Papers on Zimbabwe at
the Barcelona AIDS Conference

Acceptability of diaphragm use among women and their partners in Zimbabwe
By G Khumalo-Sakutukwa, O Mapfumo, T Chipato, S F Posner, A van der Straten, N Padian
Background:The diaphragm (DA) is one of the oldest family planning methods, and if proven effective, could be used as a woman-controlled barrier method against HIV/STIs. Due to DA’s limited use in Zimbabwe, data about its acceptability is non-existent.

Acceptability of three HIV/STD prevention methods to women in Harare, Zimbabwe
By J Moore, G Khumalo-Sakutukwa, L Loeb, A OLeary, K Irwin, N Padian
Purpose: To examine use of and preference for three HIV/STD prevention methods (male condom, female condom, and spermicide) among women in Harare, Zimbabwe. Methods: 264 married Zimbabwean women recruited from family planning clinics first participated in a three...

Acceptability of vaginal microbicide use and clinical trial participation: Lessons learned from women and men in Malawi and Zimbabwe
By J M Brown, T Mutevedzi, M Mwale, C Kelly, K Fritz, Z M Chirenje, G Khumalo-Sakutukwa, F Martinson, N Kumwenda, T Taha, I Hoffman, N Padian
Background: Microbicides may offer the potential to protect women and men from HIV infection. The objective of this study was to collect safety and acceptability data specific to use of a potential microbicidal gel and to evaluate the acceptability of ...

Alcohol use and high risk sexual behavior among adolescents and young adults in Harare, Zimbabwe
By P N Mataure, W McFarland, A Kim, G Woelk, S R Ray, G Rutherford
Background: In order to guide HIV prevention efforts among high-risk youth, we surveyed alcohol use and sexual behavior among persons 15-21 years old in Harare, Zimbabwe. Methods: We conducted a cross-sectional quantitative and qualitative survey of youth samp...

Anaemia and associated mortality among HIV-positive postnatal women in Zimbabwe
By P Zvandasara, M Miller, N Mbuya, R J Stolzfus, L C Malaba, E Marinda, P J Iliff, J H Humphrey, A Zvitambo Study Group
Background: In developed countries, anaemia is common during HIV and significantly associated with earlier death. This anaemia results from changes in cytokine production, blunted erythropoietin (EPO) response, and ARV use especially zidovudine. Treatment with...

Association of high HIV-1 RNA levels and homozygosity at HLA class II DRB in adults coinfected with Mycobacterium Tuberculosis in Harare, Zimbabwe
By L S Zijenah, W E Hartogensis, D A Katzenstein, O Tobaiwa, J Mutswangwa, P R Mason, L G Louie
Background: Mycobacteria tuberculosis (Mtb) is endemic in Zimbabwe, increasing dramatically with the onset of the HIV epidemic in the late 80's. TB is the leading cause of morbidity and mortality among HIV-1 infected individuals. HLA genes may influence disease progr...

Attitudes regarding potential introduction of male circumcision in Harare, Zimbabwe: preliminary survey and focus group acceptability data
By D T Halperin, K Fritz, G Woelk
Background: Male circumcision (MC) is increasingly discussed as a potential adjunct to HIV/STI prevention, especially in those sub-Saharan African regions with severe heterosexually spread epidemics, where most men are uncircumcised. While a large and growing ...

Baseline associations between risk behaviors and STIs among Zimbabwean, Ugandan and Thai women participating in a longitudinal study of hormonal contraception and HIV acquisition
By A Muchini, M Dunbar, P G A Cornelisse, A Lovvorn, S Brandzel, S Sriplienchan, S Rwambuya, T Chipato, N S Padian
Background: As part of a longitudinal study to examine the effect of hormonal contraception (HC) on HIV acquisition, we examined the association between socio-demographic characteristics and STI risk behaviors reported at baseline among 4,786 participants; 1789 from ...

Baseline associations between vaginal practices and vaginal infections in Zimbabwean, Ugandan and Thai women
By J H H van de Wijgert, P G A Cornelisse, C Morrison, S Chitsungo, M Munjoma, S Rugpao, J Byamugisha, A Muchini, S Sriplienchan, N S Padian
Background: There is limited evidence that vaginal practices (i.e. cleansing and drying/tightening) may be associated with vaginal infections, which in turn may be associated with HIV acquisition. Methods: As part of a prospective cohort study on horm...

