enablers of HIV transmission
Social Driver of HIV Epidemic: Multiple Sexual Partners
• Multiple sexual partnerships were more common among men than women • Highest rate of multiple sexual partnerships were among men of the immigration services
Marital status and sexual behavior of respondents in the last 12 months
Drivers of HIV Epidemic: Condom use Condom use by sexually active respondents
Characteristics Most recent partner (n=1625) 2nd Most recent
partner (n=292)
Type of relationship Married 80% 77%
Not Married 20% 23% On-going relationship 86% 90% Condom use during last sexual encounter 23% 53% Frequency of condom use
Never 47% 27% Rarely 22% 15%
Sometimes 18% 13% Most times 13% 45%
Drivers of HIV Epidemic: Risk Perception - Report not knowing sexual partners HIV status: 34% - Perception of partner’s HIV status: Unlikely infected – 51% Likely infected – 11% • Non-disclosure of HIV status: Reporting ever disclosing HIV Status: 74% Disclosed to spouse: 76%; to Peer 20% and to relative -19%
Drivers of HIV Epidemic: Generational Sex Generational and Transactional Sex
Characteristics Marital partner (n=1,077)
Non-marital partner (n=279)
Age difference between partners
0-5 years 57% 77% 6-9 years 34% 17%
10 years or more 9% 6% Condom use and age difference of partner
0-5 years 1% 3% 6-9 years 2% 1%
10 years or more 3% 3%
Drivers of HIV Epidemic: Transactional Sex
Characteristics M. of Local Government
M. of Education and Sports
M. of Internal Affairs Total
Prison Service
Police Force
Immigration
Private Security
Number of respondents reporting exchanging gifts, money or favors for sex
40 29 25 59 8 20 11%
% who believe workmates are involved in transactional sex 32% 33% 46% 46% 29% 47% 39%
Driver of HIV Epidemic: Alcohol and Drug Use
• Reported alcohol use by respondents – 41% • Respondents agree that drug use impairs judgement in sexual decision
making- 84% • Respondents report alcohol abuse by colleagues – 50% • Use of intoxicating substance other than alcohol – 5% • Most common substances were: Marijuana (41%); Bangi (18%); Nicotine (15%) and Cocaine (10%) • Substance use highest among police force and private guards
Unique social enablers of HIV transmission among public sector workers
Characteristics
M. of Local Government
M. of Education and Sports
M. of Internal Affairs Total
Prison Service
Police Force
Immigration
Private Security
Frequent staff transfer leading to family separation 39% 31% 66% 69% 8% 34% 41% Poor housing conditions/co-habiting with multiple families 14% 15% 51% 60% 7% 20% 28% Tough working hours (night shifts) 10% 11% 28% 37% 4% 24% 19% Weak policies against sexual harassment 22% 15% 14% 14% 10% 7% 14%
Recommended Workplace interventions by respondents
• Post-exposure prophylaxis (50%)
• Sensitization and awareness creation (44%)
• Worker-friendly HCT services (37%)
• Reduction of HIV related stigma (24%) • Stopping discrimination against PLHIV (13%) • Screening and treatment for STIs (33%)
Conclusion
Tailoring interventions for public sector workers must address their unique needs and the social drivers of the HIV epidemic at workplace
Acknowledgements • USAID/PEPFAR • World Vision and RTI • Stakeholders (Ministries & UPS) • Health workers • Participants
Thank you!
