Suchergebnisse

ObjectivesHIV counselling and testing is critical to HIV prevention and treatment efforts. Mass campaigns may be an effective strategy to increase HIV testing in countries with generalized HIV epidemics. We assessed the self‐reported uptake of HIV testing among individuals who had never previously tested for HIV, particularly those in high‐risk populations, during the period of a national, multisector testing campaign in South Africa (April 2010 and June 2011).DesignThis study was a prospective cohort study.MethodsWe analyzed data from two waves (2010/2011, n=16,893; 2012, n=18,707) of the National Income Dynamics Study, a nationally representative cohort that enabled prospective identification of first‐time testers. We quantified the number of adults (15 years and older) testing for the first time nationally. To assess whether the campaign reached previously underserved populations, we examined changes in HIV testing coverage by age, gender, race and province sub‐groups. We also estimated multivariable logistic regression models to identify socio‐economic and demographic predictors of first‐time testing.ResultsOverall, the proportion of adults ever tested for HIV increased from 43.7% (95% confidence interval (CI): 41.48, 45.96) to 65.2% (95% CI: 63.28, 67.10) over the study period, with approximately 7.6 million (95% CI: 6,387,910; 8,782,986) first‐time testers. Among black South Africans, the country's highest HIV prevalence sub‐group, HIV testing coverage improved among poorer and healthier individuals, thus reducing gradients in testing by wealth and health. In contrast, HIV testing coverage remained lower for men, younger individuals and the less educated, indicating persistent if not widening disparities by gender, age and education. Large geographic disparities in coverage also remained as of 2012.ConclusionsMass provision of HIV testing services can be effective in increasing population coverage of HIV testing. The geographic and socio‐economic disparities in programme impacts can help guide best practices for future efforts. These efforts should focus on hard‐to‐reach populations, including men and less‐educated individuals.

Raising women's political participation leads to faster maternal mortality decline. We estimate that the introduction of quotas for women in parliament results in a 9-12 per cent decline in maternal mortality. In terms of mechanisms, it also leads to an 8-11 per cent increase in skilled birth attendance and a 6-11 per cent increase in prenatal care utilization. We find reinforcing evidence from the period in which the United States experienced rapid declines in maternal mortality. The historical decline made feasible by the introduction of antibiotics was significantly greater in states that had longer exposure to women's suffrage.

South Africa's government disability grants are considered important in providing income support to low-income AIDS patients. Indeed, anecdotal evidence suggests that some individuals may opt to compromise their health by foregoing Highly Active Antiretroviral Treatment (HAART) to remain eligible for the grant. In this study, we examined the disability grant's importance to individual and household welfare, and the impact of its loss using a unique longitudinal dataset of HAART patients in Khayelitsha, Cape Town. We found that grant loss was associated with sizeable declines in income and changes in household composition. However, we found no evidence of individuals choosing poor health over grant loss. Our analysis also suggested that though the grants officially target those too sick to work, some people were able to keep grants longer than expected, and others received grants while employed. This has helped cushion people on HAART, but other welfare measures need consideration.

BACKGROUND: Despite preventive health benefits of the human papillomavirus (HPV) vaccination, uptake in the United States remains low. Twenty-four states have enacted legislation regarding HPV vaccination and education. One reason these policies have been controversial is because of concerns that they encourage risky adolescent sexual behaviors. Our aim in this study is to determine if state HPV legislation is associated with changes in adolescent sexual behaviors. METHODS: This is a difference-in-difference study in which we use data on adolescent sexual behaviors from the school-based state Youth Risk Behavior Surveillance System from 2001 to 2015. Sexual behaviors included ever having sexual intercourse in the last 3 months and condom use during last sexual intercourse. We compared changes in sexual behaviors among high school students before and after HPV legislation to changes among high school students in states without legislation. RESULTS: A total of 715 338 participants reported ever having sexual intercourse in the last 3 months, and 217 077 sexually active participants reported recent condom use. We found no substantive or statistically significant associations between HPV legislation and adolescent sexual behaviors. Recent sexual intercourse decreased by 0.90 percentage points (P = .21), and recent condom use increased by 0.96 percentage points (P = .32) among adolescents in states that enacted legislation compared with states that did not. Results were robust to a number of sensitivity analyses. CONCLUSIONS: Implementation of HPV legislation was not associated with changes in adolescent sexual behaviors in the United States. Concern that legislation will increase risky adolescent sexual behaviors should not be used when deciding to pass HPV legislation.