Scientific Program

Day 1 :

Keynote Forum

Nichoderms B. Mwaduma

Director and Senior Research Consultant of Dar es Salaam Abandoned Children

Keynote: Addressing the Health and Rights Needs of Sex Workers in Tanzania

Time : 10.30 AM - 11.00 AM

Biography:

Mr. Mwaduma is innovative person with  over 40 years of senior management experience and also holding various technical advisory positions with both local and international institutions including in the Government, Un agencies, Local and International NGO’s and  development partners. He has solid knowledge and research experience on social and economic issues, including doing researches related  HIV/AIDS prevention and cure particularly with at-risk populations.Mwaduma is a holder of a post graduate MSc. Degree in Development Studies specializing, Social Science Research and a Master's Degree (MA) in Economics including a  Diploma in Public Health.

 

Abstract:

Today, HIV/AIDS is recognized not only as a major public health concern but also a social, economic and developmental problem in Tanzania as in most African countries. In the year 2013, there were a total of 1.4 million people living with HIV in Tanzania. A survey conducted in Dar es Salaam in 2010 reported HIV prevalence among sexual workers to be 31.4% compared to the prevalence of 10.4% in the general populationSex work is illegal in Tanzania  and it is punishable by law. Despite this fact, the findings of many studies have revealed that a number of people engage in sex work due to an increased poverty and is an important source of income for many women. Health risks include contracting sexually transmitted diseases (STDs) and HIV. Yet sex worker health needs remain largely unmet.

The purpose of this study was to evaluate the  current challenges on health and rights needs and suggestions to improve HIV prevention policy and programming for sex workers in Tanzania

The research was based on interviews conducted in two highly STDs and HIV infected regions of Dar es Salaam, and Pwani in Tanzania to  selected household  members  among sex workers regarding their sexual behaviors, risk factors for STDs/HIV epidemics and ways of preventing from transmission.

The study found that criminalization of sex work, community and service provider stigma, marginalization, and limited access to health services and prevention commodities contribute to the high HIV burden evident among female sex workers in Tanzania. Furthermore, restrictive policy and laws towards sex workers are harmful and should be removed to increase sex worker safety and enhance the inclusiveness of the HIV response.

 

Biography:

Rong Pei has her expertise in Prevention and control of HIV, especially in ethnic areas in China. She has been engaged in the research of HIV for a long time and has conducted surveys in poverty-stricken ethnic areas for many times.

Abstract:

Background: Liangshan Prefecture, the highest HIV-affected epidemic region in China, has more than 2.5 million Yi people. The epidemic trend of HIV has gradually changed, sex transmission is the main reason of HIV infection in Liangshan Prefecture now. We firstly investigated the sexual behaviours and their related social determinants of health for HIV infection in Yi women of childbearing age in this area.

Methods: A face-to-face investigation was performing for included respondents who were randomly selected in four counties (Butuo, Zaojue, Yuexi and Meigu) with high HIV infection rates in Liangshan Prefecture. Before interview, each subject was asked to provide 3-5 ml of venous blood for HIV testing. SPSS21.0 was used for data analysis and Mplus 7 for modelling variables.

Results: A total of 800 Yi women of childbearing age were enrolled, and the prevalence of HIV was 9.88% (79/800). The average age of the respondents was 29.54. 79.88% of the respondents were married and 70.75% of them were illiteracy. Path analysis of the risk factors revealed that casual sex (0.152) and number of sex partners (0.152) were directly associated with HIV infection. Furthermore, education level (0.057), out-migrating for work (0.032), sense of self-worth (0.024) and number of sex partners (0.079) were indirect related to HIV infection, and mediated by casual sex and multiple sexual partners.

Conclusions: The epidemic of HIV infection among Yi women of childbearing age in Liangshan Prefecture is seriously, and casual sex and multiple sexual partners are strongly associated with HIV infection.

