Papers by Abigail Harrison
African Journal of Reproductive Health, 2014
This paper addresses current and emerging HIV prevention strategies for women in Sub-Saharan Afri... more This paper addresses current and emerging HIV prevention strategies for women in Sub-Saharan Africa, in light of recent trial results and ongoing research. What are the major opportunities and challenges for widespread implementation of new and emerging HIV prevention strategies? The paper discusses the major individual, social and structural factors that underpin women's disproportionate risk for HIV infection, with attention to gender, adolescents as a vulnerable population, and the need to engage men. Also, the influence of these factors on the ultimate success of both behavioral and biomedical HIV prevention technologies for women in sub-Saharan Africa is discussed. Finally, the paper examined how the new and emerging biobehavioral prevention strategies served as tools to empower women to adopt healthy HIV preventive and reproductive health behaviors.
BMC Health Services Research
Background Early sexual debut, low educational attainment, history of rape and transactional and ... more Background Early sexual debut, low educational attainment, history of rape and transactional and intergenerational sex have been associated with HIV infection among Nigerian adolescents, especially females. We sought to understand the “why”, and how to mitigate against these determinants and barriers to addressing adolescent sexual and reproductive health (SRH) and HIV prevention needs. Methods This qualitative study generated data from 49 focus group discussions with male and female adolescents living with and without HIV, healthcare workers, members of civil society organizations working with young people, and parents of adolescents living with HIV. Participants were recruited from all six geopolitical zones in Nigeria. Data was analysed with ATLAS.ti software. Hermeneutic units were created, and codes developed from focus group transcripts. Network View Manager was used to create maps of codes, memos and quotations, and relevant quotes were retrieved from transcripts. Results Fou...
Frontiers in Reproductive Health
IntroductionOf the 1.75 million adolescents aged 10–19 years living with HIV globally, 84% reside... more IntroductionOf the 1.75 million adolescents aged 10–19 years living with HIV globally, 84% reside in sub-Saharan Africa. This problem is most acute in South Africa, where there are 720,000 adolescents living with HIV (ALHIV). ALHIV navigate the same challenges as other adolescents—such as puberty and first relationships—as well as challenges specific to their HIV-status—including stigma, disclosure, and concerns about HIV transmission. This dual burden calls for tailored sexual and reproductive health (SRH) programs. Here, we qualitatively explore the reflections of South African ALHIV on SRH education, communication, and discussion provided by adults in schools, clinics, and the home related to their unique SRH needs.MethodsThis paper reports on qualitative data from a mixed-methods study to inform interventions that meet the SRH needs of ALHIV. In-depth interviews (N = 20) were conducted with ALHIV recruited from two clinics in Cape Town, South Africa. Nine males and 11 females ag...
African Journal of Reproductive Health, Nov 1, 2017
Very little is known about the sexual and reproductive health (SRH) needs of adolescents living w... more Very little is known about the sexual and reproductive health (SRH) needs of adolescents living with HIV (ALHIV) in general and the needs of those in Nigeria specifically. A review was conducted to identify the SRH of ALHIV, assess if these are different from the SRH of adolescents who are free from HIV infection, and from those of adults living with HIV. Few research have been conducted on how ALHIV deal with sexual and reproductive health challenges faced in their everyday lives-as adolescents and as persons living with HIV living in sub-Saharan Africa-to help make any meaningful inferences on these differing needs. The review suggests that the SRH needs and practices of ALHIV may differ from that of other adolescents and that of adults living with HIV. ALHIV would require support to cope with sex and sexual needs, through full integration of individualized SRH services into the HIV services received. Service providers need to appreciate the individualistic nature of health problems of ALHIV and address their health care from this holistic perspective. A 'one-size-fits-all' approach for designing SRH programmes for ALHIV would not be appropriate. We conclude that research evidence should inform the design and implementation of ALHIV friendly SRH programmes services in both urban and rural settings in Nigeria.
PLOS ONE, 2021
Objective Many men living with HIV want to have children. Opportunities to reduce periconception ... more Objective Many men living with HIV want to have children. Opportunities to reduce periconception HIV transmission include antiretroviral therapy as prevention, pre-exposure prophylaxis, limiting condomless sex to peak fertility, and sperm processing. Whether men have knowledge of or want to adopt these strategies remains unknown. Methods We conducted focus group discussions (FGDs) with men accessing HIV care in South Africa in 2014 to inform a safer conception intervention for men. Eligible men were 25–45 years old, living with HIV, not yet accessing treatment, and wanting to have a child with an HIV-negative or unknown serostatus female partner (referred to as the “desired pregnancy partner”). FGDs explored motivations for having a healthy baby, feasibility of a clinic-based safer conception intervention, and acceptability of safer conception strategies. Data were analyzed using thematic analysis. Results Twelve participants from three FGDs had a median age of 37 (range 23–45) year...
JMIR Formative Research, 2021
Background: Many men with HIV (MWH) want to have children and may thus expose partners to HIV. HI... more Background: Many men with HIV (MWH) want to have children and may thus expose partners to HIV. HIV-RNA suppression can minimize sexual HIV transmission risks while allowing for conception and optimizing the health of men, their partners, and their infants. Objective: To develop and evaluate feasibility and acceptability of an intervention to promote serostatus disclosure, ART uptake and adherence, and HIV-RNA suppression among MWH who want to have children in South Africa. Methods: We developed a Safer Conception Intervention ("Sinikithemba Kwabesilisa", or, "We give hope to men") to promote HIV-RNA suppression via ART uptake and adherence, HIV-serostatus disclosure, and other safer conception strategies for MWH in South Africa. Through 3 counseling and 2 booster sessions over 12 weeks, we offered education on safer conception strategies, and aided participants to develop a safer conception plan. We recruited MWH (HIV diagnosis known for >1 month), not yet accessing or accessing ART for <3 months, in a stable partnership with an HIV-uninfected or unknown-serostatus woman and wanting to have a child in the next year. We conducted an open pilot to evaluate acceptability based on patient participation and exit interviews, and feasibility based on recruitment and retention. In depth exit interviews were conducted with 11 men to explore intervention acceptability including affective attitudes towards the intervention, perceived efficacy, self-efficacy to benefit from the intervention. Questionnaires collected at baseline and exit assessed disclosure outcomes; CD4 and HIV-RNA data were abstracted from clinical charts to evaluate preliminary impacts on clinical outcomes of interest. Results: Among 31 eligible men, 16 enrolled in the study with a median age of 29 years (range 27-44), and a median time since diagnosis being 7 months prior to enrollment (range 1 month-9 years). All identified as black South African with nine (56%) reporting secondary school completion, 7 (43%) reporting full-time employment. Seven (44%) reported an HIV-negative (vs. unknown-serostatus) partner. Fourteen men (88%) completed the 3 primary counseling sessions. In exit interviews, men reported personal satisfaction with session content and structure, while also suggesting they would refer peers to the program. They also described perceived effectiveness of the intervention and self-efficacy to benefit by reporting that the sessions provided new knowledge, instilled hope, and were perceived as helpful overall. Though significance testing was not conducted, quantitative outcomes were that thirteen men (81%) were taking ART at exit with 100% of those on ART with HIV-RNA suppressed at 12 weeks. Twelve men (75%) reported disclosure to pregnancy partner. Conclusions: These preliminary data suggest that safer conception care is acceptable to men and has the potential to reduce HIV incidence among women and their children while supporting men's health. However, only approximately half of those who met screening eligibility enrolled. Accordingly, refinement to optimize uptake is needed. Providing safer conception care and peer support at the community level may help to reach men. Clinical Trial: ClinicalTrials.gov NCT03818984
Social Science & Medicine, 2020
PLOS ONE, 2019
Background and objectives Impacts of mindfulness-based programs on blood pressure remain equivoca... more Background and objectives Impacts of mindfulness-based programs on blood pressure remain equivocal, possibly because the programs are not adapted to engage with determinants of hypertension, or due to floor effects. Primary objectives were to create a customized Mindfulness-Based Blood Pressure Reduction (MB-BP) program, and to evaluate acceptability, feasibility, and effects on hypothesized proximal self-regulation mechanisms. Secondary outcomes included modifiable determinants of blood pressure (BP), and clinic-assessed systolic blood pressure (SBP). Methods This was a Stage 1 single-arm trial with one year follow-up. Focus groups and in-depth interviews were performed to evaluate acceptability and feasibility. Self-regulation outcomes, and determinants of BP, were assessed using validated questionnaires or objective assessments. The MB-BP curriculum was adapted from Mindfulness-Based Stress Reduction to direct participants' mindfulness skills towards modifiable determinants of blood pressure. Results Acceptability and feasibility findings showed that of 53 eligible participants, 48 enrolled (91%). Of these, 43 (90%) attended at least 7 of the 10 MB-BP classes; 43 were followed to one year (90%). Focus groups (n = 19) and semi-structured interviews (n = 10) showed all participants viewed the delivery modality favorably, and identified logistic considerations concerning program access as barriers. A priori selected primary self-regulation outcomes showed improvements at one-year follow-up vs. baseline, including attention control
Value in Health, 2018
self-care relevant. ConClusions: The CLDQ provides comprehensive assessment of fatigue and pain-r... more self-care relevant. ConClusions: The CLDQ provides comprehensive assessment of fatigue and pain-related symptoms experienced by patients with CHB, and of some aspects of emotional wellbeing. The CLDQ does not assess stigmatization and impact on self-esteem which are important concepts for many patients with CHB. Revised wording is recommended to ensure the CLDQ is easy for CHB patients to understand. EQ-5D-5L items assessing self-care and mobility may be less relevant for CHB patients.
Archives of Sexual Behavior, 2017
Despite concerted prevention efforts, young South African women remain at the epicenter of the HI... more Despite concerted prevention efforts, young South African women remain at the epicenter of the HIV epidemic. Although these women have grown up in a community powerfully affected by HIV, systematic investigation into how this ''second generation''of HIV-affected youth navigates HIV risk is lacking. This study qualitatively explored a complex inter-playoffactorsinfluencingHIVriskamongyoungpregnantwomen in KwaZulu-Natal, South Africa. We conducted in-depth interviews with 35 pregnant women (22 HIV-uninfected and 13 HIVinfected) aged 18-21, 18 healthcare providers, and focus groups with 19community stakeholders.Among the young women,HIV knowledge was high, and many reported taking some action to prevent pregnancy or HIV; however, these efforts were not routinely implemented. Themes related to HIV acquisition risk from all participants were organized using a socioecological framework andrevolved around individual and developmentalexperiences (personal experience with HIV, perceived invincibility), family barriers (lackof adult supervision,pressure toleave school), relational barriers (lack of disclosure and partner communication, ''burn out''around attempts to discuss condom use with partners, overdependence on partners), community-level barriers (township environment, lack of structured activities), and social barriers (poverty, HIV-related stigma). Some novel concepts emerged from the data, including an understanding of how overdependence on the romantic relationship may develop. Current HIV prevention efforts, including traditional HIV counseling and testing, condom distribution, and biomedical agents for HIV prevention, are unlikely to be effective without a broader, ecological upto-date understanding of the evolving, intertwined, and complex constellation of factors that drive HIV risk behavior in this highrisk population.
AIDS and Behavior, 2018
The disproportionate burden of HIV among women in sub-Saharan Africa reflects underlying gender i... more The disproportionate burden of HIV among women in sub-Saharan Africa reflects underlying gender inequities, which also impact patient-provider relationships, a key component to retention in HIV care. This study explored how gender shaped the patient-provider relationship and consequently, retention in HIV care in western Kenya. We recruited and consented 60 HIV care providers from three facilities in western Kenya affiliated with the Academic Model Providing Access to Healthcare (AMPATH). Trained research assistants conducted and audio recorded 1-h interviews in English or Swahili. Data were transcribed and analyzed in NVivo using a structured coding scheme related to provider and patient gender. Gender constructs, as culturally defined, emerged as an important barrier negatively impacting the patient-provider relationship through three main domains: (1) challenges establishing clear roles and sharing power due to conflicting gender versus patient/provider identities, (2) provider frustration over suboptimal patient adherence resulting from gender-influenced contextual barriers, and (3) negative provider perceptions shaped by differing male and female approaches to communication. Programmatic components addressing gender inequities in the health care setting are urgently needed to effectively leverage the patient-provider relationship and fully promote long-term adherence and retention in HIV care.
Journal of Behavioral Medicine, 2019
Linkage to care from mobile clinics is often poor and inadequately understood. This multimethod s... more Linkage to care from mobile clinics is often poor and inadequately understood. This multimethod study assessed linkage to care and antiretroviral therapy (ART) uptake following ART-referral by a mobile clinic in Cape Town (2015/2016). Clinic record data (N = 86) indicated that 67% linked to care (i.e., attended a clinic) and 42% initiated ART within 3 months. Linkage to care was positively associated with HIV-status disclosure intentions (aOR: 2.99, 95% CI 1.13-7.91), and treatment readiness (aOR: 2.97, 95% CI 1.05-8.34); and negatively with good health (aOR: 0.35, 95% CI 0.13-0.99), weekly alcohol consumption (aOR: 0.35, 95% CI 0.12-0.98), and internalised stigma (aOR: 0.32, 95% CI 0.11-0.91). Following linkage, perceived stigma negatively affected ART-initiation. In-depth interviews (N = 41) elucidated fears about ART side-effects, HIV-status denial, and food insecurity as barriers to ART initiation; while awareness of positive ART-effects, follow-up telephone counselling, familial responsibilities, and maintaining health to avoid involuntary disclosure were motivating factors. Results indicate that an array of
AIDS and behavior, Mar 25, 2017
Using survey data collected immediately after referral for ART (N = 87), this study examined ART-... more Using survey data collected immediately after referral for ART (N = 87), this study examined ART-readiness among individuals (18 years and older) attending a mobile health clinic in South Africa. Most participants reported being very ready (84%) and motivated (85%) to start ART, but only 72% were assessed as ready for ART on all measures. Treatment readiness was lower among individuals who did not think they would test HIV-positive (aOR 0.26, p < 0.05) and among individuals who reported being in good health (aOR 0.44, p < 0.1). In contrast, higher readiness was associated with better ART knowledge (aOR 4.31, p < 0.05) and knowing someone who had experienced positive health effects from ART (aOR 2.65, p < 0.05). Results indicate that post-test counselling will need to be designed to deal with surprise at HIV diagnosis, and that health messaging needs to be carefully crafted to support uptake of ART among HIV-positive but healthy individuals. Further research is needed on ...
AIDS and behavior, Jan 13, 2017
Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, an... more Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, and HIV prevention. There are increasing calls to involve men in reproductive health and HIV prevention. This paper describes the process of creating and evaluating the acceptability of a safer conception intervention for men living with HIV who want to have children with partners at risk for acquiring HIV in KwaZulu-Natal, South Africa. Based on formative work conducted with men and women living with HIV, their partners, and providers, we developed an intervention based on principles of cognitive-behavioral therapy to support men in the adoption of HIV risk-reduction behaviors such as HIV-serostatus disclosure and uptake of and adherence to antiretroviral therapy. Structured group discussions were used to explore intervention acceptability and feasibility. Our work demonstrates that men are eager for reproductive health services, but face unique barriers to accessing them.
Sexually transmitted infections, 1999
AIDS and Behavior, 2015
Intended conception likely contributes to a significant proportion of new HIV infections in South... more Intended conception likely contributes to a significant proportion of new HIV infections in South Africa. Safer conception strategies require healthcare provider-client communication about fertility intentions, periconception risks, and options to modify those risks. We conducted in-depth interviews with 35 HIV-infected men and women accessing care in South Africa to explore barriers and promoters to patient-provider communication around fertility desires and intentions. Few participants had discussed personal fertility goals with providers. Discussions about pregnancy focused on maternal and child health, not sexual HIV transmission; no participants had received tailored safer conception advice. Although participants welcomed safer conception counseling, barriers to client-initiated discussions included narrowly focused prevention messages and perceptions that periconception transmission risk is not modifiable.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Introduction: Safer conception strategies create opportunities for HIV-serodiscordant couples to ... more Introduction: Safer conception strategies create opportunities for HIV-serodiscordant couples to realize fertility goals and minimize periconception HIV transmission. Patient-provider communication about fertility goals is the first step in safer conception counseling. Methods: We explored provider practices of assessing fertility intentions among HIV-infected men and women, attitudes toward people living with HIV (PLWH) having children, and knowledge and provision of safer conception advice. We conducted in-depth interviews (9 counselors, 15 nurses, 5 doctors) and focus group discussions (6 counselors, 7 professional nurses) in eThekwini District, South Africa. Data were translated, transcribed, and analyzed using content analysis with NVivo10 software. Results: Among 42 participants, median age was 41 (range, 28-60) years, 93% (39) were women, and median years worked in the clinic was 7 (range, 1-27). Some providers assessed women's, not men's, plans for having children at antiretroviral therapy initiation, to avoid fetal exposure to efavirenz. When conducted, reproductive counseling included CD4 cell count and HIV viral load assessment, advising mutual HIV status disclosure, and referral to another provider. Barriers to safer conception counseling included provider assumptions of HIV seroconcordance, low knowledge of safer conception strategies, personal feelings toward PLWH having children, and challenges to tailoring safer sex messages. Conclusions: Providers need information about HIV serodiscordance and safer conception strategies to move beyond discussing only perinatal transmission and maternal health for PLWH who choose to conceive. Safer conception counseling may be more feasible if the message is distilled to delaying conception attempts until the infected partner is on antiretroviral therapy. Designated and motivated nurse providers may be required to provide comprehensive safer conception counseling.
Sexually Transmitted Infections, 2005
This report examines early sexual debut (,age 15) among young men in rural South Africa including... more This report examines early sexual debut (,age 15) among young men in rural South Africa including (1) risk behaviours at first sexual experience, and (2) age at first sex as a predictor of later sexual risk. Methods: Analysis of sexual behaviour data for men 15-24 years (n = 314) from representative cross sectional household survey. Results: 13.1% of 15-24 year old men experienced sexual debut before age 15. Men with sexual debut at less than age 15 were more likely to report risk behaviours at first sexual experience: no condom use (19%), a casual partner (26.8%), and not feeling they had been ''ready and wanted to have sex'' (19.5%). In multivariate analysis, early sexual debut was strongly associated with >3 partners in the past 3 years (OR = 10.26, p,0.01). Conclusions: Men who initiate sex before age 15 form a distinct risk group in this setting. Specific interventions are needed for young men in the preteen years, before sexual debut.
Evaluation and Program Planning, 2018
A 142-item questionnaire was administered to 289 Grade 6 and 7 female learners (average age 12.3 ... more A 142-item questionnaire was administered to 289 Grade 6 and 7 female learners (average age 12.3 years) on mobile phones using Open Data Kit (ODK) software immediately before and after the five-week programme. The Wilcoxon signed rank sum test was used to assess changes on questionnaire items. Eight focus group discussions (FGDs) and four in-depth interviews (IDIs) were conducted, involving SS participants, parents, teachers, coaches, and a health-care worker. FGDs and IDIs were recorded, translated, and transcribed. Thematic analysis was performed by a four-person team using NVivo 10 software. Structured participant observation was conducted at 11 sessions. Participants showed increased self-efficacy to make healthy decisions, stand up for themselves, and question prevailing gender norms in their communities.
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Papers by Abigail Harrison