ReproNet-Africa acts as an umbrella regional Network linking, coordinating & strengthening existing reproductive health research & training

institutions for the purpose of improving the RH status in Africa.

Volume 3, Issue 1

31 May 2011

News: KenyaOutrage over "cash for contraception" offer to HIV-positive women

tively means to use a contraceptive method of their choice, whether long or short term - the key word here is informed choice. "Giving economic incentives to women with HIV, or any woman for that matter, to undertake long-term contraception is a form of coercion and violates women's reproductive rights and choices," she added. "HIV has been the longest disaster and only birth control amongst HIVpositive women provides an opportunity to end it," he said. "Why should you give birth to a child who will remain an orphan, or who is likely to die before his or her fifth birthday because the mother had infected them... prevent the suffering before it occurs," Okoth told IRIN/PlusNews. According to the US Health Policy Initiative, there is an unmet family planning Illegal need of almost 20 percent among married According to James Kamau, coorKenyan women. The government is workdinator of the Kenya Treatment Access ing to reduce this gap, and the prevalence Movement, the project was "wrong, imof contraceptive use has increased from moral and unethical". 39 percent in 1998 to 46 percent a decade He noted that it contradicted provilater. sions against discrimination The country is also increasin the country's HIV and Someone, ing access to services for AIDS Prevention and Con- somewhere is prevention of mother-to-child trol Act of 2006. Ministry of sleeping on the HIV transmission (PMTCT); Health officials say Project job because a an estimated 72 percent of Prevention did not seek the project like this HIV-positive pregnant government's authority becannot and should women receive antiretroviral fore beginning its operaprophylaxis to reduce the tions, making its activities not be allowed to practice in Kenya risk of HIV transmission to illegal. their babies, while more than "Someone, some3,300 health facilities around the country where, is sleeping on the job because a offer PMTCT services. project like this cannot and should not be "Fine, one would argue that allowed to practise in Kenya," Kamau said. PMTCT has reduced cases of HIV-positive South African media reports in May babies but statistics from government said Project Prevention planned to start show that just 44 percent of deliveries similar operations in South Africa. occur in health facilities," said Okoth. "It Defence means many more HIV-positive mothers Willice Okoth, coordinator of the who do not deliver at the hospital stand the Kenyan operation, argued that the pro- risk of infecting their unborn children. ject's aim was to fill family planning gaps, When you look at the intentions of prevent HIV-related infant deaths and PMTCT, prevention of unintended preglower the number of orphans in the coun- nancies is one of the key pillars." try. Poverty, ignorance

The project gives Kenyan women US$40 to undergo long-term contraception. Photo: Dogs and music/flickr

KAKAMEGA, 12 May 2011 (PlusNews) - The Kenyan government and rights groups have expressed outrage at a project in western Kenya that is paying HIV-positive women to undergo long-term contraception. Project Prevention, a US-based NGO, offers cash to drug addicts in the US and the UK to undergo long-term contraception or permanent sterilization. In 2010, the project started offering HIV-positive women in western Kenya US$40 to be fitted with intrauterine devices (IUDs), which can prevent pregnancy for over a decade. The project uses a medical practitioner in the western Kenyan town of Kakamega to insert the IUDs for $7 per woman; so far, 22 women have undergone the procedure. "There are two issues here; one is using incentives to push women into taking up birth control, and the second is pushing women with HIV to take up long-term birth control irrespective of their reproductive needs," said Agnes Odhiambo of New York-based Human Rights Watch. "All women, including women with HIV, have the right to make informed choices about their reproductive health and that effec-

