Month: February 2024

Navigating the Landscape of Emergency Contraception and Unplanned Pregnancy

Posted on by admin

Insights from a South African Survey**

 

Authors: Mrs Yashmita Naidoo CEO of HIV SA, Dr Venessa Timmerman (PhD) and Mr Siraaj Adams (MBA, MPH).

HIVSA is an NGO that commissioned the national survey.

 

Introduction

Studies have reported that students between 18 and 24 years have one of the highest rates of unplanned pregnancies. The lack of effective knowledge concerning contraceptive use results in an increase in unplanned pregnancies (Bryant 2009:12; Trieu et al. 2011:431).

In a study amongst 15 to 24-year-old South African women, it was estimated that only 52.2% of sexually experienced women are using contraceptives (MacPhail et al. 2007:3). Because of the fact that 80% of undergraduate students at higher educational institutions are sexually active, it is vital that they have access to safe, accessible and adequate contraceptive services (Bryant 2009:12). Dreyer (2012:6) suggests that the main reasons for women not utilising or discontinuing the use of contraceptives are side effects, lack of knowledge about different methods available, or lack of interest in utilising it.

In the study amongst students in Durban, South Africa, Roberts, Moodley and Esterhuizen (2004:441) suggested that an increase in the use of emergency contraceptives might reduce the number of unplanned pregnancies.

In our recent survey conducted in South Africa, we embarked on a comprehensive examination of emergency contraception and unplanned pregnancy among 469 female respondents aged between 20 and 35. This survey sought to uncover the prevailing landscape surrounding the use of emergency contraception, experiences with unplanned pregnancies, and the evolving attitudes toward contraceptive accessibility. The data gathered provides crucial insights into the reproductive health dynamics of young women in South Africa.

 

Understanding Emergency Contraception Practices

Our survey captured the experiences and choices of a diverse group of women,469 respondents from all 9 provinces, offering a comprehensive view of emergency contraception practices. The respondents provided valuable insights into the frequency of morning-after pill usage and the prevalence of unplanned pregnancies.

 

Key Survey Findings

  1. Morning After Pill Usage

A significant 49.3% of respondents reported having used the morning-after pill, highlighting the concerning high utilisation of emergency contraception in managing reproductive health.

  1. Repetitive Morning After Pill Usage:

Over 21% of respondents revealed using the morning-after pill more than 2 to 3 times, indicating a recurring reliance on emergency contraception among a notable portion of the surveyed population.

  1. Unplanned Pregnancies on Hormonal Contraception

Alarmingly, 18.6% of respondents reported falling pregnant while on some form of hormonal contraception. This finding underscores the need for further exploration into the effectiveness of existing contraceptive methods or whether or not non-compliance by patients is a factor.

  1. Incidence of Unplanned Pregnancies

Nearly 45% of respondents disclosed experiencing unplanned pregnancies, verifying the concerningly high prevalence of unexpected reproductive outcomes among young women in South Africa.

  1. Termination of Pregnancy

A significant 19% of respondents confirmed having undergone a termination of pregnancy, primarily at public health facilities. This highlights the crucial role these facilities play in addressing reproductive health needs.

  1. Preference for Online Morning After Pill Purchase

Almost half of the respondents, approximately 47%, expressed a willingness to purchase the morning-after pill online. This inclination reflects a growing demand for convenient and discreet avenues for accessing emergency contraception.

Implications and Considerations

These survey findings carry substantial implications for reproductive health policies, healthcare providers, and the broader community. The prevalence of unplanned pregnancies, the repetition of morning-after pill usage, and the occurrence of pregnancies while on hormonal contraception warrant careful consideration.

 

Conclusion

The prevalence of contraceptive use by sexually active students in previous research was high at 79%. However, inconsistent use of contraceptives is a major challenge. Females were aware of the benefits of contraceptives in preventing unplanned pregnancies; however, they used contraceptives inconsistently as a result of being afraid of possible side effects. Overall, there was limited awareness and use of emergency contraceptives. Consistent use of regular contraceptives and condoms should be emphasised to reduce not only unplanned pregnancies but also sexually transmitted diseases (Brunner Huber & Ersek 2009:1069).

