Ahmadi, Azal

Public Health



Swaziland - Assessing population size, triangulating HIV epidemiology, and mapping of prevention services of key populations (MARPS) including sex workers (SW) and men who have sex with men (MSM) in Swaziland

This study in Swaziland will focus on size estimations of the SW and MSM populations, a mapping of HIV prevention services, and a triangulation of HIV prevention, treatment and care data to inform content of programs and policies and the allocation of resources. The project is supported through the HC3 Initiative being implemented by the Center for Communication Programs (CCP) in the Department of Health, Behavior and Society at the Johns Hopkins School of Public Health. This study is conducted collaboratively with the Center for Public Health and Human Rights, in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Study Objectives: Population Size Estimations of men who have sex with men (MSM) and female sex workers (FSW) Mapping of HIV prevention services programs using geographic information systems methods Triangulate HIV epidemiology, prevention, treatment, and care data to inform content of programs and policies and the allocation of resources. The student will work collaboratively with JHSPH faculty and the in-country collaborating organization to ensure the successful conduct of the quantitative research project. This project offers an intersection of professional and academic opportunities that is an integral opportunity to include surveillance, triangulation, and mapping methods in driving evidence-based public health programming in a low income country. Working in the field with local counterparts gives the applicant the opportunity to observe current surveillance and mapping methods, what is efficient and effective, and critically analyze how they would design future projects. The ability to apply academic theory that the applicant is learning in epidemiology and biostatistics classes, to the practical application of developing evidence-based projects from epidemiological data will be an invaluable experience to the student.

Global Health Mentor: Stefan Baral, MD

Director, Key Populations Program

Swaziland has the highest prevalence of HIV/AIDS in the world, which is currently estimated around 30% for adults in the small, landlocked nation. While the epidemic is still generalized, key populations (KP), including female sex workers (FSW) and men who have sex with men (MSM) are disproportionately affected. For my field placement, I assisted with a national formative research study with the aim of generating data to inform the development and implementation of cost-effective and high-quality HIV prevention, care and support services among populations at-risk in the country. Although I traveled throughout the country to a variety of study sites, I was primarily based in the capital, Mbabane.

As a student in the Department of International Health, I have a primary interest in HIV/AIDS research among KP in cross-cultural contexts, especially in Sub-Saharan Africa. The placement proved to be an invaluable experience in gaining on-the-ground experience conducting HIV/AIDS research and programmatic work in a sub-Saharan African sociocultural context, in which I had limited experience prior to the placement. Indeed, the internship allowed me to build upon my previous public health skill set and to effectively contribute to the respective project, while advancing my career, research and personal objectives in the global HIV/AIDS sphere.

Ahmadi_2014The objective of the internship was to provide me with field experience in developing and implementing a research study, in addition to programming around KP, HIV transmission and clinical services. For the research component of the internship, I engaged community partners in protocol development and study implementation and facilitated the protocol submission process to the Institutional Review Board at the Johns Hopkins Bloomberg School of Public Health and the Swaziland Scientific Ethics Committee. I was also responsible for developing survey indicators pertaining to adherence to antiretroviral therapy (ARV) and patient satisfaction with health services for both FSW and MSM.

For the programmatic component of the internship, I met with local implementing partners to document and map their KP work in Swaziland, assisted with a KP Expert Speakers Seminar for peer educators in Swaziland and built a database to analyze results of the pre/post-test intervention from the training.

My field practicum re-affirmed how the HIV/AIDS epidemic in the country is heavily influenced by a variety of socio-cultural factors. For instance, throughout my discussions with FSW, many women stated that they avoided going to clinics because of the profound stigma experienced from clinicians, especially nurses. Often, nurses would ridicule these women if they presented with a sexually transmitted infection, turning them away and thus posing a barrier in women’s HIV/AIDS care-seeking behavior. The police force in the country also contributed to gender-based violence among this population, further contributing to lack of uptake of HIV care services. Basic levels of HIV/AIDS knowledge were also quite low among those with whom I interacted, most notably the KP peer educators. Only 18% and 8% of KP peer educators correctly identified what the HIV acronym stood for and how long after unsafe sex an individual should obtain an HIV test, respectively. Overall, the experience highlighted how a multi-level, socio-culturally sensitive approach should be employed to help reduce the burden of HIV/AIDS among KP in the country.

Photo Captions:

1.Scenery in Swaziland

2.Condom distribution container at the South African Swaziland land border


August 2022



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