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Yunia*, a 31-year-old mother of six, says she would have chosen to stop having children as soon as she was diagnosed with HIV four years ago, but had no access to contraceptives. "I didn't want to have a child, but here in the rural area, people cannot advise you because they also don't know. I have had two children since, and one of them died," she told IRIN/PlusNews. Yunia was happy to take the oneoff payment of $40, which she says will help her family income. "I have six children and I could still give birth to more because I am fertile but have nothing to buy food or clothes for them; now if you can get some small money to start a business plus you are helped also to stop giving birth - why not take it?" Project Prevention gives the

money to groups of 10 women for income- have been good at providing family plangenerating projects; Yunia and her group ning needs of women or even men but we have not are putting measures in place. But it is important to stress that even HIV-positive women have the right to have children if and when they desire. HIV doesn't take that right way, not at all," said Peter Anyang' Nyong'o, Minister for Medical Services. "Women need reproductive health Photo: Edgar Mwakaba/IRIN services - including family planning - but Government officials say cash incentives are the wrong way to fill the gap in women's access to contraceptives before you give those services, you must educate them and give them a range of yet decided on a business venture. choices and then they voluntarily agree to take the one they feel best suited for their Wrong way to go Senior government officials say, case, but to flash money and say take this however, that cash incentives targeting a - no, that is not how to do it," he added. particular group of women is the wrong *Not her real name way address family planning gaps. Source: IRIN News http://bit.ly/kQuKuG "We can't say as a government we

Report: ZAMFOHR Policy Brief Writing Workshop

OVERVIEW Prof. Fadi El-Jardali, Evidence to Policy Fellow of the Alliance for Health Policy and Systems, and member of the Canadian Coalition for Global Health Research, visited the Zambia Forum for Health Reseach (ZAMFOHR) from May 15th-20th, 2011, to provide technical assistance in policy brief writing and to lend impetus to the overall work of the ZAMFOHR Research to Action Groups (RAGs). There are currently fours RAGs namely: Mental Health, e-Learning for Health, Human Resources for Health (HRH) and Reproductive Health (RH). The Mental Health RAG recently completed their policy brief and conducted a policy dialogue which included a number of stakeholders, policy makers and researchers. The HRH and RH RAGs are in currently working on the policy briefs which are due at eh end of July. On May 18th, Prof. El-Jardali facilitated a policy brief writing workshop at which a diversity of ZAMFOHR Research to Action Groups (RAG) participated. The workshop was facilitated in a participatory manner with presentations serving as introductions to group consultation and practical group work. PARTICIPANTS The content of the workshop may be helpfully divided into four sections: (I) Policy Making Overview (II) Interaction with policy-makers, (III) Preparation of policy briefs, and (IV) The Policy Dialogue Process. Section III, on the preparation of policy briefs, involved group work, which is detailed on pages 4-5. Throughout the workshop, the experiences of the Mental Health RAG who have recently completed their first policy brief, were discussed in order to derive key lessons learned to lend assistance to the work of other ZAMFOHR RAGs. CONCLUSION The policy brief writing workshop provided technical assistance to ZAMFOHR RAGs in policy brief writing. A number of positive comments were received at the end of the workshop, indicating that participants felt their understanding of Knowledge Translation (in general) and the policy brief writing process (in particular) improved tremendously as a result of the workshop. It was reflected throughout the workshop that the work of the Mental Health RAG in creating an excellent policy brief as well as facilitating a fruitful policy dialogue was a great success for ZAMFOHR. Given that the Human Resource for Health and Reproductive Health RAGs must have similar successes this year, the policy brief writing workshop provided a crucial opportunity for these RAGs to learn from the experience of the Mental Health RAG and draw from the expertise of Mr. Fadi El-Jardali.

Four members of the Human Resources for Health RAG, four members of the mental health RAG, three members of the Reproductive Health RAG, and two members of the e-Learning RAG participated in the workshop. There were no attendees representing the Health Systems Research to Action Group. Full Report: www.repronet-africa.org CONTENT