Beliefs and practices on alcohol and sexual behaviour among rural Zimbabweans
By G B Woelk, D Kasprzyk, D E Montaño, N I H NIMH Collaborative HIV/STD Prevention Trial
Background: AIDS is devastating Zimbabwe, a country in southern Africa hard hit by the epidemic. Risk factors for HIV transmission include labor migration, rapid urbanization, transactional sex and alcohol use. The role of alcohol in generating risk has been examined...

Challenges encountered during a clinical trial to prevent mother to child transmission (MTCT) of HIV in urban Zimbabwe: A nurse's perspective
By A Munhenga, S Chiwara, S Jena, J Chirwa, J Wells, A K Shetty, M T Bassett, Y A Maldonado
Issues: Core problems must be addressed prior to the expansion of MTCT prevention programs in Zimbabwe. Description: HIV-positive pregnant women at 2 antenatal clinics in Zimbabwe were enrolled to receive either AZT or nevirapine for prevention of MTCT. Study nurses...

Churches' response to HIV/AIDS: a study of Zimbabwe, Botswana and Namibia
By S Parry, M Kurian
Issues: Churches are an integral structural and credible part of communities in Africa. Their involvement in health and education services and focus on social needs affords considerable opportunity to combat HIV/AIDS. The World Council of Churches, togethe...

Comparison of computer-assisted interviewing (CAI) modes for behavioral surveillance among interviewees in two rural villages in Zimbabwe
By D Kasprzyk, G B Woelk, D E Montaño, N I H NIMH Collaborative HIV/STD Prevention Trial
Background: Self-administered questionnaires (SAQs) increase reporting of sensitive behaviors; ie, sexual, drug, alcohol use. Audio Computer Assisted Self-Interviews (ACASI) have been promoted as an SAQ that does not rely on reading level. Methods research shows ind...

Comparison of HIV and sexually transmitted infections among asymptomatic women in tanzania and zimbabwe
By E Mbizvo, S Msuya, M Chirenje, M T Mbizvo, A Hussan, B Stray-Pedersen
Background: As HIV infection continues to rise especially in sub-Saharan Africa, elaboration of HIV prevalence and associated risk factors in similar study populations, could help elucidate factors which determine the rate and extent of spread of HIV. Such info...

The coverage of HIV and AIDS in nine Zimbabwean newspapers: A content analysis
By S Page
Background: For the Zimbabwean public, the news media is considered a valuable source of information on HIV and AIDS. By exploring the coverage of HIV and AIDS in the news media, health educators, communicators and organisations like SAfAIDS can have a better underst...

Cremation: An acceptable solution to burial space shortage in Zimbabwe?
By O Chigariro
Issues: Cremation as a solution to the increased burial space shortage and ever rising cost of funerals against increased deaths due to AIDS. Description: Due to the increased deaths mainly due to AIDS, the problem of burial space especially in

The cultural and social factors influencing the spread of HIV infection in Zimbabwe: a social constructionist perspective
By T Zhuwau
Background: Despite almost universal knowledge of HIV/AIDS, infection levels continue to rise among sexually active adults in Zimbabwe. HIV prevalence is estimated to be 25% among sexually active adults. Specific risk groups are estimated to have a prevalence higher...

Cultural constructions and responses to HIV/AIDS in rural Zimbabwe
By T N Taylor
Issues: Zimbabwe is experiencing one of the most severe AIDS epidemics in the world; one out of four people is infected with HIV. Many infected people rely on traditional healing as an alternative explanation of illness. Through the distinct cultural sensibilities of...

Diaphragms are well accepted in sexually active zimbabwean women
By A van der Straten, S F Posner, O Mapfumo, G Khumalo-Sakutukwa, T Chipato, M Callahan, N Padian
Background: In Zimbabwe where HIV prevalence is over 30%, alternative methods to condoms are urgently needed. This is an ongoing cohort study to assess acceptability and use over time of diaphragms with KY jelly among women who are inconsistent condom users. Method...

Dual HIV-1-2 infection in Zimbabwe: Clinical, immunological and virological indicators
By G A Stanczuk, A Mashu, S Madzime, M Munjoma, E N Sibanda
Background: We have in the last decade conducted three surveys and tested 1463 men and women for the presence of HIV-2 infection. These studies included 1168 expectant mothers , 245 males attending genito-urinary clinics and cohort of 50 men and women who were scree...

