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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 June 2020) | Viewed by 52565

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Special Issue Editors

Dr. Sónia Dias

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Guest Editor

National School of Public Health, Universidade NOVA Lisboa, 1600-560 Lisboa, Portugal
Interests: health promotion; health literacy; community-based participatory research; key populations; health equity; behavior and social change
Special Issues, Collections and Topics in MDPI journals

Dr. Ana Gama

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Guest Editor

Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Portugal
Interests: sexual health; HIV infection; key populations; community-based participatory research

Dr. Christiana Nöstlinger

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Guest Editor

Institute of Tropical Medicine, Department of Public Health, Belgium
Interests: HIV prevention; sexual health promotion; key populations; behavior and social change theories; systematic health promotion intervention; community-based participatory research

Special Issue Information

Dear Colleagues,

The past decades have seen great improvements in sexual health promotion and HIV prevention worldwide. However, to reverse the HIV epidemic, poor sexual health and its drivers must continually be tackled. Indeed, the major impacts of HIV infection demand a strong response from researchers, professionals, policy-makers and affected communities to address the problem and seek solutions to improve, in particular, the sexual health of vulnerable populations. Key vulnerable populations affected by HIV are those with a higher risk of exposure in combination with interpersonal, socio-political and cultural contexts. It is broadly acknowledged that HIV infection is influenced by multiple complex and interrelated factors. A better understanding of the demographic, socioeconomic and network factors as well as the cultural, structural and political contexts that influence sexual health risks is needed to effectively develop, implement and evaluate targeted and tailored sexual health promotion and HIV prevention interventions. For this special issue of the IJERPH, we invite submissions that examine the drivers of HIV infection and poor sexual health outcomes as well as provide evidence for successful health promotion and prevention strategies, including in high-vulnerability contexts. Manuscripts that present multidisciplinary qualitative, quantitative and mixed-method research are welcomed as well as theoretical, implementation and evaluation studies.

Prof. Sónia Dias
Dr. Ana Gama
Dr. Christiana Nöstlinger
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health promotion for sexual health
HIV infection
risk factors
vulnerability contexts
key populations
prevention interventions

Published Papers (12 papers)

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Research

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11 pages, 323 KiB

Open AccessArticle

Provider Perspectives on Sexual Health Services Used by Bangladeshi Women with mHealth Digital Approach: A Qualitative Study

by Yamin Tauseef Jahangir, Amit Arora, Pranee Liamputtong, Mohammad Hayatun Nabi and Samantha B. Meyer

Int. J. Environ. Res. Public Health 2020, 17(17), 6195; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176195 - 26 Aug 2020

Cited by 5 | Viewed by 4960

Abstract

Cases of sexually transmitted infections (STIs) are underreported in Bangladesh. Women in general suffer from poor sexual health outcomes due to a lack of access to sexual health services. mHealth, a digital approach to STI services, is an easier and cheaper way to disseminate health information in Bangladesh. However, women have less autonomy in accessing STI services and it is important to learn if, how and/or why women use mHealth. A qualitative study was conducted with 26 medical doctors to explore their perceptions of the mHealth STI services used by Bangladeshi women. Themes were grouped under four categories: (1) provider perceptions of mHealth for sexual healthcare; (2) the health literacy of women clients; (3) cost and maintaining timeliness in providing mHealth services; (4) mHealth service accessibility. Data suggest that mHealth can play a significant role in improving the awareness and utilization of STI services in Bangladeshi women. Successful opportunities for STI service expansion using mHealth were identified, depending on the quality and type of service delivery options, awareness of challenges related to health literacy framework, cost, accessibility to information and availability of culturally competent health experts to disseminate health information. We identify the need to increase access and use of mHealth services for sexual health, as it provides an innovative platform to bridge the health communication gaps in sexual health for Bangladeshi women. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

20 pages, 784 KiB

Open AccessArticle

Exploring the Perceived Risks and Benefits of Heroin Use among Young People (18–24 Years) in Mauritius: Economic Insights from an Exploratory Qualitative Study

by Gareth White, Susan E. Luczak, Bernard Mundia and Smita Goorah

Int. J. Environ. Res. Public Health 2020, 17(17), 6126; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17176126 - 23 Aug 2020