Alicia Zarey, Intern ZAMFOHR

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SRH Research
Biology rather than viral factor or host genetics may be responsible for regional variability observed in HIV prevalence. Viral factors, host genetics, co-infections, and host immunology are all hypothesized to influence the two most important determinants of sexual HIV transmissionthe level of HIV in genital/rectal secretions in the partner with HIV infection and the number and density of HIVsusceptible target cells in the mucosal lining of the penis, rectum, or female genital tract of the HIV-uninfected partner. The perexposure risk of HIV transmission from men to women is almost 4-fold higher and that from women to men is 9-fold higher in lowincome countries compared to high-income countries. Why is this the case? It is unclear whether virus clade affects patterns of HIV spread and geographic mapping is incomplete of genetic determinants, such as absence of the HIV co-receptor CCR5 on the cell surface created by homozygous CCR5-delta 32 deletion. However, the prevalence of co-infections may explain much of the geographical disparity in HIV. Treatments for tuberculosis, malaria, helminths, schistosomiasis, and filariasis have all been shown to reduce plasma viral load. Genital co-infections are known to increase both HIV transmission and susceptibility. Immune activation and inflammation are key host responses to invading pathogens and HIV replicates more efficiently in activated CD4 cells. Thus, rather than viral factors or host genetics, coinfections are the most likely biological explanation for geographical differences in HIV prevalence worldwide. The two study abstracts below lend credence to this hypothesis. Happy reading

Biological Factors that May Contribute to Regional and Racial Disparities in HIV Prevalence
Kaul R, Cohen CR, Chege D, Yi TJ, Tharao W, McKinnon LR, Remis R, Anzala O, Kimani J Am J Reprod Immunol 2011 Mar;65(3):317-324

Despite tremendous regional and subregional disparities in HIV prevalence around the world, epidemiology consistently demonstrates that black communities have been disproportionately affected by the pandemic. There are many reasons for this, and a narrow focus on socio-behavioural causes may be seen as laying blame on affected communities or individuals. HIV sexual transmission is very inefficient, and a number of biological factors are critical in determining whether an unprotected sexual exposure to HIV results in productive infection. This review will focus on ways in which biology, rather than behaviour, may contribute to regional and racial differences in HIV epidemic spread. Specific areas of focus are viral factors, host genetics, and the impact of co-infections and host immunology. Considering biological causes for these racial disparities may help to destigmatize the issue and lead to new and more effective strategies for prevention. Abstract : http://1.usa.gov/iUw36V

2.24, 95% confidence interval (CI) 1.62-3.12; women: estimated OR 2.44, 95% CI 1.85-3.21]. This is the first study to report malaria as a risk factor of concurrent HIV infection at the population level. According to these results, individuals who live in areas with high P.falciparum parasite rate have about twice the risk of being HIV positive compared with individuals who live in areas with low P. falciparum parasite rate. This work emphasizes the need for field studies focused on quantifying the interaction among parasitic infections and risk of HIV infection, and studies to explore the impact of control interventions. programmes focused on reducing malaria transmission will be important to address, especially in HIV-infected individuals. Abstract: http://1.usa.gov/j6AeWB

Comments: There are more than 247 million cases of malaria

infection each year, 86% of which are in Africa. The geographical overlap between malaria and HIV has suggested the idea that malaria infection could be playing a role in HIV transmission. Exposure to bacterial, viral, and parasitic infections is known to activate the immune system, increasing HIV viral load if a person has HIV and increasing susceptibility to HIV if a person is not infected with HIV. So, although mosquitoes dont transmit HIV, is the malaria they transmit the real culprit? This well-conducted study combined HIV prevalence data with a spatial database for P. Falciparum parasite prevalence, using GIS (Geographical Information Systems) tools and found a distinct co-factor effect of malaria. After adjusting for important socioeconomic and biological factors, malaria parasite intensity in areas of residence was positively associated with HIV prevalence. Although malaria is not transmitted sexually, the immune activation and increases in HIV viral load that it generates suggests that it may have a similar role to herpes simplex-2 infection in mature HIV epidemics. The authors estimate that HIV viral load increases induced by malaria may account for around 27% of new HIV infections in areas of high malaria parasite intensity. Reducing malaria transmission could have an important impact on the relative risk of HIV infectionmalaria control could be conceived as a structural component of combination HIV prevention if it changes the risk environment. Culled from: http://bit.ly/lp9w01 Prof O.A. Ladipo, ARFH

HIV-malaria co-infection: effects of malaria on the prevalence of HIV in East sub-Saharan Africa
Cuadros DF, Branscum AJ, Crowley PH. Int J Epidemiol. 2011 Jan 11

