Voluntary counseling and testing among post-partum women in Botswana.
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OBJECTIVE: To determine uptake and socio-demographics predictors of acceptance of voluntary counseling and testing (VCT) among post-partum women in Botswana. METHODS: Women attending maternal and child health clinics for their first post-partum or well baby visit in three sites in Botswana were offered VCT after a written informed consent. A standardized questionnaire was used to collect socio-demographic characteristics and reasons for declining VCT. RESULTS: From March 1999 to November 2000, we approached 1735 post-partum women. Only 937 (54%) of those approached accepted VCT. In multiple logistic regression analysis, younger maternal age, not being married, and less formal education were significant predictors of acceptance of VCT. Thirty percent of women who accepted VCT were HIV-positive. CONCLUSION: Our results indicated that in Botswana prior to the initiation of a government Mother to Child Transmission (MTCT) prevention program, younger, unmarried, and less educated post-partum women were more likely to undergo VCT. PRACTICE IMPLICATIONS: Our results have shown that interventions to improve VCT among post-partum women and more generally among women of reproductive age are warranted in Botswana. These interventions should account for differences such age, marital status, education, and partner involvement to maximize VCT uptake. (+info)
Knowledge of HIV/AIDS and attitude towards voluntary counseling and testing among adults.
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BACKGROUND: Nigeria has the third highest population of people living with human immunodeficiency virus (HIV). Despite this, the knowledge of HIV/AIDS and uptake of voluntary counseling and testing (VCT) is still low, especially in the rural areas. This study assessed knowledge of HIV/AIDS and attitude towards VCT among adults in a rural community in northern Nigeria. METHODS: A pretested questionnaire was administered on a cross-section of 210 adults in Danbare village, northern Nigeria. Information about knowledge of HIV/AIDS and attitudes toward VCT was elicited among respondents. RESULTS: The majority of respondents (59%) did not know the causative agent of AIDS; however, knowledge of route of disease transmission was high, with 71% and 64% of study participants mentioning sexual activity and unscreened blood transfusion, respectively, as possible transmission routes. Respondents listed avoidance of premarital sex, outlawing prostitution, condom use and screening of blood before transfusion as protective measures. Overall, 58 (27.6%), 80 (38.1%) and 72 (34.3%) of the respondents had good, fair and poor knowledge of HIV/AIDS, respectively. After adjusting for confounders, female gender and formal education remained significant predictors of HIV/AIDS knowledge. Reasons for rejection of VCT included fear of stigma, marital disharmony, incurable nature of the disease and cost of treatment. Formal education, female gender and HIV knowledge significantly predicted positive attitude toward VCT for HIV/AIDS among the study population. CONCLUSION: More than half of the respondents had adequate knowledge of HIV/AIDS, and the majority were willing to have VCT. However, misconceptions, fear, gaps in knowledge and limited access to VCT remain prevalent. Our findings suggest the need to provide health education and scale up VCT services in northern Nigeria by targeting the efforts of international and local development partners to underserved rural areas. (+info)
Evidence of a healthy volunteer effect in the prostate, lung, colorectal, and ovarian cancer screening trial.
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Volunteers for prevention or screening trials are generally healthier and have lower mortality than the general population. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) is an ongoing, multicenter, randomized trial that randomized 155,000 men and women aged 55-74 years to a screening or control arm between 1993 and 2001. The authors compared demographics, mortality rates, and cancer incidence and survival rates of PLCO subjects during the early phase of the trial with those of the US population. Incidence and mortality from PLCO cancers (prostate, lung, colorectal, and ovarian) were excluded because they are the subject of the ongoing trial. Standardized mortality ratios for all-cause mortality were 46 for men, 38 for women, and 43 overall (100 = standard). Cause-specific standardized mortality ratios were 56 for cancer, 37 for cardiovascular disease, and 34 for both respiratory and digestive diseases. Standardized mortality ratios for all-cause mortality increased with time on study from 31 at year 1 to 48 at year 7. Adjusting the PLCO population to a standardized demographic distribution would increase the standardized mortality ratio only modestly to 54 for women and 55 for men. Standardized incidence ratios for all cancer were 84 in women and 73 in men, with a large range of standardized incidence ratios observed for specific cancers. (+info)
Does risk equalization reduce the viability of voluntary deductibles?
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Theoretically, a risk avers consumer takes a deductible if the premium rebate (far) exceeds his/her expected out-of-pocket expenditures. In the absence of risk equalization, insurers are able to offer high rebates because those who select into a deductible plan have below-average expenses. This paper shows that, for high deductibles, such rebates cannot be offered if risk equalization would "perfectly" adjust for the effect of self selection. Since the main goal of user charges is to reduce moral hazard, some effect of self selection on the premium rebate can be justified to increase the viability of voluntary deductibles. (+info)
Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India.