 

  • Sex Workers and Health Rights

Session Introduction

N C Kaphagawani

Malawi College of Health Sciences

Title: Prevention of HIV/AIDS in sex workers
Biography:

I am Nurse Midwife by profession. I work at Malawi College of Health Sciences as a principal. I obtained Doctor of Philosophy in Nursing and Midwifery in 2016 at North West University, Republic of South Africa. I have vast experience Maternal and neonatal health. I am a lecturer and a master trainer in sexual and reproductive health and accumulated experience I have also worked with John Hopkins International Education in Gynaecology and Obstetrics (JPIEGO) as a Master Trainer in Reproductive and sexual health issues including HIV Aids and Prevention of Mother to Child Transmission of HIV/AIDS (PMTCT). I am a board member of Youth Net and Counselling an organisation which promotes prevention and mitigation of the impact of HIV/AIDS including. prevention of HIV/ AIDs in sexual workers.

 

Abstract:

Globally, the HIV prevalence among Female Sex Workers (FSW) is 12%, with a higher prevalence of 37% in sub-Saharan Africa. The prevalence of HIV in Malawi is disproportionately high among the sex workers despite prevention activities. HIV-infected FSW have a higher number of sexual partners compared to other women of reproductive age, increasing the likelihood of HIV acquisition, as well as transmission to their clients. It is important that effective strategies are available to reduce HIV acquisition and transmission.

Youth Net and Counseling is an organization that is providing services to sex workers to intensify HIV prevention interventions. Services that are provided include HIV testing and counseling of sex workers and their most likely customers at different centers as well as at their work places. In addition to providing treatment for Sexually Transmitted Infections and Anti Retroviral Therapy (ART) those that are HIV positive to mitigate the impact of HIV AIDs.

 

  • Sex Workers Health and Rights
Location: Las Vegas, USA

Session Introduction

CHRISTINE NAMUKASA

Program Officer/ HIV/AIDs Coordinator: - ALLIED EFFORTS FOR COMMUNITY NETWORK ORGANIZATION.-KAMPALA-UGANDA

Title: Prevention of HIV/AIDS /STIs among Most At Risk Populations (MARPS) in Uganda
Biography:

CHRISTINE NAMUKASA-BA (SW)-Dip-PPM-4years –Project planning, monitoring, evaluation and coordination.

 Program Officer/ HIV/AIDs Coordinator: - ALLIED EFFORTS FOR COMMUNITY NETWORK ORGANIZATION.-KAMPALA-UGANDA

 

Abstract:

This presentation documents the experience of ALLIED Efforts for Community Network Organization a rural Community Based Organization in Uganda targeting Most At risk Populations (MARPs) to HIV/AIDS.

The project implemented aims at reducing HIV/AIDS/STs transmission among the MARPs who include Commercial sex workers and their clients, particularly, truck drivers.

 Strategies deployed include establishment of health service centers, psychosocial support, economic empowerment for safer income alternatives, HIV Counseling and Testing (HCT), peer education, dissemination of messages on socio-cultural factors escalating HIV/AIDS and safer sex.

Commercial sex work is illegal in Uganda but Policy on HIV/AIDS acknowledges the victims as at risk Populations.  Policies provide the framework guiding interventions that include, bringing on board local community members, government, community organizations and beneficiaries for community mobilization and awareness raising on HIV/AIDS. Project challenges include limited resources and upsurge in demand for services. As a way forward, it is imperative to continue sustainable combination HIV prevention strategies to curb its surge.

BACKGROUND AND INTRODUCTION

HIV is one of the leading causes of death worldwide; Sub-Saharan Africa continues to be the most gravely affected region of the world. In Uganda targeting of prevention efforts to Most-at-risk Population is a strategy being used to address HIV epidemics. By focusing programmes towards populations and behaviors conferring a large proportion of new infections, greater impact can be made in halting the epidemic.