Early age of coital debut and intergenerational sex are risk factors for HIV among Zimbabwean women
By A van der Straten, A Pettifor, M Dunbar, T Chipato, N Padian
Background: Early age of coital debut and older male partners (intergenerational sex) may be risk factors that partially explain the high rates of HIV infection among young women in sub Saharan Africa. Methods: Using data from a longitudinal study examining the eff...

Early follow-up of a rural programme of prevention of mother-to-child transmission of HIV in Murambinda Mission Hospital (Buhera district), Zimbabwe * * Project funded by the Elizabeth Glaser Paediatric AIDS Foundation
By F Perez, J Orne-Gliemann, T Mukotekwa, A Miller, M Glenshaw, F Dabis
Issues: In Zimbabwe, it is estimated that each year 50 000 new-borns acquire HIV infection through perinatal transmission. Simplified antiretroviral regimens for reducing mother-to-child transmission (MTCT) of HIV-1 have been proposed for resource poor countrie...

Economic and social factors related to HIV risk among adolescent females in Zimbabwe
By M S Dunbar, H Chinake, A van der Straten, B Makunike, A Vere, S Esim, N S Padian
Background: In Zimbabwe, 25% of females (vs. 11% of males) aged 15-24 are infected with HIV. Economic and social factors may contribute to HIV risk behavior (e.g. engaging in transactional and/or intergenerational sex) and could partially explain this high ra...

Evaluating infant neutropenia in the context of ARV prophylaxis and treatment in Zimbabwe
By J A Wells, A K Shetty, L J Stranix, P Mateta, N Nyoni, C Maponga, M T Bassett, T Chipato, Y A Maldonado
Background: Anti-retrovirals are rapidly becoming available to resource-poor countries. Hematological abnormalities are a common side effect of ARV regimens, particularly those which include AZT. The evaluation of neutropenia in particular may be problematic in infan...

Experience and concerns of HIV infected women enrolled in MTCT program in Zimbabwe
http://www.iasociety.org/abstract/show.asp?abstract_id=7198
Issues: In recent years, numerous clinical trials for prevention of perinatal HIV transmission has been conducted in sub Saharan Africa. In this context, it is important to determine the experience and concerns of HIV infected women enrolled in a MTCT prevention prog...

Experience with a cotrimoxazole prophylaxis program in Rural Zimbabwe
By P Thistle, S Quinn, A Zvomuya, M Silverman
Background: The WHO recommends that cotrimoxazole (CTM) prophylaxis become the standard of care for HIV positive patients in Africa. The feasibility and potential personal impact of such programs, as well as the characteristics of the patients who would be able to pa...

Experiences of community lay counselors working in antenatal care clinics in Chitungwiza, Zimbabwe
By R Maredza, L Banda, Z Muchabaiwa, P Sande, C Kagona, J Wells, S Moyo, A K Shetty, Y A Maldonado
Issues: While the system of community lay counselors in Chitungwiza, Zimbabwe has been successful, several challenges have been faced. Description: The community lay counseling system was developed in 1999 to assist in recruitment for MTCT studies by providing pre- ...

Feasibility and accuracy of rapid on-site HIV tests in antenatal clinics in urban Zimbabwe
By N Nyoni, P Mateta, M T Bassett, Y Maldonado, J Wells, D Katzeinstein, A K Shetty
Background: Efforts at implementing MTCT programs in high prevalence, resource-poor settings may benefit from the availability of reliable, simple, and rapid methods for HIV screening. Data from Zimbabwe on the reliability of rapid HIV tests for screening pregnant...

Feasibility of preventing mother-to-child transmission of HIV in Zimbabwe
By P Mateta, L Stranix, S Moyo, N Nyoni, M Mhazo, A von Lieven, L Langhaug, Y Maldonado, D Katzenstein, D Hill, N Gonah, A K Shetty, M T Bassett
Background: Acceptability of VCT by pregnant women is critical in the context of trials assessing interventions to reduce MTCT of HIV. We studied the logistics and uptake of short-course AZT regimen by HIV-infected pregnant women after VCT in urban Zimbabwe. Metho...

Feasisbility of HIV/AIDS counseling for pregnant women using community volunteers: Experience from Zimbabwe
By S Moyo, M Mhazo, P Mateta, A von Lieven, A K Shetty, Y Maldonado, C Maponga, D Katzenstein, M T Bassett
Issues: Prevention and treatment of HIV/AIDS requires voluntary HIV counseling and testing(VCT. A significant barrier to VCT is providing sustainable counseling services on a large scale. Overburdened health care systems cannot afford a new cadre of professional coun...

First suggestion of a decline in HIV prevalence in Zimbabwe
By Perpetua Kububa, L Dube, S.M. Midzi, P Nesara, M.E. St. Louis
Background:. Zimbabwe has experienced a severe generalized HIV epidemic, and the aggregate HIV prevalence in HIV surveillance in antenatal care centers (ANC) in 2000 was 35%. Methods. To monitor progress in response to the epidemic, ANC surveillance...

Gender-related causes and socio-economic effects of HIV/AIDS in Zimbabwe
By E Chirebvu, M Mahonde, C Maposhere, P Gwatirisa
Issues: HIV/AIDS and its consequences exacerbate an already precarious economic situation. This applies especially to women, who remain to care for the sick and orphaned without sufficient resources. Women are seeking alternative means of economic support for thems...

HIV prevalence, recent seroconversion, sexual risk behavior, and alcohol use among male beerhall patrons in Harare, Zimbabwe
By K E Fritz, G B Woelk, W C McFarland, R D Stall
Background: Beerhalls are a widespread social institution in Zimbabwe and drinking beer is a central part of social life for men. This study examined Zimbabwean men's alcohol use as a potential risk factor for acquiring HIV infection and the feasibility of conducting...

HIV prevention and control beyond the workplace: The role of the private sector in Zimbabwe
By N Z Nyazema, F Mpofu, Z Machekanyanga, T Pembere
Issues: Increasingly, businesses in their annual reports to shareholders are now being urged to include the impact of HIV/AIDS on their work force. Time has come to encourage the private sector in Zimbabwe, to go beyond their workplaces and, take on preventi...

Impact of perceived HIV risk, history of child loss and spontaneous abortion on desire for pregnancy among ever-married women in Zimbabwe
By W Moyo
Background: In a background of very high prevalence of HIV infection among women of child-bearing age and increasing demand for treatment to prevent mother to child transmission, we investigated the impact of perceived HIV risk, reporting at least one child de...

Impact of workplace peer education: End point achievements among harare factory workers in Zimbabwe
By V Mzezewa, G Makarawo, K Noko, S Rusakaniko, A Chingono, M T Bassett, A S Latif
Peer education has been employed widely as an intervention for HIV prevention. The study conducted by Zimbabwe AIDS Prevention Project (ZAPP) in 1994 to 1997 showed that peer education reduced HIV infection by 34%. Due to the success of this study, ZAPP implemented t...

Innovative approaches to encourage doctors in Zimbabwe to refer clients for HIV counselling and testing
By S Ray
Issue: Availability of antiretroviral treatments has led to remedicalisation of HIV in many parts of Southern Africa. Private doctors in particular are becoming more interested in HIV testing as entry points to providing treatment through the private sector. However,...

Intergenerational sex among adolescents in Zimbabwe
By H Chinake, M Dunbar, A van der Straten, S Esim, B Makunike, A Vere, N Padian
Background: Studies indicate that many adolescent girls and some adolescent boys in sub-Saharan Africa engage in sexual relationships with older partners (intergenerational sex), which may put them at risk for HIV infection. Methods: We conducted eig...

Knowledge and perceptions of attitudes and sexual risk behaviors among rural residents in Zimbabwe and their implications for interventions
By G Ndimande, D Kasprzyk, G B Woelk, D E Montaño, N I H NIMH Collaborative HIV/STD Prevention Trial
Background: A rapid assessment (RAP) formative study was conducted in 32 rural Growth Point Villages in Zimbabwe to prepare for an international trial of the Community Popular Opinion Leader (CPOL) intervention. RAP study results will be used to develop intervention ...

The lived experience of family caregivers of AIDS orphans in rural Zimbabwe
By J F K Mutikani
Background: There is an ever increasing number of AIDS orphans in Zimbabwe. Little has been documented on the plight of family members that care for these children. I Zimbabwe's tradition specifically the Karanga in Masvingo Province, orphans are absorbe in the exten...