In a study among students in Durban, South Africa, Roberts et al. (2004, p. 441), suggested that an increase in the use of emergency contraceptives might reduce the number of unplanned pregnancies. However, due to the lack of knowledge and awareness thereof, the family planning services were underutilised (Roberts et al. 2004, p. 441).

Our survey provides a comprehensive snapshot of the current landscape of emergency contraception and unplanned pregnancy among young South African women. The findings underscore the importance of accessible and effective reproductive health services. Efforts should be directed towards enhancing awareness, ensuring the availability and education around use of reliable contraceptive methods, and exploring innovative solutions, such as online access to emergency contraception. By addressing these needs, we can empower women to make informed choices about their reproductive health, contributing to a healthier and more equitable future. This survey serves as a catalyst for ongoing discussions and actions aimed at fostering reproductive well-being among South African women.

 

References

Bryant, K.D., 2009, ‘Contraceptive use and attitudes among female college students’, Journal of ABNF 20(1), 12-16. PMID: 19278182.

Dreyer, G., 2012, Contraception: A South African perspective, Van Schaik Publishers, Pretoria.

MacPhail, C., Pettifor, A.E., Pascoe, S. & Rees, H.V., 2007, ‘Contraception use and pregnancy among 15-24-year-old South African women: A nationally representative cross-sectional survey’, BMC Medicine 5, 31. PMID: 17963521, http://dx.doi.org/10.1186/1741-17015/5/31

Roberts, C, Moodley, J & Esterhuizen, T 2004, Emergency contraception: knowledge and practices of tertiary students in Durban, South Africa, Journal of Obstetrics and Gynaecology, vol. 24, no. 4 pp. 441-445, doi:10.1080/0144361040001685619

Failure of the emergency contraceptive levonorgestrel and the risk of adverse effects in pregnancy and on fetal development: an observational cohort study”: https://www.sciencedirect.com/science/article/pii/S0015028205008861

Navigating the Market Landscape of STI Treatment

Posted on by admin

Insights from a Survey of South African Women

Authors: Mrs Yashmita Naidoo CEO of HIV SA, Dr Venessa Timmerman (PhD) and Mr Siraaj Adams (MBA, MPH)

HIVSA is an NGO that commissioned the national survey.

 

Introduction

According to research, South Africa has the highest prevalence of sexually transmitted infections (STIs), including Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in Africa. In 2017, there were an estimated 6 million new CT, 4.5 million NG and 71,000 Treponema pallidum infections among South African men and women of reproductive age(1).

In our recent market survey conducted in South Africa, we aimed to gain a deeper understanding of the sexual health practices, preferences, and treatment experiences of female respondents aged between 20 and 35. An online survey was conducted targeting 500 female respondents in the 20 to 35 age group and 469 responses were received. This exploration focused on assessing the current landscape for sexually transmitted infection (STI) treatment, shedding light on awareness, accessibility, and the evolving preferences of young women.

 

Understanding Sexual Health Practices

Our respondents provided a comprehensive view of sexual health practices among South African women in the specified age range. The survey explored key aspects, including the prevalence of casual sexual partners, awareness of STI treatment facilities, and the frequency of STI treatment.

 

Key Survey Findings

  1. Casual Sexual Partners

Approximately 33% of respondents reported having confirmed some form of casual sexual partnership (including friends with benefits, multiple casual partnerships, situationships and open relationships), highlighting the diversity of sexual health preferences within this demographic.

 

  1. Awareness of STI Treatment Facilities

A commendable 90% of respondents indicated awareness of where to receive STI treatment, suggesting successful dissemination of information regarding available treatment facilities.

  1. STI Treatment Uptake

Over 23% of respondents confirmed receiving STI treatment, signalling a proactive approach to seeking medical intervention when faced with STIs. The disparity between 90% of participants having been tested for an STI compared to only 23% receiving treatment may indicate a need to research barriers to STI treatments more in-depth.

  1. Commonly Treated STIs

Specific STIs treated included 48% for urinary tract infections, 10% for chlamydia, 8% for genital warts, and 7% for gonorrhoea, providing valuable insights into the prevalence of different STIs.

  1. Preference for Treatment Delivery

A notable 47.8% of respondents expressed a preference for receiving STI treatment or treatment delivery at home. This inclination suggests a growing demand for convenient and discreet healthcare options.

