Browsing by Author "Thorson, Anna"

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    Effect of home based HIV counselling and testing intervention in rural South Africa: cluster randomised trial
    (BMJ Publishing Group Ltd, 2013) Doherty, Tanya; Tabana, Hanani; Jackson, Debra; Naik, Reshma; Zembe, Wanga; Lombard, Carl; Swanevelder, Sonja; Fox, Matthew P.; Thorson, Anna; Ekström, Anna Mia; Chopra, Mickey
    OBJECTIVE: To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. DESIGN: Cluster randomised controlled trial. SETTING: 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. PARTICIPANTS: 4154 people aged 14 years or more who participated in a community survey. INTERVENTION: Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. MAIN OUTCOME MEASURES: Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. RESULTS: Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Conclusions Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour.
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    Testing together challenges the relationship': Consequences of HIV Testing as a couple in a High HIV prevalence setting in Rural South Africa
    (Public Library of Science, 2013) Tabana, Hanani; Doherty, Tanya; Jackson, Debra; Rubenson, Birgitta; Ekström, Anna Mia; Thorson, Anna
    OBJECTIVE: We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention. METHODS: This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples. FINDINGS: Learning about each other’s status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised. CONCLUSIONS: Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed women’s vulnerability and their lack of decision-making power.