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APHA Scientific Session and Event Listing

Recorded presentation

Karen S. Leiter, JD, MPH¹, Sheri D. Weiser, MD, MPH², Michele Heisler, MD, MPA³, Fiona Percy-de Korte, DPH¹, Sonya DeMonner, MPH¹, Zakhe Hlanze, MA⁴, Nthabiseng Phaladze, PhD⁵, David Tuller¹, Sibongile Maseko, MPH⁶, and Vincent Iacopino, MD, PhD¹. (1) Physicians for Human Rights, 2 Arrow Street, Suite 301, Cambridge, MA 02138, 617.301.4217, kleiter@phrusa.org, (2) Epidemiology and Prevention Interventions Center, University of California, San Francisco, POB 1372, San Francisco, CA 94110, (3) Division of General Medicine, Department of Internal Medicine, University of Michigan, VA HSR & D, PO Box 130170, Ann Arbor, MI 48113, (4) Women and Law in Southern Africa Research Trust - Swaziland, Portuguese Club, 1st Floor Commercial Road, Mbabane, Swaziland, (5) Department of Nursing Education, University of Botswana, Private Bag 0022, Gaborone, Botswana, (6) United Nations Development Programme, PO Box 261, Mbabane, H100, Swaziland

Background: Botswana and Swaziland are the two countries with the highest prevalence of HIV/AIDS. Though neighbors, their political, economic and social conditions differ and consequently contribute differentially to women's circumstances relevant to HIV-related interventions.

Methods: A cross-sectional, population-based study of 1,268 individuals in five districts in Botswana and 812 women and men in four regions of Swaziland, using a two-stage probability design. Descriptive statistics characterized the study populations and distribution of responses and multivariate logistic regression analyses examined factors associated with HIV testing and sexual risk-taking.

Results: A wide range of health and human rights concerns were identified. For example, the majority of individuals held HIV-related stigmatizing beliefs and gender discriminatory attitudes. A much higher percentage of participants held two or more gender discriminatory attitudes in Swaziland (84%) than in Botswana (44%). Holding these attitudes predicted sexual risk-taking. Women reported lacking control over decisions to have sex or use condoms more often than men. Food insecurity was more common among women (28% in Botswana, 38% in Swaziland) and was associated with lack of control in sexual relationships and risky sex practices. In Swaziland, perceived access to testing was much lower (57%) compared to Botswana (84%), which has a program of universal access to antiretroviral treatment. In both studies there were significant gender differences in reported barriers to HIV testing.

Conclusion: In order for HIV/AIDS interventions to be effective, a health and human rights perspective is essential to identify and holistically address human rights concerns and gender-specific factors driving the epidemic.

Learning Objectives: By the end of the session, the participant will be able to

• Identify and describe human rights concerns relevant to HIV prevention, testing and treatment in Botswana and Swaziland;
• Apply a health and human rights perspective to the design and implementation of HIV/AIDS interventions for women, such as pMTCT, in southern Africa.

Keywords: Women and HIV/AIDS, Human Rights

Related Web page: www.phrusa.org

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation