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Zalwango F.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Seeley J.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Seeley J.,University of East Anglia | Scholten F.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS
African Journal of AIDS Research | Year: 2013

This study explored how women's and men's gendered experiences from childhood to old age have shaped their vulnerability in relation to HIV both in terms of their individual risk of HIV and their access to and experiences of HIV services. It was a small scale-scale study conducted in urban and rural sites in Uganda between October 2011 and March 2012. The study used qualitative methods: in-depth interviews (with 31 participants) and focus group discussions (FGDs) with older women (2) and men (2) in urban and rural sites and 7 key informant interviews (KIIs) with stakeholders from government and non-government agencies working on HIV issues. Women's position, the cultural management of sex and gender and contextual stigma related to HIV and to old age inter-relate to produce particular areas of vulnerability to the HIV epidemic among older women and men. Women report the compounding factor of gender-based violence marking many of their sexual relationships throughout their lives, including in older age. Both women and men report extremely fragile livelihoods in their old age. Older people are exposed to HIV through multiple and intersecting drivers of risk and represent an often neglected population within health systems. Research and interventions need to go beyond only conceptualising older people as 'carers' to better address their gendered vulnerabilities to HIV in relation to all aspects of policy and programming. © 2013 Copyright © NISC (Pty) Ltd.


Kaleebu P.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Kaleebu P.,Uganda Virus Research Institute | Kaleebu P.,London School of Hygiene and Tropical Medicine | Kamali A.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | And 7 more authors.
Tropical Medicine and International Health | Year: 2015

For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south. © 2015 John Wiley & Sons Ltd.


Riha J.,University of Cambridge | Riha J.,Wellcome Trust Sanger Institute | Karabarinde A.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Ssenyomo G.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | And 11 more authors.
PLoS Medicine | Year: 2014

Background:Urban living is associated with unhealthy lifestyles that can increase the risk of cardiometabolic diseases. In sub-Saharan Africa (SSA), where the majority of people live in rural areas, it is still unclear if there is a corresponding increase in unhealthy lifestyles as rural areas adopt urban characteristics. This study examines the distribution of urban characteristics across rural communities in Uganda and their associations with lifestyle risk factors for chronic diseases.Methods and Findings:Using data collected in 2011, we examined cross-sectional associations between urbanicity and lifestyle risk factors in rural communities in Uganda, with 7,340 participants aged 13 y and above across 25 villages. Urbanicity was defined according to a multi-component scale, and Poisson regression models were used to examine associations between urbanicity and lifestyle risk factors by quartile of urbanicity. Despite all of the villages not having paved roads and running water, there was marked variation in levels of urbanicity across the villages, largely attributable to differences in economic activity, civil infrastructure, and availability of educational and healthcare services. In regression models, after adjustment for clustering and potential confounders including socioeconomic status, increasing urbanicity was associated with an increase in lifestyle risk factors such as physical inactivity (risk ratio [RR]: 1.19; 95% CI: 1.14, 1.24), low fruit and vegetable consumption (RR: 1.17; 95% CI: 1.10, 1.23), and high body mass index (RR: 1.48; 95% CI: 1.24, 1.77).Conclusions:This study indicates that even across rural communities in SSA, increasing urbanicity is associated with a higher prevalence of lifestyle risk factors for cardiometabolic diseases. This finding highlights the need to consider the health impact of urbanization in rural areas across SSA.Please see later in the article for the Editors' Summary. © 2014 Riha et al.


Kinyanda E.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Waswa L.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Baisley K.,London School of Hygiene and Tropical Medicine | Maher D.,Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS | Maher D.,London School of Hygiene and Tropical Medicine
BMC Psychiatry | Year: 2011

Background: The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care.This study set out to investigate SMD and it's associated factors in a rural population-based cohort in south-west Uganda.Methods: 6,663 respondents aged 13 years and above in a general population cohort in southwestern Uganda were screened for probable SMD and possible associated factors.Results: 0.9% screened positive for probable SMD. The factors significantly associated with SMD included older age, male sex, low socio-economic status, being a current smoker, having multiple or no sexual partners in the past year, reported epilepsy and consulting a traditional healer.Conclusion: SMD in this study was associated with both socio-demographic and behavioural factors. The association between SMD and high risk sexual behaviour calls for the integration of HIV prevention in mental health care programmes in high HIV prevalence settings. © 2011 Kinyanda et al; licensee BioMed Central Ltd.


PubMed | Anglia and Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS
Type: Journal Article | Journal: BMC medical ethics | Year: 2015

Informed consent as stipulated in regulatory human research guidelines requires that a volunteer is well-informed about what will happen to them in a trial. However researchers are faced with a challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. We conducted a qualitative study among volunteers taking part in two HIV clinical trials in Uganda to find out how they defined informed consent and their perceptions of the trial procedures, study information and interactions with the research team.Between January and December 2012, 23 volunteers who had been in the two trials for over 6months, consented to be interviewed about their experience in the trial three times over a period of nine months. They also took part in focus group discussions. Themes informed by study research questions and emerging findings were used for content analysis.Volunteers defined the informed consent process in terms of their individual welfare. Only two of the volunteers reported having referred during the trial to the participant information sheets given at the start of the trial. Volunteers remembered the information they had been given at the start of the trial on procedures that involved drawing blood and urine samples but not information about study design and randomisation. Volunteers said that they had understood the purpose of the trial. They said that signing a consent form showed that they had consented to take part in the trial but they also described it as being done to protect the researcher in case a volunteer later experienced side effects.Volunteers pay more attention during the consent process to procedures requiring biological tests than to study design issues. Trust built between volunteers and the research team could enhance the successful conduct of clinical trials by allowing for informal discussions to identify and review volunteers perceptions. These results point to the need for researchers to view informed consent as a process rather than an event.


PubMed | Medical Research Council Uganda Virus Research Institute MRC UVRI Uganda Research Unit on AIDS
Type: Journal Article | Journal: Public health nutrition | Year: 2013

To assess the associations between maternal HIV infection and growth outcomes of HIV-exposed but uninfected infants and to identify other predictors for poor growth among this population.Within a trial of de-worming during pregnancy, the cohort of offspring was followed from birth. HIV status of the mothers and their children was investigated and growth data for children were obtained at age 1 year. Length-for-age, weight-for-age and weight-for-length Z-scores were calculated for each child; Z-scores ,22 were defined as stunting, underweight and wasting, respectively.The study was conducted in Entebbe municipality and Katabi subcounty, Uganda.The sample consisted of 1502 children aged 1 year: HIV-unexposed (n 1380) and HIV-exposed not infected (n 122).Prevalence of stunting, underweight and wasting was 14.2%, 8.0% and 3.9%, respectively. There was evidence for an association between maternal HIV infection and odds of being underweight (adjusted OR52.32; 95% CI 1.32, 4.09; P=0.006) but no evidence for an association with stunting or with wasting. Young maternal age, low maternal education, low birth weight, early weaning and experiencing a higher number of episodes of malaria during infancy were independent predictors for stunting and underweight. A higher number of living children in the family was associated with wasting.Maternal HIV infection was associated with being underweight in HIV-exposed uninfected infants. The success of programmes for prevention of mother-to-child HIV transmission means that an increasing number of infants will be born to HIV-infected women without acquiring HIV. Therefore, viable nutritional interventions need to be identified for this population.

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