  1. Online Consultation Preference

Significantly, 54.8% of respondents expressed a preference for online consultations for their STI treatment. This finding underscores the evolving dynamics in healthcare preferences, emphasizing the need for innovative solutions to meet the demands of a changing telehealth landscape.

  1. **Sexual Activity Frequency

More than 65% of respondents reported engaging in sexual activity either daily or weekly, highlighting the importance of accessible and timely STI treatment services to support the sexual health of this demographic.

Implications and Considerations

Although research has shown that a high percentage of sexually active people in SA understand the importance of condom use, there is still a need to emphasise better STI screening and management strategies (1).

The Choma survey findings carry implications for healthcare providers and policymakers. While the high awareness and treatment uptake is positive, efforts should continue to ensure accessibility and address potential barriers to seeking treatment.

Untreated sexually transmitted infections (STIs) can lead to significant morbidity, particularly among women, resulting in complications such as pelvic inflammatory disease, ectopic pregnancy, infertility, pregnancy complications, and newborn infections. Additionally, STIs can induce genital inflammation and increase the risk of HIV acquisition and transmission, even in asymptomatic cases. The majority of STIs occur in low- and middle-income countries, with sub-Saharan Africa bearing the highest burden in terms of age-standardized incidence rates and disability-adjusted life years lost. In southern Africa, there’s a notable epidemiologic overlap between curable STIs and HIV, especially among adolescents and young adults who face the highest risk of STI acquisition and have the highest HIV incidence rates. Therefore, improved diagnosis and treatment of curable STIs are crucial in reducing morbidity and are integral components of multimodal HIV prevention efforts(2).

The expressed preferences for home-based treatment delivery and online consultations emphasize the need for innovative and flexible healthcare solutions to cater to the evolving needs and preferences of the population.

 

Conclusion

Our survey provides valuable insights into the current state of STI treatment awareness, preferences, and practices among young South African women. The identified preferences for home-based treatment delivery and online consultations underscore the importance of adapting healthcare services to meet the evolving needs of the population.

 

References

  1. Harryparsad R, Meyer B, Taku O, Serrano M, Chen PL, Gao X, Williamson AL, Mehou-Loko C, d’Hellencourt FL, Smit J, Strauss J, Nanda K, Ahmed K, Beksinska M, Buck G, Morrison C, Deese J, Masson L. Prevalence and incidence of sexually transmitted infections among South African women initiating injectable and long-acting contraceptives. PLoS One. 2023 Nov 10;18(11):e0294285. doi: 10.1371/journal.pone.0294285. PMID: 37948399; PMCID: PMC10637674.
  2. Jarolimova, Jana MD, MPH; Chidumwa, Glory PhD; Chimbindi, Natsayi PhD; Okesola, Nonhlanhla BSN; Dreyer, Jaco NDipIT; Smit, Theresa PhD; Seeley, Janet PhD; Harling, Guy ScD; Copas, Andrew PhD; Baisley, Kathy MSc; Shahmanesh, Maryam PhD; the Isisekelo Research Group; Herbst, (Carina MSc; McGrath, Nuala ScD; Zuma, Thembelihle PhD; Khoza, Thandeka MBChB; Behuhuma, Ngundu MBChB; Bassett, Ingrid V. MD, MPH; Sherr, Lorraine PhD). Prevalence of Curable Sexually Transmitted Infections in a Population-Representative Sample of Young Adults in a High HIV Incidence Area in South Africa. Sexually Transmitted Diseases 50(12):p 796-803, December 2023. | DOI: 10.1097/OLQ.0000000000001871

Unveiling the Landscape of HIV Self-Testing in South Africa

Posted on by admin

A Comprehensive Survey Analysis

Authors: Mrs Yashmita Naidoo (CEO of HIVSA), Dr Venessa Timmerman (PHD) and Mr Siraaj Adams (MBA, MPH).

HIVSA is an NGO that commissioned the national survey.

 

Introduction

HIV testing is the first step in linkage to HIV care, including prevention or treatment services. The United Nations Joint Programme on HIV/AIDS has set interim 95-95-95 targets: that 95% of people living with HIV know their HIV status, 95% of these are to be initiated onto antiretroviral treatment (ART), and that 95% of these should be virally suppressed by the end of 2030(1). Alternative HIV testing strategies are needed to overcome barriers to traditional clinic-based testing; HIV self-testing (HST) is one modality that offers promise in reaching individuals who experience barriers to clinic-based testing.