Although commercial sex work is illegal in Uganda, the National HIV/AIDS Strategic Plan (NSP, 2016 – 2017), recognizes that, commercial sex workers and their clients are one of the Most at Risk Populations (MARPS). The Modes of Transmission study, 2017 reveals that, Commercial sex workers, their clients and partners of clients contribute 10% of new HIV infections. Sex workers serve several clients a day and each sexual encounter is associated with some form of risk hence a community risk. There is also evidence that, while 99% of Commercial sex workers report use of condoms, consistent condom use is very low among their clients,). Such sexual practices with inconsistent condom use are a danger to the community. With the emerging issues in the prevention of HIV that include the right to health and services, Gender Based Violence, Male Medical Circumcision, Post Exposure Prophylaxis among others we have a challenge and an opportunity  to strongly adopt these issues as we strive to the curb the escalation of the AIDS/ST1s  epidemic.

This presentation will document what our organization has done to address these challenges. It will detail the challenges and the opportunities in the provision of HIV and STIs prevention and control   services to Most At Risk Populations   today in a developing country.  Strategies and good practices that address the empowerment of Most at Risk Populations will also be addressed.

 

  • Public Awareness on STD&AIDS
Location: Las Vegas, USA

Session Introduction

Abdulwahab

Deputy director at School of public health and research, Somali national university

Title: Sick and solo: A qualitative study on lived experience of living with HIV/AIDS in Somalia
Speaker
Biography:

Abdul is the deputy director at School of public health and research, Somali national university. His research interest involve in the field of infectious diseases, maternal and child health as well as occupational and environmental health. He authored number of international peer-reviewed articles.

 

Abstract:

HIV-stigma and the resultant fear of being identified as HIV-positive can compromise the effectivenes of HIV programs by undermining early daignosis and anti-retroviral treatment initiation and adherence of people living with HIVAIDS (PLWHA). The aim of this study is to explore the situation of PLWHA to better inform researchers, program managers and policymakers in order to improve the national response to HIVAIDS, and to scale up testing and treatment of HIV in Somalia.

A qualitative study using unstructured interviews was conducted in Mogadishu from September to Decemeber of 2017. A convinience sampling approach was used to recruit 13 participants, including 10 persons who live with HIVAIDS and three senior officials who work for the HIV program at the Ministry of Health. Data were analyzed using a thematic analysis.

Our findings show that people do not seek voluntary diagnosis and treatment of HIV. They come to know about their status when their partners are found HIV positive, they are tested for other clinical purposes, or when an individual’s health deteriorates, and all other means fail to work in improving hisher situation. The study reports a widespread stigma subjected to PLWHA by their family members, society, employers and health providers, which continue to undermine the scale-up of testing and treatment of PLWHA in Somalia. The study also pointed out a shortage of facilities that provide HIV diagnosis, counselling and treatment, which is another critical challenge in HIV control program in Somalia. Addressing stigma and discrimination subjected to PLWHA are critical to a successful HIV response in Somalia. However, to adress stigma, HIV programmes need evidence on effective interventions at individual, community and societal levels in order to strategically incorporate stigma and discrimination reduction into national HIVAIDS programs.

 

  • HIV and Cancer

Session Introduction

Irina Ferreira

Internist Clinica Sagarada Esperança

Title: An extensive case of kaposi´s sarcoma in HIV/AIDS patient
Biography:

Irina Ferreira is an Angolan born British doctor who trained in the UK and after completing a master’s degree in infectious disease has decided to move to Angola to practice medicine. Her passion is tropical medicine and she wanted to move to Angola in the hope if making a difference to the health care system. She is currently an internist at Sagrada esperança. Dra Ana Abreu is an Angolan doctor trained in Portugal who has been working in Angola as an internist for the past 7 years and specializes in HIV care.

 

Abstract:

A 38-year-old man presented to the emergency department with extensive, nodular skin lesions all over his body, getting progressively worse over a 1-year period. The patient was an electrician and denied any recent travel outside of Angola. Physical examination revealed peri-orbital oedema; violaceous plaques on the soft palate; violaceous nodules and plaques on his face, chest and upper limbs and multiple nodular, ulcerated and exophytic lesions on his lower limbs with severe bilateral leg and scrotal oedema (Images A and B). Laboratory studies revealed anemia with Hb 8.1g/dl (reference range 13-15g/dl), positive Enzyme-linked immunosorbent assay (ELISA) test for the human immunodeficiency virus (HIV) and a CD4+ count of 44 cells per cubic millimeter (reference range 500- 1500 cells/mm3). A skin biopsy confirmed the diagnosis of nodular Kaposi Sarcoma. Upper and lower gastrointestinal (GI) tract endoscopy showed extensive involvement of the colon but minimal involvement of the upper GI tract (Image C). Antiretroviral therapy was initiated, and the patient underwent 1 cycle of chemotherapy and was discharged. Kaposi’s sarcoma is a malignant vascular tumor caused by the human herpesvirus 8 (HHV-8) and is an Acquired immune deficiency syndrome (AIDS) defining illness with a variable course and clinical presentation. Peri-orbital edema, lymphedema and extensive lesions, as seen in this patient are poor prognostic signs. One week after chemotherapy the patient presented to the emergency department with episodes of hematochezia, severe anemia (Hb 5.1g/dl) and in hypovolemic shock with a lactate of 12 mmol/L (reference range 0.5-1mmol/L) and in severe acidosis with pH 7.18 (reference range pH 7.35-7.45). Unfortunately, he passed away within hours of admission.

 

Day 2 :

Biography:

Animut Alebel is from Ethiopia and is graduated with a BSc degree in Nursing from Debre Markos University in 2013 and served as Assistant Lecturer at Debre Markos University for two years. Now he is  a Master’s student in Advanced Clinical Pediatrics and Child Health Nursing at the University of Gondar.

 

Abstract:

Background: In Ethiopia, despite the availability of highly active antiretroviral therapy for more than 13 years there is still a scarcity of data in related to mortality rate among human immunodeficiency virus infected children on antiretroviral therapy. Therefore, the study assessed the incidence and predictors of mortality among human immunodeficiency virus infected children on antiretroviral therapy in Amhara regional state referral hospitals, Northwest Ethiopia.

Methods: An institution based retrospective follow up study was conducted among 553 among human immunodeficiency virus infected children on antiretroviral therapy from January 1, 2012 to February 28, 2017. A simple random sampling technique was employed to select the study participants. Data were entered into Epi-data version 3.1 and analysis was done using STATA 13. Kaplan-Meier survival curve was used to estimate the survival time. Log rank tests were used to compare the survival curves between different predictor variables. Bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of mortality.

Results: Among 538 children, records included in the final analysis, 7.1% of them died. In The overall mortality rate of this study was 3.2 (95% CI: 2.3, 4.3) per 100 child-years. Baseline opportunistic infection (AHR: 2.5, 95% CI: 1.0, 5.6.0), low hemoglobin level (AHR: 3.1, 95% CI: 1.4, 6.7), CD4 cell count or percent below the threshold (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3) and advanced disease stage (III and IV) (AHR: 95% CI: 3.0 (1.3, 7.1) were  found to be predictors of mortality.

Conclusion: There was a high rate of mortality. Baseline opportunistic infection, low hemoglobin level, CD4 count or percent below the threshold, severe wasting, severe stunting and advanced disease stage were found to be the predictors of mortality.  

