Author Archives: Becca Fielding-Miller

Love, lust and the emotional context of multiple and concurrent sexual partnerships among young Swazi adults

Ruark, A., Dlamini, L., Mazibuko, N., Green, E. C., Kennedy, C., Nunn, A., … & Surkan, P. J. (2014). Love, lust and the emotional context of multiple and concurrent sexual partnerships among young Swazi adults. African Journal of AIDS Research, 13(2), 133-143.

Men distinguished sexual partnerships that were just for sex from those that were considered to be ‘real relationships’, while women represented most of their relationships, even those which included significant financial support, as being based on love. Besides being motivated by love, concurrent sexual partnerships were described as motivated by a lack of sexual satisfaction, a desire for emotional support and/or as a means to exact revenge against a cheating partner. Social and structural factors were also found to play a role in creating an enabling environment for high-risk sexual partnerships. These factors included social pressure and norms; a lack of social trust; poverty and a desire for material goods; and geographical separation of partners.

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Generational inversions:‘working’for social reproduction amid HIV in Swaziland

Golomski, C. (2014). Generational inversions:‘working’for social reproduction amid HIV in Swaziland. African Journal of AIDS Research, 13(4), 351-359.

Based on discourse analyses of ethnography at church worship services and life cycle rites between 2008 and 2011, the findings show how both elders and youth understood this crisis of ‘generational inversions’ as a non-alignment of age groups and articulated projects to restore succession and continuity in vernacular idioms of ‘work’ as moralised social and ritual action.

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Barriers and facilitators to combined ART initiation in pregnant women with HIV: lessons learnt from a PMTCT B+ pilot program in Swaziland

Parker, L. A., Jobanputra, K., Okello, V., Nhlangamandla, M., Mazibuko, S., Kourline, T., … & Teck, R. (2015). Barriers and facilitators to combined ART initiation in pregnant women with HIV: lessons learnt from a PMTCT B+ pilot program in Swaziland. Journal of acquired immune deficiency syndromes.

This study not only demonstrates challenges in initiating pregnant women on ART, but also identifies opportunities offered by PMTCT B+ for improving treatment initiation among women with lower CD4 counts.

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Sex is never the same: Men’s perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland

Adams, A., & Moyer, E. (2015). Sex is never the same: Men’s perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland. Global public health, 1-18.

We argue that the campaign’s failure can be partly explained by the fact that circumcision was perceived as a threat to Swazi masculinities, a factor hardly considered in the planning of the intervention. Results show that men believed circumcision resulted in reduced penis sensitivity, reduced sexual pleasure and adverse events such as possible mistakes during surgery and post-operative complications that could have negative effects on their sexual lives. Given the conflicting state of scientific data about the effects of circumcision on sexuality or sexual pleasure, this study addresses important lacunae, while also demonstrating the need for more research into the relationship between sexuality, masculinity and health interventions seeking to involve men.

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Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

Jobanputra, K., Parker, L. A., Azih, C., Okello, V., Maphalala, G., Kershberger, B., … & Reid, T. (2015). Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland. PloS one, 10(2).

Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.

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Feasibility and effectiveness of two community‐based HIV testing models in rural Swaziland

Parker, L. A., Jobanputra, K., Rusike, L., Mazibuko, S., Okello, V., Kerschberger, B., … & Teck, R. (2015). Feasibility and effectiveness of two community‐based HIV testing models in rural Swaziland. Tropical Medicine & International Health.   

In this high HIV prevalence setting, a community-based testing programme achieved high uptake of testing and appears to be an effective and affordable way to encourage large numbers of people to learn their HIV status (particularly underserved populations such as men and young people). However, for community HTC to impact mortality and incidence, strategies need to be implemented to ensure people testing HIV-positive in the community are linked to HIV care.

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Underutilization of isoniazid drug therapy to prevent TB disease progression in Swaziland

Cronin, B., Calnan, M., Haumba, S., & Adams, L. V. (2015). Underutilization of isoniazid drug therapy to prevent TB disease progression in Swaziland. Annals of Global Health, 81(1), 5.

An estimated 80% of the Swaziland population unknowingly contract tuberculosis (TB) as children and harbor inactive TB bacteria in their bodies – a condition called latent TB infection (LTBI). The TB infection can reactivate to cause TB disease in these individuals during their lifetime, especially if they are immunosuppresed by HIV (in Swaziland 75-80% of HIV patients also have latent TB infection). Swaziland has the highest TB incidence rate of any country in the world and TB causes an estimated 50% of the nation’s HIV patient deaths.

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Contraceptive usage in women requesting emergency contraception in Swaziland

Sonubi, S. A., & Nkombua, L. (2015). Contraceptive usage in women requesting emergency contraception in Swaziland. South African Family Practice, 1-4.

Reasons given for not using contraception previously ranged from medical conditions to not being sexually active. Widely used contraceptives are male condoms, injectable hormones and combined oral contraceptives while the least popular are implants, and post-coital pills. Knowledge of contraceptives came mainly from the health facilities, peers and mass media while parents are the least consulted sources. A high percentage (97%) are aware of sexually transmitted diseases (STDs) and that male and female condoms are the best forms of protection against STDs. Demographic and socio-economic variables are not significantly related to the use of contraceptives.

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Closing the health gap in a generation: exploring the association between household characteristics and schooling status among orphans and vulnerable children in Swaziland.

Dlamini, B. N., & Chiao, C. (2015). Closing the health gap in a generation: exploring the association between household characteristics and schooling status among orphans and vulnerable children in Swaziland. AIDS care, (ahead-of-print), 1-10.

Using existing data from the Swaziland Multiple Indicator Cluster Survey 2010, a total of 5890 children aged 7–18 years old were analyzed. The results from the multivariate logistic regressions showed that non-OVC were more likely than OVC to be in school (OR = 2.18, p < 0.001), even after taking other variables into considerations. The OVC in socioeconomically disadvantaged households, such as those with lower levels of household wealt, and those who resided in an urban area, were less likely to be in school. These findings suggest that education programs for OVC need to be household-appropriate.

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Telemedicine for Africa: collaborative action between Italy and Swaziland against HIV infection.

Pizzi, R., Oreni, L., Grassi, S., Ridolfo, A. L., Rusconi, S., Croce, F., & Galli, M. Telemedicine for Africa: collaborative action between Italy and Swaziland against HIV infection.

We developed a Telemedicine platform with a minimum need of connectivity and software resource and high usability, to support the Swaziland caregivers in their fight against the AIDS/HIV disease. The platform offers the possibility of realtime professional consulting, learning tools, scientific documentation availability, and data exchange to the physician of the Siteki Hospital in Swaziland, whose number is severely insufficient. The platform is supported by the physicians of the Division of Infectious Diseases, Hospital L. Sacco, Milan, Italy, and has been implemented using the WordPress CMS enhanced with LMS facilities to ensure an easy management by the African caregivers. After the positive training and testing stage, we aim to integrate the platform with the Siteki Hospital information system to facilitate the clinical data exchange.

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