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HIVAN/ECI September 2004 Journal Club
Jo-Ann Du Plessis. HIVAN Networking Office, September 2004.
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A report-back from the XV International AIDS Conference in Bangkok was the order of the day at the Journal Club held on 3 September this year. Both Dr Ayesha Kharsany (STDs and Risk Behaviour) and Dr Myra Taylor (Reducing HIV infection among Adolescents) gave outstanding overviews of their areas of interest, covering both oral presentations and posters that were presented at the conference.
Dr Kharsany began by noting that there is evidence to show that women are being infected with HIV at an earlier age than men, and that the gap in HIV prevalence by gender continues to grow. She also pointed out that there is epidemiological evidence to show that STDs (especially ulcerative conditions) increase the probability of transmission of HIV.
Dr Kharsany reviewed papers relating to ?“STDs and Risk Behaviour?” by Rosanna Peeling, Dan Kayonga, and Mari Langa & Bea Nuylsteke which were included in Symposium 6 of the conference. Unfortunately there was no mention of innovative molecular-based tests in the first paper and the last paper was based on 1999 data, which was disappointing. It was clear from the paper by Kayonga, that primary health care services are not being implemented uniformly across South Africa, as his paper titled ?“Bring back ANC screening for syphilis?” was evidence that screening for syphilis during ANC is not the protocol in the Eastern Cape as it is in KwaZulu-Natal.
As could be expected, many more posters than oral presentations were presented at the Bangkok conference, and Dr Kharsany outlined at least seven of these in her talk. They ranged from studies in periodic presumptive treatment of STIs, to modelling the impact of STD treatment and behavioural change interventions on HIV incidence, to non-vaccine prevention strategies such as condom use, to investigations on microbicides (over 50 produces are being tested, all of which are still only in Phase I or II trials).
In conclusion, Dr Kharsany expressed disappointment in the lack of oral presentations on STDs, but noted that there were numerous excellent poster presentations at the conference. She also emphasised that the conference raised interesting questions, such as: What are the key components of behavioural change interventions? How do we change care seeking behaviour? How do we accurately measure behaviour change? It is always hoped that any meeting or conference will raise questions like these which can fuel further debate and discussion in the fight against HIV/AIDS.
Dr Myra Taylor provided an excellent review of progress in understanding determinants of youth?’s risky sexual behaviour for HIV/AIDS, the availability of interventions to reduce youth?’s risk behaviour, and the effectiveness of such interventions, which emanated from papers presented at the Bangkok conference. In total, eight different papers were covered, by Jewkes et al., Hlongwa-Madkizela et al., Hargreaves et al., Harrison et al., Rees et al., MacPhail, Walker et al. and Reddy et al. Some of the findings of these papers were:
- Youth living with both parents (25% of youth interviewed in the study) are at less risk for acquiring HIV (Hlongwa-Madkizela et al.)
- The greater the household wealth, the more probable that children in that household were attending school. Being in school is protective, and thus these children were at less risk of HIV (Hargreaves et al.)
- 75% of men in Harrison et al?’s study admitted to having concurrent partners, and 40% of women believe that their partners also had other partners. Nearly 25% of women in the study had partners that were more than five years their senior.
- Looking at HIV and contraceptive use, Rees et al. found that only 20.9% of women in their study used condoms consistently.
- Both Walker et al. (Mexico) and Reddy et al. (KZN, South Africa) carried out two post-intervention measurements of behaviour change in schools, and found that behaviour changed positively in the months immediately after the intervention, but dropped off after 10 months or a year post-intervention. Reddy et al. also found that not all educators fulfilled the necessary syllabic criteria for Lifeskills Education, and thus their results differentiated between learners who underwent the full syllabus and those who only had exposure to parts of the syllabus. The former group showed increased behaviour change when compared to the latter group and the control group (no education).
Dr Taylor concluded her presentation by confirming that that youth?’s behaviour places them at risk of HIV/AIDS. The posters and papers presented at the conference did provide a better understanding of the risk factors and determinants of HIV transmission among adolescents, but that many studies were still descriptive. Similarly to Dr Kharsany, Dr Taylor was disappointed in the seeming lack interventionist studies with rigorous evaluation criteria at the conference.
One notable question from the floor asked if the lack of rigorous research presented at Bangkok was a result of the selection procedures employed by the conference organizers, or if it reflected the state of HIV/AIDS research today, and, if the latter, what we, as researchers, could do in the future to fill this gap. A response to this question was that while there is a definite place for descriptive studies, and many investigations work off the foundation of description before moving into, for example, clinical trials, there is certainly a need for more interventionist or action research in HIV/AIDS.
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Dr Ayesha Kharsany and Myra Taylor
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