The objective of this study was to examine the association between malaria and HIV prevalence in East sub-Saharan Africa. Using large nationally representative samples of 19,735 sexually active adults from the 2003-04 HIV/AIDS indicator surveys conducted in Kenya, Malawi and Tanzania, and the atlas malaria project, Cuadros and colleagues analysed the relationship between malaria and HIV prevalence adjusting for important socioeconomic and biological cofactors. In adjusted models, individuals who live in areas with a high Plasmodium falciparum parasite rate (> 0.42) had increased estimated odds of being HIV positive than individuals who live in areas with low P. falciparum parasite rate ( 0.10) [men: estimated odds ratio (OR)

Volume 3, Issue 1

Page 4

Employment Opportunity

Amsterdam Institute for Social Science Research Centre for Global Health and Inequality The University of Amsterdam: The University of Amsterdam (UvA) is one of Europes leading academic institutions. Its social science faculty is the largest in the Netherlands. To sustain and build upon its position as top-quality research university the UvA designated several research priority areas that represent the very best that the UvA has to offer, areas in which the University is a leader worldwide. One of these priority areas is the study of global health and development. The Centre for Global Health and Inequality: The Center for Global Health and Inequality (CGHI) is the social science partner in the research priority area Global Health and Development (see also www.cghi.nl). The CGHI engages in research on the global flows of health-related personnel and technologies; socio-cultural factors that constrain access to health care; user views on and experiences with health care; (inter) generational issues in health and health care; mental and chronic health and health care; reproductive and sexual health and rights; diverging logics of care; and new forms of health-related personhood. The CGHI conducts its studies in collaboration with key partner institutions in Asia, Africa and Latin America, involving around 20 PhD students and postdoctoral fellows (most of whom conduct studies in Africa). To enhance the value of the knowledge generated, national and international stakeholders are involved in all phases of the studies. The CGHI is a partner in the recently funded project Ending new HIV infections in Swaziland: A catalytic model for Southern Africa. This project, led by the Dutch NGO STOP AIDS NOW! (SAN!) and the Clinton Health Access Initiative (CHAI), has three ambitious goals: 1. To achieve universal access to treatment for those who are eligible based on clinical and immunological criteria in three years in Swaziland To evaluate the impact of universal access to treatment, at the current threshold of eligibility, on prevention efforts To provide proof of concept for treatment-centred prevention (TCP) through the launch and completion of a TCP pilot programme. now widely available in the country and given in a wide range of different health facilities. The current emphasis counsellors give to HIV prevention for those clients who test positive is not well documented and no literature is available. Additionally, though there is an increased focus on disclosure support in HIV care and treatment trainings in Swaziland, the specific support offered to HIV-positive clients is unknown. The selected candidate will research these topics in HTC-providing facilities and will study subsequent disclosure patterns of HIV positive people within the community. The candidate will conduct a series of in-depth studies - at baseline, 6 months and 18 months in a nationwide representative sample of HCT sites. The studies will focus on HIV-positive clients understandings of the prevention messages that they receive during counselling, in addition to the disclosure support that they are offered. In addition, the candidate will conduct community-based surveys to determine the extent to which people access HIV testing services, the reasons for non-use of services, as well as disclosure patterns among people who test HIV-positive. The research findings will be translated into actionable and accessible policy recommendations and concrete products (tools or guidelines) that will be shared at learning events in Swaziland in order to facilitate learning by key actors in Swaziland. Position B The greatest barrier to the success of an antiretroviral treatment regimen is non-adherence. Research in Africa shows that people generally are very committed to the adherence goals of ART programmes; however structural barriers make it hard for them to achieve the optimal levels of adherence necessary. Non-adherence to antiretroviral medication can lead to treatment failure, viral resistance, toxicities and is a waste of financial resources. Without a greater understanding of the factors associated with non-adherence and interventions to mitigate them, the prevention benefits of antiretroviral therapy could be threatened. The selected candidate will assess both levels of adherence and reasons for lapses in adherence. The study will provide evidence about how to achieve optimal adherence, which is essential to our key target verifying that universal access to treatment can lead to a 50% reduction of the number of new infections over a period of 10 years. A previous developed adherence instrument will be used to assess adherence levels in clients of ART programmes (quantitative) and gain insights into the most important barriers to adherence (qualitative), using a combination of semi-structured interviews (including self-reported adherence) and pill counts at 16 health facilities. The research findings will be translated into actionable and accessible policy recommendations and concrete products (tools or guidelines) that will be shared at learning events in Swaziland in order to facilitate learning by key actors in Swaziland.