In December 2023, HIVSA conducted a comprehensive survey targeting 500 female respondents in South Africa, aged between 20 and 35 years. An important objective of the survey was to assess the current landscape of HIV self-testing in the country. With representation from all nine provinces, this survey delved into crucial aspects of awareness, testing patterns, and the potential acceptance of online purchase options for HIV testing kits.

 

Method

A survey was created digitally and hosted on the Choma website, comprising of the following categories: personal details, e-commerce habits, financial wellness, sexual and reproductive health, family planning and health and wellness. Each category was presented as a separate page, with a progress bar to indicate how much of the survey had been completed.

All survey submissions were saved and stored in a cloud-based platform for our data analyst to generate a report from, and our marketing team to track submission numbers. Once we had identified a plateau or slowing of survey submissions, we generated reports from 469 submissions.

Our survey submission collection period was from the 27th of December 2023 to the 15th of January 2024, when it was observed that survey submissions had slowed significantly.

 

Key Survey Findings

  1. Understanding the RespondentsHIV self testing survey demographics
  2. Description of Participants based on the Graph

Our diverse pool of respondents provided a holistic representation of South African women in the specified age group. Their insights offer a valuable snapshot of the prevailing attitudes and behaviours related to HIV testing.

  1. Willingness to Purchase Online

Notably, 52.4% of the respondents expressed a willingness to purchase HIV testing kits online. This finding underscores a growing openness to utilizing online platforms for obtaining essential healthcare resources.

HIV self testing survey online purchase

  1. Awareness of HIV Status

A staggering 91.4% of respondents reported being aware of their HIV status. This high level of awareness is a positive indicator of the effectiveness of existing HIV awareness and testing initiatives in South Africa.

Awareness of HIV status

  1. HIV Testing Patterns

Over 60% of respondents revealed that they had undergone HIV testing within the last three months. The frequency in testing pattern is encouraging and suggests a proactive approach to monitoring one’s health status.

HIV testing patterns

  1. Regional Representation

Our survey reached respondents across all nine provinces in South Africa, ensuring a geographically diverse sample. The inclusion of perspectives from different regions enhances the reliability and applicability of our findings, considering the diverse healthcare landscape in South Africa.

Survey respondent locations

  1. Online Purchase and Accessibility

The willingness of 52.4% of the respondents to buy HIV testing kits online indicates a potential shift in the accessibility and distribution of essential healthcare tools. This trend aligns with the global movement toward digital health solutions, emphasizing convenience and privacy.

 

  1. The Significance of HIV Awareness

The exceptionally high rate of HIV awareness (91%) among our respondents showcases the effectiveness of awareness campaigns and healthcare education in South Africa. It suggests that efforts to destigmatize HIV testing and encourage regular screenings have made a positive impact.

 

  1. Encouraging Proactive Healthcare

The finding that over 60% of respondents have undergone HIV testing in the last three months reflects a proactive and responsible approach to healthcare. Regular testing is crucial for early detection and timely intervention, contributing to overall public health improvement.

 

Conclusion

Research in 2020, found that the vast majority (95%) of young women chose HIVST over clinic-based HCT.

The insights gained from our survey paint a promising picture of the state of HIV self-testing awareness and practices among South African women aged 20 to 35. The data reveals a willingness to embrace online avenues for purchasing testing kits, a high level of HIV awareness, and a commendable commitment to regular testing. These findings not only shed light on the current landscape but also provide valuable information for shaping future healthcare policies and interventions related to HIV testing in South Africa. As we move forward, it is imperative to build upon these positive trends, ensuring continued accessibility and acceptance of online healthcare platforms.

 

References:

  1. UNAIDS. Understanding fast-track targets. Accelerating action to end the AIDS epidemic by 2030 [document on the Internet]. UNAIDS, 2015. [cited September 28, 2021]; p. 12. Available from: https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf [Google Scholar]
  2. Audrey Pettifor, HIV self-testing among young women in rural South Africa: A randomized controlled trial comparing clinic-based HIV testing to the choice of either clinic testing or HIV self-testing with secondary distribution to peers and partners. 2020