Social Drivers of the HIV and AIDS Epidemic_Ekpo

1. Social Drivers of HIV Epidemic
Among Public Sector Workers
Gloria Ekpo, MD, FMCOG, MPH
Senior Technical Advisor, HIV & AIDS, Health and Hope, International Programs
Group, World Vision
CORE Group Global Health Practitioner Conference
April 14, 2015
Experience from SPEAR Project, Uganda

2. Supporting Public Sector Workplace to Expand Actions and Responses Against
HIV and AIDS (SPEAR)
• A six-year USAID/PEPFAR funded HIV
and AIDS intervention
• Targeting Uganda public sector:
• Ministries of Local Government, Education
and Sports and
• Ministry of Internal Affairs (Uganda Police
force (UPF), Uganda Prison Services (UPS)
and Immigration Services
• Implemented by WorldVision, RTI and
local partners

3. Main Interventions under the SPEAR Project
• Strengthen institutional capacity of the target ministries through HIV
Policy Development.
• Scale up HIV Prevention Initiatives (Behavior Change, HIV testing,
Voluntary Medical Male Circumcision, PMTCT)
• Provide wrap around services for people living with HIV
• Strengthen linkages to care and support program in a continuum of care
for beneficiaries

4. Assessment sought to provide answers to three main questions:
• What were the most common drivers of the HIV epidemic in the target population?
• Were there unique enablers of the social drivers peculiar to the population assessed?
• What were the level of access and utilization of HIV related services for public sector
workers

5. • Cross sectional survey of
20 out of the 83 SPEAR
implementing districts
(Jinja, Busia, Gulu,
Kampala, Mbale, Hoima,
Mbarara, Oyam and
others)
• Respondents were 18
years and older
• 1700 participated in the
survey

6. Assessment Findings
• Level of Participation:
-Ministry of Internal Affairs: 58.8%
- Ministry of Local Government: 20%
- Ministry of Education and Sports: 21%
• Sex: Male: 63% and Female: 37%
• Mean Age: Male - 36 years; Female - 33years
• Marital status: Married: Male - 74%; Female - 57%
• Educational Level:
Secondary School: Male - 53%; Female - 46%
University: Male - 43%; Female - 49%

7. Common drivers of HIV Epidemic among public sector
workers
• Multiple sexual partners
• Behavioral disinhibition/Risk perception
• Limited Condom use
• Non-disclosure of HIV status
• Cross-generational and Transactional sex
• Alcohol and Drug use
• Unique social enablers of HIV transmission

8. Social Driver of HIV Epidemic: Multiple Sexual Partners
• Multiple sexual partnerships were more common among men than women
• Highest rate of multiple sexual partnerships were among men of the immigration services
Marital status and sexual behavior of respondents in the last 12 months

9. Drivers of HIV Epidemic: Condom use
Condom use by sexually active respondents
Characteristics
Most recent partner (n=1625)
2nd Most recent
partner (n=292)
Type of relationship
Married 80% 77%
Not Married 20% 23%
On-going relationship 86% 90%
Condom use during last sexual
encounter 23% 53%
Frequency of condom use
Never 47% 27%
Rarely 22% 15%
Sometimes 18% 13%
Most times 13% 45%

10. Drivers of HIV Epidemic: Risk Perception
- Report not knowing sexual partners HIV status: 34%
- Perception of partner’s HIV status:
Unlikely infected – 51%
Likely infected – 11%
• Non-disclosure of HIV status:
Reporting ever disclosing HIV Status: 74%
Disclosed to spouse: 76%; to Peer 20% and to relative -19%

11. Drivers of HIV Epidemic: Generational Sex
Generational and Transactional Sex
Characteristics
Marital partner
(n=1,077)
Non-marital
partner (n=279)
Age difference between
partners
0-5 years 57% 77%
6-9 years 34% 17%
10 years or more 9% 6%
Condom use and age
difference of partner
0-5 years 1% 3%
6-9 years 2% 1%
10 years or more 3% 3%

12. Drivers of HIV Epidemic: Transactional Sex
Characteristics
M. of Local
Government
M. of
Education
and Sports
M. of Internal
Affairs
Total
Prison
Service
Police
Force
Immigra
tion
Private
Security
Number of respondents
reporting exchanging gifts,
money or favors for sex
40 29 25 59 8 20 11%
% who believe workmates
are involved in
transactional sex 32% 33% 46% 46% 29% 47% 39%

13. Driver of HIV Epidemic: Alcohol and Drug Use
• Reported alcohol use by respondents – 41%
• Respondents agree that drug use impairs judgement in sexual decision
making- 84%
• Respondents report alcohol abuse by colleagues – 50%
• Use of intoxicating substance other than alcohol – 5%
• Most common substances were:
Marijuana (41%);
Bangi (18%);
Nicotine (15%) and
Cocaine (10%)
• Substance use highest among police force and private guards

14. Unique social enablers of HIV transmission among public sector workers
Characteristics
M. of Local
Governme
nt
M. of
Educatio
n and
Sports
M. of Internal
Affairs
Total
Prison
Service
Police
Force
Immigrat
ion
Private
Securit
y
Frequent staff transfer
leading to family separation
39% 31% 66% 69% 8% 34% 41%
Poor housing conditions/co-
habiting with multiple
families 14% 15% 51% 60% 7% 20% 28%
Tough working hours (night
shifts) 10% 11% 28% 37% 4% 24% 19%
Weak policies against sexual
harassment 22% 15% 14% 14% 10% 7% 14%

15. Recommended Workplace interventions by respondents
• Post-exposure prophylaxis (50%)
• Sensitization and awareness creation (44%)
• Worker-friendly HCT services (37%)
• Reduction of HIV related stigma (24%)
• Stopping discrimination against PLHIV (13%)
• Screening and treatment for STIs (33%)

16. Conclusion
Tailoring interventions for public sector workers must address
their unique needs and the social drivers of the HIV epidemic
at workplace

17. Acknowledgements
• USAID/PEPFAR
• WorldVision and RTI
• Stakeholders (Ministries & UPS)
• Health workers
• Participants
Thank you!

18. Gloria Ekpo, MD, FMCOG, MPH
Phone: 202.572.6538
Email: gekpo@worldvision.org
Skype: gloria.ekpo