Mobility and the spread of HIV in rural East-Zimbabwe
By H A C Voeten, M Mlilo, B W Zaba, E J Knoops, J D F Habbema, S Gregson
Background: The rapid rise in HIV prevalence in Zimbabwe may be linked to high mobility. Cross sectional data from the baseline survey of a population-based cohort study in rural Manicaland are used to analyse the associations of in-migration and travel with H...

National survey of behavioral risk for STDs and HIV among residents in rural growth point villages in Zimbabwe
By D E Montaño, D Kasprzyk, G B Woelk, N I H NIMH Collaborative HIV/STD Prevention Trial
Background: A comprehensive national survey of risk behaviors and STD/HIV was conducted in 32 rural Growth Point Villages in Zimbabwe as part of a cooperative international trial in 5 countries. The trial will use the Community Popular Opinion Leader Intervent...

National survey of STDs and HIV prevalence among residents in rural growth point villages in Zimbabwe
By G B Woelk, D Kasprzyk, D E Montaño, R Mutsindiri, N I H NIMH Collaborative HIV/STD Prevention Trial
Background: A comprehensive national survey of risk behaviors and STD/HIV was conducted in 32 rural Growth Point Villages in Zimbabwe as part of a cooperative international trial in 5 countries. The trial will use the Community Popular Opinion Leader Intervent...

On the contribution if HIV to fertility decline in Zimbabwe
By S Gregson, N Terceira, B Zaba, P R Mason
Background: Lower fertility in HIV+ women slightly limits AIDS impact on early childhood mortality & orphanhood and can lead to understatement in HIV estimates from samples of pregnant women when contraceptive-use is low. This study quantifies the effect in a ...

Orphan prevalence, household characteristics & education in the context of AIDS in Zimbabwe
By C Nyamukapa, G Foster, J Lewis, S Gregson
Background: Socio-economic circumstances of orphans & effects of different forms of orphanhood by size & stage of HIV epidemic remain poorly understood. In a major, maturing epidemic, we describe the infection burden and orphan levels & household circumstances...

Partners in action – A community-based reinforcement strategy to support a radio serial drama for prevention of human immunodeficiency virus infection in Zimbabwe
By S M Laver, L Gavin, M E St. Louis, J M Kraft, N Harford, C Galavotti
Issues. Ecological theory suggests that behavior change efforts are most likely to succeed when multiple levels and sectors of society are engaged; yet many HIV prevention efforts are limited to a single sector/level. The MARCH [Modeling and Reinforcement to Combat ...

A partnership forum for prevention of mother-to-child transmission: a effective strategy for coordinating and scaling up a national program in Zimbabwe
By M E St. Louis, I Chitsike, M Manase, P Walsh, R Nheta-Todd, N Tavengwa, A Miller, C Gandolfini, O Mugurungi
Issues. Pressure exists to scale up PMTCT programs in African countries highly affected by HIV, often from international donors, but infrastructure for scaling up is often weak. Most critically, National Program Offices (NPOs) typically have few and underpaid staff... Patterns of sexual behaviour and the risk of HIV infection

Patterns of sexual behaviour and the risk of HIV infection in rural Zimbabwe
By J J C Lewis, S Chandiwana, C Nyamukapa, G P Garnett, C A Donnelly, S Gregson
Background: HIV-1 has spread widely throughout rural Zimbabwe reaching unprecedented prevalences. A wide range of social, economic, demographic and behavioural variables contribute to the spread of HIV within populations. Detailed quantitative data on patterns of...

Positive Women: Voices and Choices project - Zimbabwe
By C Maposhere
Issues:There is no information that women living with HIV and AIDS service organisations can use for advocacy on policy change to improve sexual and reproductive health of HIV positive women. Usually, women living with HIV are not involved in research on issue...

Power- and negotiation- related predictors of consistent condom use by Zimbabwean women
By A O'Leary, J Moore, G Sakutukwa, L Loeb, D Hrushka, N Padian
Purpose: Seronegative women seeking contraceptive services in Harare, Zimbabwe (N = 339) received a 3-session intervention to help them to negotiate condom use with their male partners. We wished to identify relationship factors and specific negotiation strategies a...