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CONTEXT: Violence against women is a global phenomenon that cuts across all social and economic classes. AIMS: This study was designed to measure the prevalence and correlates of domestic violence (DV) among women seeking services at a voluntary counseling and testing (VCT) center in Bangalore, India. SETTINGS AND DESIGNS: A cross-sectional survey was conducted among women visiting an human immunodeficiency virus (HIV) VCT center in Bangalore, between September and November 2005. MATERIALS AND METHODS: An interviewer-administered questionnaire was used to collect information about violence and other variables. STATISTICAL ANALYSIS USED: Univariable associations with DV were made using Pearson Chi-squared test for categorical variables and Student t-test or the Mann-Whitney test for continuous variables. RESULTS: Forty-two percent of respondents reported DV, including physical abuse (29%), psychological abuse (69%) and sexual abuse (1%). Among the women who reported violence of any kind, 67% also reported that they were HIV seropositive. The most common reasons reported for DV included financial problems (38%), husband's alcohol use (29%) and woman's HIV status (18%). Older women (P < 0.001) and those with low income levels were the most likely to have experienced DV (P = 0.02). Other factors included husband's education, HIV seropositivity and alcohol or tobacco use (P < 0.001). CONCLUSION: This study found DV levels comparable to other studies from around the world. The findings highlight the need for additional training among health care providers in VCT centers in screening for DV, detection of signs of physical abuse and provisions and referrals for women suffering from domestic partner violence. (+info)
Hey Buddy can you spare a DNA? New surveillance technologies and the growth of mandatory volunteerism in collecting personal information.
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The new social surveillance can be defined as scrutiny through the use of technical means to extract or create personal or group data, whether from individuals or contexts. Examples include: video cameras; computer matching, profiling and data mining; work, computer and electronic location monitoring; biometrics; DNA analysis; drug tests; brain scans for lie detection; various forms of imaging to reveal what is behind walls and enclosures. There are two problems with the new surveillance technologies. One is that they don't work and the other is that they work too well. If the first, they fail to prevent disasters, bring miscarriages of justice, and waste resources. If the second, they can further inequality and invidious social categorization; they chill liberty. These twin threats are part of the enduring paradox of democratic government that must be strong enough to maintain reasonable order, but not so strong as to become undemocratic. (+info)
Routine voluntary HIV testing in Durban, South Africa: the experience from an outpatient department.
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OBJECTIVE: To evaluate the yield of a routine voluntary HIV testing program compared with traditional provider-referred voluntary counseling and testing (VCT) in a hospital-affiliated outpatient department (OPD) in Durban, South Africa. DESIGN AND METHODS: In a prospective 14-week "standard of care" period, we compared OPD physician logs documenting patient referrals to the hospital VCT site with HIV test registers to measure patient completion of HIV test referral. The standard of care period was followed by a 12-week intervention during which all patients who registered at the OPD were given an educational intervention and offered a rapid HIV test at no charge as part of routine care. RESULTS: During the standard of care period, OPD physicians referred 435 patients aged > or = 18 years for HIV testing; 137 (31.5%) of the referred patients completed testing at the VCT site within 4 weeks. Among those tested, 102 (74.5%) were HIV infected. During the intervention period, 1414 adults accepted HIV testing and 1498 declined. Of those tested, 463 (32.7%, 95% confidence interval: 30.3 to 35.3) were HIV infected. Routine HIV testing in the OPD identified 39 new HIV cases per week compared with 8 new cases per week with standard of care testing based on physician referral to a VCT site (P < 0.0001). CONCLUSIONS: Routine voluntary HIV testing in an OPD in South Africa leads to significantly higher rates of detection of HIV disease. This strategy should be implemented more widely in high HIV prevalence areas where treatment is available. (+info)
The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout.
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The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment. Of the 236 participants, 39.4% (n = 93) met criteria for ASPD and 72.5% (n = 171) were mandated to treatment through a pretrial release-to-treatment program. Results indicated a significant interaction between ASPD and CM status, such that patients with ASPD who were voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete time survival analyses to predict days until dropout, using Cox proportional hazards regression, indicated similar findings, with patients with ASPD who were voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining patients with ASPD, as well as the role of ASPD in predicting treatment dropout for individuals who are in treatment voluntarily. Implications, including the potential value of the early implementation of specialized interventions aimed at improving adherence for patients with ASPD who are receiving treatment voluntarily, are discussed. (+info)