2. 3.

The CGHI is the lead partner for the social science component in this project and currently has an opening for 2 (junior) researchers to conduct one community study each within this project. Position A

In the past, HIV tests were conducted in Swaziland through voluntary counselling and testing (VCT) facilities, at which trained counsellors followed a detailed protocol, which emphasized prevention Profile during both the pre- and post-test sessions. Recently, Swaziland MA degree in Social Sciences or Public Health, or a BA degree has adopted the WHO international guidance on PIHTC and HTC,

Improving Reproductive Health Through: Forging Partnerships, Strengthening Research & Disseminating Evidence

and two years of relevant working experience Excellent proficiency in English and SiSwati Interest in conducting health-related research. Experience with qualitative research is an advantage. Knowledge of HIV/AIDS policies and developments in Southern Africa Willing and able to spend 7 months (September 2011November 2011 and January 2012 April 2012) in Amsterdam, The Netherlands Appointment

study. Further information and application For more information about this position, please contact the research coordinator of the CGHI, Rosalijn Both, e-mail: R.E.C.Both@uva.nl For the first round interested candidates are requested to send a motivation letter and a CV before June 11 th 2011, to the University of Amsterdam, Prof. R. Reis, Oudezijds Achterburgwal 185, 1012 DK Amsterdam, The Netherlands. You can also reply by email to R.Reis@uva.nl Selected candidates will be contacted and invited to write a short proposal for the second round in which they describe their research plans with regard to this study. On the basis of these proposals a final selection will be made. A test in proficiency in English (TOEFL or IELTS) and an interview through skype may form part of the selection procedure.

REPRONET-AFRICA

C/O Zambia Forum for Health Research (ZAMFOHR) 23 Chindo Road Post-net 261 Woodlands Lusaka, Zambia T: +260 211 261718 F: +260 211 261719 E: nkunda.v@repronetafrica.org

The (junior) researchers will be appointed for three years, starting July 1st 2011. The first year will exist of preparations for fieldwork, a pilot study, and training at the Amsterdam Masters in Medical Anthropology (AMMA) [see also www.fmg.uva.nl/amma]. During the training the candidates will be based in Amsterdam. Upon successfully finalizing the community studies, and NB: please make clear in your motivation letter to depending on academic level and performance, which position you apply the researchers may be given the opportunity to Dr Heli Bathija, WHO-RHR write a doctoral thesis based on the results of the

repronet-africa.org

Funding Opportunities
Australian Leadership Awards Scholarships
MS/PhD Degree | Deadline: May-June 2011 (annual) | Study in: Australia | Course starts 2012 Source: bit.ly/jHECtd

International Development Scholarships at Swansea University

BS/Masters | Deadline: 1 July 2011 | Study in: UK | Course starts Sept 2011 Source link: bit.ly/k8QXmX

Synergos Senior Fellows Network: Fellowship opportunity for civil society leaders
Deadline: July 1, 2011 | Course starts 2012 The Synergos Institutes Senior Fellows Network program is a fellowship opportunity for civil society leaders to enhance their leadership skills to become catalysts and play a major role in partnerships that address problems of poverty and social injustice Source Link: http://www.synergos.org/fellows/application.htm

Your Contribution is Important!

Special thanks for suggestions and article contributions made towards this issue go to: Dr Joseph Kasonde, Zambia Forum for Health Research (ZAMFOHR), Zambia Prof. O.A. Ladipo, Association for Reproductive and Family Health (ARFH), Nigeria Dr Mags Beksinska, Maternal Adolescent and Child Health, South Africa Dr Heli Bathija, World Health Organisation Dept. of Reproductive Health Research Thank you all so much for your comments, contributions and suggestions towards the April issue. We look forward to receiving more of your article suggestions for future issues. These as well as any feedback you may have can be forwarded at any time to nkunda.v@repronet-africa.org. Warmest wishes Nkunda Vundamina, Coordinator