Predictors of condom use among ever-married women in Zimbabwe: Is HIV/AIDS risk a factor?
By W Moyo
Background: Condom use among married women and women in steady relationships in Zimbabwe remains low despite a high likelihood of acquiring HIV infection from husbands and primary partners. To better understand factors promoting protective behavior within r...

Prevalence and incidence of HIV and sexually transmitted infections (STI) among young women in Thailand, Uganda and Zimbabwe participating in the hormonal contraception and risk of HIV acquisition cohort
By R Salata, P Cornelisse, T Chipato, F Mmiro, C Morrison, N Padian, S Rugpao, D Celentano
Background: The burden of STI among young women in societies with mature HIV epidemics in international settings requires more effective preventive interventions. Methods: Since Nov 1999, we enrolled women 18-35 years from Family Planning and STD clini...

Prevalence of common mental disorder in HIV-positive pregnant women in Zimbabwe
By L J Stranix, D Chibanda, A Chingono, E T Montgomery, J Wells, Y A Maldonado, M T Bassett, D W Hill, T Chipato, T Chipato, A K Shetty
Objective: Recently, HIV-positive women have been the focus of considerable research related to biomedical aspects of perinatal transmission worldwide. However, limited data are available on the psychological morbidity of these women in resource poor countries. This...

Prevention of maternal to child transmission through early HIV testing antenatally and Neverapine intervention during labor for HIV positive moms in rural Zimbabwe
By K A McCarty
Issues: Short dose Neverapine has been proven effective in decreasing the transmission rate from HIV positive moms and their newborns in countries unable to afford the cost of full anti-viral drug therapy for HIV positive antenatal clients. Although Zimbabwe h...

The role of community participation in the scaling up of Voluntary Counseling and Testing services in a rural area of Zimbabwe
By S Godfree, B Mwaramba, S Manyenya, E Serima
Background: In scaling up VCT (Voluntary Counselling and Testing) services, ZAPSO (Zimbabwe Aids Prevention and Support Organization), a local NGO adopted a participatory approach in the planning and implementation stage of the project cycle. By applying qualitativ...

Self-reported clinical signs and symptoms in the prognostic assessment of severe immunodeficiency in men with subtype C HIV infection in Harare, Zimbabwe
By R N Machekano, M T Bassett, W McFarland, D A Katzenstein
Objective: Providing low-cost interventions such as co-trimoxazole as prophylaxis against opportunistic infections among HIV infected individuals depends on the identification of those at risk. We describe the prevalence of self-reported signs and symptoms and CD4...

Social capital and HIV avoidance in men and women in rural Zimbabwe
By P Mushati, M Mlilo, C Campbell, C Nyamukapa, S Gregson
Background: Social capital has been linked to enhanced health status. Communities with greater social capital may support the adoption of behaviour patterns that facilitate HIV-avoidance. This study contrasts the patterns of association between community group...

Social marketing approach to Voluntary Counseling & Testing (VCT) in Zimbabwe
By S Ghosh, K Chatora, N Taruberekera, P Osewe, P Moses
Issue: Despite universal awareness, AIDS is still a highly stigmatized disease in Zimbabwe. Consequently, there is a genuine fear of being tested for HIV. Since the prevalence of HIV among sexually active adults is 35%, and more than 90% of the infected unawar...

Superiority of An “Ultra short” Zidovudine (ZDV) regimen in the prevention of perinatal HIV transmission in rural Zimbabwe
By M S Silverman, P Thistle, G Arbess, R Glazier, I Chitsikie, R Pilon, A Simor, I Chipato
Background: A 4-week course of ZDV at the end of pregnancy was demonstrated to decrease Perinatal transmission by 51% in Thailand. This abbreviated regimen became the WHO recommendation for resource poor countries. Unfortunately due to cost, even this abbreviated reg...

Traditional attitudes to children and the psychosocial impact of aids on children in Zimbabwe
By R B Beatson
Background: The high AIDS mortality of young adults in Zimbabwe has a devastating impact on children. The role of children confronted with illness and death in the family is determined by traditions that evolved to ensure their continued care and support. But there i...

Using community outreach to reduce TI/HIV risk among pregnant women and their partners in Zimbabwe
By R Marindo, S Pearson, L Tongoona, J Pulerwitz, E Weiss
Differences in education and power between the providers and those seeking health care may create barriers that keep illiterate people away from health centers. Opportunities for treatment of STIs and prevention of HIV may be lost because people feel dis-empowered a...