Cited by 1 | Viewed by 3955

Abstract

The decreasing age of young people injecting illicit drugs is an under-reported challenge for the prevention of HIV transmission worldwide. Young people aged 15–24 years represent 1 in 5 persons living with HIV in Mauritius where the epidemic is driven by injecting drug use and risky sexual behaviours. We recruited 22 heroin users aged 18–24 and 5 service providers working in harm reduction (HR) for the present study. Qualitative data were collected through unstructured interviews. We adopted an economic framework and an inductive approach to the analysis, which implied revising codes and themes. The risks heroin users described as consumers of illicit drugs and as clients of HR services could not be analyzed in isolation. Polydrug use emerged as a recurrent coping mechanism resulting from the changing dynamics within the heroin market. The risks faced by women went beyond addiction and infection with HIV. How participants viewed the risks and benefits linked to using heroin was greatly influenced by gaps in knowledge that left room for uncertainty and reinforcing mechanisms such as peer influence. The study shows that qualitative research can produce in-depth socio-behavioural insights required to produce more effective services for young people. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

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15 pages, 343 KiB

Open AccessArticle

Changes in Sex Life among People in Taiwan during the COVID-19 Pandemic: The Roles of Risk Perception, General Anxiety, and Demographic Characteristics

by Nai-Ying Ko, Wei-Hsin Lu, Yi-Lung Chen, Dian-Jeng Li, Yu-Ping Chang, Chia-Fen Wu, Peng-Wei Wang and Cheng-Fang Yen

Int. J. Environ. Res. Public Health 2020, 17(16), 5822; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165822 - 11 Aug 2020

Cited by 46 | Viewed by 6684

Abstract

This study used data collected from an online survey study on coronavirus disease 2019 (COVID-19) in Taiwan to examine changes in sex life during the pandemic and the factors affecting such changes. In total, 1954 respondents were recruited from a Facebook advertisement. The survey inquired changes in sex life during the pandemic, including satisfaction with the individual’s sex life, frequency of sexual activity, frequency of sex-seeking activity, and frequency of using protection for sex. The associations of change in sex life with risk perception of COVID-19, general anxiety, gender, age, and sexual orientation were also examined. For each aspect of their sex life, 1.4%–13.5% of respondents reported a decrease in frequency or satisfaction, and 1.6%–2.9% reported an increase in frequency or satisfaction. Risk perception of COVID-19 was significantly and negatively associated with frequencies of sexual and sex-seeking activities. Higher general anxiety was significantly and negatively associated with satisfaction of sex life and frequencies of sexual and sex-seeking activities. Sexual minority respondents were more likely to report decreased satisfaction with sex life and frequencies of sexual activity and sex-seeking activities during COVID-19. Health care providers should consider these factors when developing strategies for sexual wellness amid respiratory infection epidemics. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

13 pages, 317 KiB

Open AccessArticle

An Exploration of U.S. Southern Faith Leaders’ Perspectives of HIV Prevention, Sexuality, and Sexual Health Teachings

by Latrice C. Pichon, Terrinieka Williams Powell, Andrea Williams Stubbs, Nicole Becton-Odum, Siri Ogg, Trisha Arnold and Idia B. Thurston

Int. J. Environ. Res. Public Health 2020, 17(16), 5734; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17165734 - 08 Aug 2020

Cited by 10 | Viewed by 2774

Abstract

Reducing human immunodeficiency viruses (HIV) and acquired immune deficiency syndrome (AIDS) racial/ethnic disparities in the Deep South has been a critical objective of the U.S. National HIV/AIDS Strategy. This finding, originally published in 2010 by the Office of National AIDS Policy, serves as a complement to the Health and Human Resources and Services Administration’s Ending the HIV Epidemic (EtHE): A Plan for America. The EtHE plan, released in 2019, emphasizes community stakeholder involvement to achieve the planning goals of decreasing new HIV infections in key U.S. geographic areas. According to the plan, an important stakeholder is faith leaders, especially around stigma reduction. This paper focuses on a community–academic research partnership’s exploration of southern Black faith leaders’ teaching perspectives regarding HIV prevention, sexuality, and sexual health in predominantly Black congregations in Memphis, Tennessee. The partnership conducted four focus groups using a semi-structured discussion interview. Any adult faith leader involved in ministry work in a predominantly Black church was eligible to participate in the discussion. A total of 26 faith leaders with a mean age of 54, representing four Christian denominations, consented to participate in the study. Emerging themes included: (1) restriction of scripture to teach prevention and address sexuality, (2) role of secrecy and silence in living with HIV, and (3) impact of the stigma of HIV and sexuality. Findings may inform nationwide jurisdictional implementation plans, particularly for faith-based interventions in southern churches working toward ending the HIV epidemic. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

19 pages, 855 KiB

Open AccessArticle

The Effects of Comprehensive Sexual and Reproductive Health/Family Planning Intervention Based on Knowledge, Attitudes, and Practices Among the Domestic Migrant Population of Reproductive Age in China: A Randomized Community Study

by Shuang-Fei Xu, Jun-Qing Wu, Chuan-Ning Yu, Yu-Yan Li, Rui Zhao, Yi-Ran Li and Ying Zhou

Int. J. Environ. Res. Public Health 2020, 17(6), 2093; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17062093 - 21 Mar 2020

Cited by 4 | Viewed by 5526

Abstract

Background: Domestic migrant populations are highly mobilized at a sexually active age, and often fail to meet their needs for contraception. Moreover, they assume sexual and reproductive health (SRH) risks and utilize fewer family planning services. Method: A quasi-experimental trial (community intervention) was adopted. Two-stage stratified cluster sampling was applied to recruit participants in Beijing and Chongqing. A comprehensive SRH/family planning intervention was implemented from August 4 2014 to August 3 2015. Propensity score matching (PSM) and multivariate probit models were adopted. Results: In total, 2100 and 2024 eligible participants were involved, and 815 and 629 pairs were matched by PSM in Beijing and Chongqing, respectively. The knowledge and attitudes of the participants regarding SRH and contraception were significantly improved through the comprehensive intervention. Reversible contraceptive methods were the most prevalent; couples largely decided to utilize condoms and family planning services. Conclusions: The comprehensive intervention had positive effects on knowledge, attitudes, and practices (KAP) for SRH/family planning among the domestic migrant population. The results acquired can be extrapolated to some extent, and the pattern of this intervention is well geared toward other similar settings in China. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

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14 pages, 777 KiB

Open AccessArticle

Promoting Safer Sexual Behaviours by Employing Social Cognitive Theory Among Gay University Students: A Pilot Study of A Peer Modelling Programme

by Luis Miguel Dos Santos

Int. J. Environ. Res. Public Health 2020, 17(5), 1804; https://doi.org/10.3390/ijerph17051804 - 10 Mar 2020

Cited by 14 | Viewed by 6354

Abstract

Unsafe and unprotected sexual behaviours are some of the significant challenges of health promotions and planning for current school environment. Although schools and health specialists constantly host conferences and workshops for adolescents and university students, the results are not significant. Particularly for sexual minorities, the heterosexual-oriented materials may not satisfy their needs due to the differences. As a recommendation, the current pilot study established a Peer Modelling Programme which engaged gay social workers and gay university students who have associated with unsafe and unprotected sexual activities. The outcomes of this Peer Modelling Programme indicated that gay undergraduate students tended to accept the recommendations and peer modelling exchanges from their gay social workers who understood their difficulties and sexual needs as sexual minorities based on the guideline of Social Cognitive Theory. In conclusion, this study may be used to develop additional social work materials, sexual health promotions and health plans for sexual minorities and people with special needs in the society. This research serves as a guideline to social workers who care about the issues of LGBT and sexual minorities. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

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23 pages, 2018 KiB

Open AccessArticle

Effects of an Educational Intervention on Angolan Adolescents’ Knowledge of Human Reproduction: A Quasi-Experimental Study

by Natércia Almeida, Andreia Teixeira, José Garcia, Natália Martins and Carla Ramalho

Int. J. Environ. Res. Public Health 2019, 16(24), 5155; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16245155 - 17 Dec 2019

Cited by 3 | Viewed by 3163

Abstract

Background and objectives: Sex education is a necessity and a right of young people in Angola. However, this education is deficient or even absent in various subsystems and, therefore, the impact of an educational intervention on human biology and sexuality was addressed. Materials and methods: This quasi-experimental study employed a non-equivalent control group, pre-test post-test design. It was conducted with students from three secondary schools (6th to 12th grade, two public and one private) in Huambo (Angola), between June and December 2017. First, a questionnaire was distributed to assess the students’ knowledge on aspects related to sexual maturation, psychological development, gynecological organs’ anatomy, human fertilization, contraception, and risks of unprotected sexuality. Then, an educational program was developed by the principal investigator along with the school’s moral and civic education and biology teachers selected for a group of students (experimental group, EG); the others constituted the control group (CG). Classes were held on non-working days, on Saturday mornings (8:00 to 10:00 a.m.), so as not to interfere with the school calendar. The initial questionnaire was redistributed two months later to assess the impact of the intervention. Results: Of the 589 individuals included (mean age of 16.8 ± 2.5 years), 56.7% were males. EG (n = 241) consisted of students from the public school and CG (n = 348) by students from public and private schools. The last part of the questionnaire consisted of 30 questions to assess students’ knowledge, and in 23 of these questions, both groups showed no differences at baseline. After the intervention, the EG showed significant improvements (p < 0.05), while the CG revealed only slight improvements. Conclusions: Students from Huambo province have a significant lack of knowledge on human biology and sexuality. Rigorous development and evaluation of interventions addressing multiple individual and environmental level factors is needed, notably for effective education in human biology and sexuality. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

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15 pages, 513 KiB

Open AccessArticle

Congruence between Hypothetical Willingness to Use Pre-Exposure Prophylaxis (PrEP) and Eligibility: An Online Survey among Belgian Men Having Sex with Men

by Johannes Bullinger, Thijs Reyniers, Bea Vuylsteke, Marie Laga and Christiana Nöstlinger

Int. J. Environ. Res. Public Health 2019, 16(22), 4411; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16224411 - 11 Nov 2019

Cited by 7 | Viewed by 2526

Abstract

Men who have sex with men (MSM) are at high risk for acquiring HIV in Belgium. This study explores MSMs’ hypothetical willingness to use pre-exposure prophylaxis (PrEP), assesses it against formal PrEP eligibility criteria, and identifies factors associated with incongruence between eligibility and willingness. We used data from an online survey of n = 1444 self-reported HIV-negative MSM. Participants were recruited through social media of MSM organizations and dating apps. Univariate analysis described PrEP willingness and eligibility; bivariate analyses examined how specific co-variates (socio-demographic, knowledge-related, and attitudinal and behavioral factors) were associated with eligibility and willingness. About 44% were eligible for PrEP and about 70% were willing to use it. Those who were eligible were significantly more likely be willing to take PrEP (p < 0.001). Two incongruent groups emerged: 16% of eligible participants were unwilling and 58% of ineligible participants were willing to use PrEP. Factors associated with this incongruence were sexual risk behavior, HIV risk perception, partner status, PrEP knowledge, and attitudinal factors. Because the two groups differ in terms of profiles, it is important to tailor HIV prevention and sexual health promotion to their needs. Among those at risk but not willing to take PrEP, misconceptions about PrEP, and adequate risk perception should be addressed. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

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10 pages, 306 KiB

Open AccessArticle

Role of Knowledge, Sociodemographic, and Behavioral Factors on Lifetime HIV Testing among Adult Population in Nepal: Evidence from a Cross-Sectional National Survey

by Bimala Sharma and Eun Woo Nam

Int. J. Environ. Res. Public Health 2019, 16(18), 3311; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16183311 - 09 Sep 2019

Cited by 4 | Viewed by 2256

Abstract

Human immunodeficiency virus (HIV) testing is important to HIV prevention, treatment, and care. We aimed to assess the role of sociodemographic, behavioral factors and HIV knowledge on HIV testing among people aged 15–49 years in Nepal. The 2011 Nepal Demographic and Health Survey data was used for secondary data analysis. Herein, 9843 women and 3017 men who had experienced coitus were included. The respondents were asked if they underwent HIV testing and received the test results in their lifetime. Chi-square test and multivariate logistic regression analysis were applied at 5% level of significance. Adjusted odds ratios and 95% confidence intervals were computed separately for women and men. Of the total, 18.0% of men and 7.4% of women had been tested for HIV in their lifetime. As compared to the age of 15 to 24 years, males aged 25 to 29 years were more likely to report, whereas females aged 35 to 49 years were less likely to report HIV testing. Lower caste groups had more likelihood of reporting HIV testing than the other caste in both sexes. The odds of being tested for HIV were significantly higher among those who had higher education in both sexes. There was significant positive association between HIV testing and economic status in males whereas this association was reverse among females. The male respondents who spent more than one month away from home in the last 12 months were 1.68 times more likely to have been tested for HIV in their lifetime. Having multiple sexual partners was associated with higher odds of testing for HIV in both sexes. Having comprehensive HIV knowledge was independently associated with the reporting of higher odds of HIV testing in females. Promotion of HIV testing should consider sociodemographic factors, sexual behavior, and imparting comprehensive HIV knowledge. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

15 pages, 348 KiB

Open AccessArticle

Are Opportunities Being Missed? Burden of HIV, STI and TB, and Unawareness of HIV among African Migrants

by Sónia Dias, Ana Gama, Ana Maria Tavares, Vera Reigado, Daniel Simões, Emília Carreiras, Cristina Mora and Andreia Pinto Ferreira