 

Biography:

Baker nativity is Uganda and is a graduate in Diploma Business Administration, Sales and Marketing. Had 4 years of experience in general Managing in Bakerm Enterprises Limited and is now the Executive Director

Abstract:

Background: There is limited documentation on knowledge, attitudes and barriers to condom use among female sex workers (FSWs) and truck drivers (truckers). Objective: To explore knowledge, attitudes and barriers to condom use among FSWs and truckers operating along major transport corridors in Uganda

Methods: Structured questionnaires were administered to explore FSWs’ and truckers’ knowledge of and attitudes towards condom use among 259 FSWs and 261 truckers. Qualitative data were collected on barriers to condom use using focus group discussions. Quantitative data were analyzed using SPSS while qualitative data were audio-recorded, transcribed and thematically analyzed.

Results: Condom knowledge was high with 97% of FSWs and 95% of truckers agreeing with the statement, “Using condoms properly and consistently reduces risk of HIV infection”. Attitudes towards condom use were generally favorable with 91% of FSWs and 82% of truckers agreeing with the statement, “Condom use is the best method of HIV prevention”. Qualitative findings show that poverty, refusal to use condoms by male partners, alcohol use before sex and beliefs that condoms ‘kill the mood for sex’ remain key barriers to consistent condom use.

Conclusions: Consistent condom use among FSWs and truckers is still hampered by economic and relationship factors.

 

  • HIV Drug Resistance
Biography:

Kidist Zealiyas from Ethiopia. have MSc in Biomedical science in Addis Ababa university and have also done thesis research on Anti-promastigote and hemolytic activity of selected Ethiopian traditional medicinal plants used for treatment of leishmaniasis. Is currently working in Ethiopia public health institute as assistant researcher in traditional and modern drug research directorate at biomedical case team. She also has especial interest in conducting studies on traditional medicine in the issue of efficacy, safety and quality parameters.

Abstract:

Background: With the rapid scale-up of antiretroviral treatment (ART) availability in sub-Saharan Africa, the need for appropriate treatment monitoring has also increased. The World Health Organization (WHO) recommends viral load test as the preferred monitoring approach to diagnose and confirm ART failure. In Ethiopia, immunologic and clinical parameters have been used to monitor HIV patients on ART. Recently the government has implemented a VL testing in multiple testing centers across the regions; however, the viral suppression rate is not well studies. The aim of this study was therefore, to determine the level of viral suppression and associated factors among HIV patients on active ART.

Methods:  We used routine VL program data of 8,389 adults and children, measured for patient clinical monitoring at Ethiopian public health institute, HIV national reference laboratory.  The laboratory received biological sample (Plasma, whole blood or dried blood spot) to determine the viral load from 70 health facilities referral linkage. The laboratory diagnostic result was entered in to a database built for this purpose on daily basis by trained data clerk. Duration of client on ART was at least six months at the time of viral load measurement. The main outcome variable of the study was VL measured by Abbott Real Time and Cobas Ampliprep/Cobas Taqman plat forms. Socio-demographics and baseline clinical characteristics were used as exposure variable.  Multivariable regression analysis was employed to identify the associated factors with high viral load. P value less than 0.05 was used to declare the statistical significance.

Results: Of the participants 5,038(60%) were female, 1,136 (13.6%) were children (less than 15).  The overall viral load suppression (HIV RNA copies<1000 copies/ml) was found to be 86%.  The VL suppression was not significantly different between the two genders. Advanced WHO clinical stage and poor adherence were significantly associated with impaired virologic suppression.

Conclusion: This study showed generally sub optimal viral suppression among patient under ART which might pose a question on the success of ART program in Ethiopia.  This finding would supplement to serve as the evidence for tracking the progress towards the third of the 90-90-90 UNAIDS ambitious plan.

 

  • Public Awareness on STDS and AIDS

Session Introduction

Emmanuel Etim

Digital Marketer and Health Specialist, IMH-INITIATIVE, Nigeria

Title: How digital healthcare marketing can be used to curb the spread of HIV in Nigeria
Biography:

Emmanuel Etim has his expertise in Digital marketing and Programs development for health intervention strategies within the LGBTI community, with a strong passion for an improved health, lifestyle and total wellbeing of the general population. He has built workable digital models over 5 years for the LGBTI community in Nigeria for their safety and confidentiality in data collection, sharing and documentation especially because of the same sex marriage law which is strong in Nigeria. His models have been digitally tested and proven with best practices within the community.