Int. J. Environ. Res. Public Health 2019, 16(15), 2710; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16152710 - 30 Jul 2019

Cited by 6 | Viewed by 2682

Abstract

Sub-Saharan African migrants (SSAMs) have been disproportionately affected by infectious disease burden. We aimed to identify correlates of HIV, past sexually transmitted infection (STI) and past Tuberculosis infection (TB), as well as examine HIV seropositivity unawareness and testing history among SSAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive or having a past STI were higher among participants with low socioeconomic status and who experienced violence from a partner. Increased odds of having a past STI were also found among long-term migrants and those who reported sexual risk behaviors. In total, 4.1% of participants had TB in the past; these were more likely male and HIV positive. Unawareness of HIV-positive status was notably high (35%). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

18 pages, 333 KiB

Open AccessArticle

Effectiveness of a Health Behavioural Intervention Aimed at Reduction of Risky Sexual Behaviours among Young Men in the KwaZulu-Natal Province, South Africa

by Thabang Manyaapelo, Bart Van den Borne, Robert A. C. Ruiter, Sibusiso Sifunda and Priscilla Reddy

Int. J. Environ. Res. Public Health 2019, 16(11), 1938; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16111938 - 31 May 2019

Cited by 10 | Viewed by 5865

Abstract

Two studies evaluating the same behavioural intervention were conducted in two areas in the KwaZulu-Natal province of South Africa using a randomized pre-test post-test control group design for study 1 (peri-urban) and a pre-test post-test design without a control group for study 2 (rural). The intervention included discussions and skills training on: (1) notions of masculinity, manhood, and responsibility, (2) personal and sexual relationships, (3) general communication skills, and (4) alcohol and other substance use. The intervention was aimed at men between 18 and 35 years of age. Measures of attitude, subjective norms, perceived behavioural control and intention for condom use, human immunodeficiency virus (HIV) testing, reduction of alcohol and drug use, avoiding sex while intoxicated, and avoiding sex with intoxicated people were assessed using a facilitator-administered questionnaire. The results for study 1 showed that 4 of the 19 variables scored significantly different at baseline and that all 19 variables showed no significant changes between pre-test and post-test. For study 2, one significant difference was found for attitude towards avoiding sex when one is intoxicated. Overall, the intervention had minimal success with just one area of positive effect. Further development and testing of this programme is recommended before it can be considered for broader scale implementation. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

Review

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28 pages, 1799 KiB

Open AccessReview

Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review

by Linda Campbell, Caroline Masquillier, Estrelle Thunnissen, Esther Ariyo, Hanani Tabana, Neo Sematlane, Anton Delport, Lorraine Tanyaradzwa Dube, Lucia Knight, Tair Kasztan Flechner and Edwin Wouters

Int. J. Environ. Res. Public Health 2020, 17(11), 3808; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17113808 - 27 May 2020

Cited by 12 | Viewed by 4861

Abstract

Adherence to HIV antiretroviral therapy (ART) is a crucial factor in health outcomes for people living with HIV (PLWH). Interventions to support ART adherence are increasingly focused on the household as a source of social support. This review aims to examine the social and structural determinants of support for ART adherence within households and families in low- and middle-income countries (LMICs). The review methodology followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven databases were searched for peer-reviewed literature. The terms searched thematically covered (1) ART adherence, (2) household and family and (3) support and care. Thirty-three studies conducted in 15 LMICs were selected and a mixed methods synthesis was undertaken. Social and structural determinants affected the type, quality and amount of support for PLWH of all ages, which affected PLWH’s ART adherence. Gender norms affected the type of support that household members give to PLWH. Education moderated household support for ART adherence through literacy and language skills. Cultural context, religious beliefs, and social norms reinforced or undermined household support for ART adherence. Stigma affected disclosure, generated secrecy around giving medication and impeded access to support from the community. Supporting PLWH exacerbated economic hardship for household members. Health system dysfunction negatively impacted trust and communication between household members and health professionals. Intersecting social and structural determinants particularly affected the care given by household members who were older, female, with little education and low socioeconomic status. Household members were able to overcome some of these barriers when they received support themselves. Household interventions to support PLWH’s ART adherence should take structural factors into account to have maximum impact. Full article

(This article belongs to the Special Issue Health Promotion for Sexual Health and Prevention of HIV)

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