 

 

Abstract:

Statement of the problem: Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infections in sub-Saharan Africa. Many people living with HIV in Nigeria are unaware of their status and Nigeria continues to fall short of providing the recommended number of HIV testing and counseling sites. Furthermore, low levels of access to antiretroviral treatment remains an issue for people living with HIV, meaning that there are still many AIDS-related deaths in Nigeria, as well as the punitive laws against homosexuality, with men who have sex with men, facing difficulties accessing HIV services.

The purpose of this study is to use digital marketing as a medium to create awareness on the prevention and treatment of HIV, as well as engage patients online, in order to provide the necessary information on HIV-related issues, whilst maintaining the user's anonymity.

Methodology and theoretical significance: A qualitative focus group study, using semi-structured interviews. Participants were selected by the use of purposive sampling. This study is grounded on the healthcare marketing framework.

Findings: The use of digital health marketing is useful in the curbing of the spread of HIV, particularly amongst youthful population in Nigeria, who are amongst the most active users of the internet. Digital healthcare marketing will also be useful to the LGBTI community, who previously might not be able to access treatment due to predominant discrimination against their sexuality, which was made worsened by Nigeria's anti-gay legislations.

Conclusions and recommendations: For digital healthcare marketing to be effective there is need for marketers and health practitioners to ensure a two-way communication with online patients. It is recommended that government should partner with healthcare NGOs and state health authorities in the adoption of digital marketing.


  • Sex workers health and rights

Session Introduction

Chrispine Sibande

Executive Director of Center for the advancement of Human Rights and Development, Malawi.

Title: Realisation on sex workers rights in Southern African Development Community (SADC). a critical analysis of sadc protocol on gender and development
Biography:

Is a Human Rights Expert, Sexual and Reproductive Health Rights Expert, Policy Expert, Development Practitioner. Is also well experienced in Managing Donor Funded Projects, Policy Design and Implementation, Advocacy, Community Mobilization, Building Strategic Partnerships and Fundraising. He is currently the Executive Director of Center for the advancement of Human Rights and Development. He is a PhD graduate from University of Pretoria.

 

Abstract:

Southern African Development Community (SADC) is a grouping of sixteen (16) countries in Africa established under a Treaty and founded on principles of human rights, democracy and rule of law.  The aim of the grouping is economic growth in the region. However, these SADC countries have committed themselves to address human rights issues by developing charters, protocols and declarations. Southern African Development Community (SADC) Protocol on Gender and Development is one of such protocols that was adopted with an aim of promoting women’s rights, empowering women and girls to achieve gender equality and equity in SADC countries.

This paper analyses SADC Protocol on Gender and Development from the perspective of sex workers rights. The focus is on female sex workers and female sex work exists in all SADC countries. However, all SADC countries have criminal laws that have an impact on sex work. At the same time all the SADC countries have signed and ratified international and regional human rights instruments such as International Convention on Civil and Political Rights (ICCPR), Convention on Elimination of All Forms of Discrimination Against Women (CEDAW), African Charter on Human and Peoples Rights (ACHPR) and Protocol to the African Charter on Human and Peoples Rights on the Rights of Women in Africa. These human rights instruments provide the framework on women’s rights and gender equality.

One issue to address in women’s rights and gender equality is sex workers rights. Majority of countries in SADC region criminalise sex work. The paper therefore analyses the implication of criminalising sex work in addressing issues of women’s rights and gender equality. The paper focuses on SADC Protocol on Gender and Development as opportunity to address issues of equality and non-discrimination and whether the protocol addresses issues of female sex workers at all. Did SADC countries make progress on sex workers rights under the Protocol on Gender and Development?