Maria J Wawer
Biographic Data
| ID | 198494 |
|---|---|
| NAME | Maria J Wawer |
| GIVEN NAMES | Maria J |
| FAMILY NAME | Wawer |
| SIGNATURE | WAWER M J |
| AFFILIATIONS | Johns Hopkins University |
| ORCID | 0000-0002-3601-4469 |
| VERIFIED | Yes |
| TOTAL WORKS | 51 |
| TOTAL CITATIONS | 89 |
| AUTHOR COUNT | 51 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1986 |
| LATEST PUBLICATION YEAR | 2025 |
| H-INDEX | 5 |
Mental health phenotypes of well-controlled HIV in Uganda
Introduction The phenotypic expression of mental health (MH) conditions among people with HIV (PWH) in Uganda and worldwide are heterogeneous. Accordingly, there has been a shift toward identifying MH phenotypes using data-driven methods capable of identifying novel insights into mechanisms of divergent MH phenotypes among PWH. We leverage the analytic strengths of machine learning combined with inferential methods to identify novel MH phenotypes…
HIV epidemiologic trends among occupational groups in Rakai, Uganda
Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the…
Use of mobile phones to collect data on Covid-19
During the COVID-19 pandemic lockdown, we deployed a rapid, mobile phone-based survey to assess access and participation rates when using mobile phones to collect data on COVID-19 in Rakai, south-central Uganda. We sampled prior Rakai Community Cohort Study (RCCS) participants based on HIV status using mobile phone contacts. We administered a 30-minute phone-based interview to consenting participants to assess their knowledge about different aspe…
Motivational interviewing experiences from a community health worker-led HIV prevention and care intervention in rural Uganda
Motivational Interviewing (MI) and Community Health Workers (CHWs) are increasingly utilized in global settings to improve HIV outcomes, yet research exploring implementation strategies using MI and CHWs is lacking. We examined the experiences of CHWs and their clients in a counseling intervention which used MI-informed counseling to increase engagement in HIV prevention and treatment. This study was nested within the mLAKE cluster-randomized tri…
In the era of universal test and treat in Uganda, recent intimate partner violence is not associated with subsequent ART use or viral suppression
Intimate partner violence (IPV) has been associated with delays throughout the HIV care continuum. This study explored prospective associations between experiences of past-year IPV and two HIV care outcomes in the context of current universal test and treat guidelines using two consecutive rounds of an ongoing HIV surveillance study conducted in the Rakai region of Uganda. Longitudinal logistic regression models examined associations between IPV,…
From ‘no problem’ to ‘a lot of difficulties’
Migration is increasingly common in Africa, especially for employment. Migrants may face additional barriers to accessing health care, including human immunodeficiency virus (HIV) prevention and treatment, compared with long-term residents. Exploring migrants’ experiences with health services can provide insights to inform the design of health programmes. In this study, we used qualitative methods to understand migrants’ barriers to health servic…
Overweight and obesity in south central Uganda
Obesity is a rapidly growing global health challenge, but there are few population-level studies from non-urban settings in sub-Saharan Africa. We evaluated the prevalence of overweight (body mass index (BMI)>25 kg/m 2 ), obesity (BMI>30 kg/m 2 ), and associated factors using data from May 2018 to November 2020 from the Rakai Community Cohort Study, a population-based cohort of residents aged 15 to 49 living in forty-one fishing, trading, and agr…
Antiretroviral treatment sharing among highly mobile Ugandan fisherfolk living with HIV
Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 2…
Population-level adult mortality following the expansion of antiretroviral therapy in Rakai, Uganda
There are limited data on the impact of antiretroviral therapy (ART) on population-level adult mortality in sub-Saharan Africa. We analysed data for 2000-14 from the Rakai Community Cohort Study (RCCS) in Uganda, where free ART was scaled up after 2004. Using non-parametric and parametric (Weibull) survival analysis, we estimated trends in average person-years lived between exact ages 15 and 50, per capita life-years lost to HIV, and the mortalit…
Caregiver versus self-reported activities of daily living among HIV-positive persons in Rakai, Uganda
Assessment of an individual's functional status, as measured by activities of daily living (ADL), is an essential element in the diagnosis of HIV-associated neurocognitive disorders (HAND) but individuals with cognitive impairment may not accurately report ADL. We assessed agreement between self- and caregiver-reported ADL in HIV-positive persons. Antiretroviral therapy (ART)-naïve HIV-positive persons (n = 321) and HIV-negative controls (n = 134…
Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda
HIV Partner Notification Values and Preferences Among Sex Workers, Fishermen, and Mainland Community Members in Rakai, Uganda
Multilevel influences on acceptance of medical male circumcision in Rakai District, Uganda
Despite access to safe medical male circumcision (MMC) and proven effectiveness of the procedure in reducing acquisition of HIV and other sexually transmitted infections, uptake remains suboptimal in many settings in sub-Saharan Africa, including Rakai District, Uganda. This study explored multilevel barriers and facilitators to MMC in focus group discussions (FGDs) (n = 35 groups) in Rakai. Focus groups were conducted from May through July 2012 …
Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda
The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant g…
Mobility among youth in Rakai, Uganda
Mobility, including migration and travel, influences risk of HIV. This study examined time trends and characteristics among mobile youth (15-24 years) in rural Uganda, and the relationship between mobility and risk factors for HIV. We used data from an annual household census and population-based cohort study in the Rakai district, Uganda. Data on in-migration and out-migration were collected among youth (15-24 years) from 43 communities from 199…
Understanding the socio-structural context of high HIV transmission in kasensero fishing community, South Western Uganda
The current combination HIV prevention services by the RHSP need to be enhanced with more government involvement including ensuring sustainable supply of ART and circumcision services since they are reportedly highly demanded. Community involvement through the engagement of popular peers could also help in the campaign to change the HIV predisposing culture, misconceptions and risky social norms of the population. Social Context HIV Transmission …
Effectiveness of Peer Support on Care Engagement and Preventive Care Intervention Utilization Among Pre-antiretroviral Therapy, HIV-Infected Adults in Rakai, Uganda
Combined Intimate Partner Violence and HIV/Aids Prevention in Rural Uganda
Intimate partner violence (IPV) has a bidirectional relationship with HIV infection. Researchers from the Rakai Health Sciences Program (RHSP), an HIV research and services organization in rural Uganda, conducted a combination IPV and HIV prevention intervention called the Safe Homes and Respect for Everyone (SHARE) Project between 2005 and 2009. SHARE was associated with significant declines in physical and sexual IPV and overall HIV incidence, …
Male Circumcision Coverage, Knowledge, and Attitudes After 4-Years of Program Scale-up in Rakai, Uganda
Intimate partner violence is associated with incident HIV infection in women in Uganda
OBJECTIVES: To quantify the association between intimate partner violence (IPV) and incident HIV infection in women in the Rakai Community Cohort Study between 2000 and 2009. DESIGN AND METHODS: Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Longitudinal data analysis was used to estimate the adjusted incidence rate ratio (IRR) of incident HIV associated with IPV in sexually active women aged 15-49 years, us…
Risk and Protective Correlates of Young Women s First Sexual Experiences in Rakai, Uganda
CONTEXT: Sexually active young women bear the brunt of the HIV epidemic in Sub-Saharan Africa. Information is needed on risk and protective correlates at the family, partner and individual level for the design of programs to encourage safer sexual behaviors and reduce HIV risk among young women. METHODS: The study was conducted among 1,675 sexually experienced women aged 15-24 living in Rakai, Uganda. The sample was taken from an ongoing communit…
Community understandings of and responses to gender equality and empowerment in Rakai, Uganda
Women's rights and gender empowerment programmes are now part of the international agenda for improving global public health, the benefits of which are well documented. However, the public health community has, yet, to address how people define and understand gender equality and how they enact the process of empowerment in their lives. This study uses safe homes and respect for everyone (SHARE), an anti-violence intervention in rural Rakai, Ugand…
Risk factors for intimate partner violence in women in the Rakai Community Cohort Study, Uganda, from 2000 to 2009
Using longitudinal data, this study identified a number of risk factors for IPV. These findings are useful for the development of prevention strategies to prevent and mitigate IPV in women
Family structure effects on early sexual debut among adolescent girls in Rakai, Uganda
This study assessed the association between household family structure and early sexual debut among adolescent girls, ages 15-19, in rural Rakai District, Uganda. Early sexual debut is associated with detrimental physical, emotional and social outcomes, including increased risk of HIV. However, research on the family's role on adolescents' sexual risk behaviors in sub-Sahara Africa has been minimal and rarely takes into account the varying family…
Contextual Barriers and Motivators to Adult Male Medical Circumcision in Rakai, Uganda
Medical male circumcision (MMC) is a central component of HIV prevention. In this study we examined barriers to and facilitators of MMC in Rakai, Uganda. Interviews and focus groups with MMC acceptors, decliners, and community members were collected and analyzed iteratively. Themes were developed based on immersion, repeated reading, sorting, and coding of data using grounded theory. Pain, medical complications, infertility, lack of empirical eff…
Coercive sex in rural Uganda
HIV status and union dissolution in Sub-saharan Africa
Little is known about the impact of HIV infection on the disruption of families through separation, divorce, and widowhood. Using life tables and multinomial logistic regression, this research examined the influence of HIV status on the risk of separation or divorce and widowhood among women in Rakai, Uganda. The multivariate results revealed that dissolution is more common among HIV-infected women and that infected women in HIV-discordant couple…
Origins and working conditions of female sex workers in urban Thailand
This paper examines the social origins and working conditions of selected female commercial sex workers in Thailand. Quantitative data gathered from 678 commercial sex workers (CSWs) in low-price brothels, tea houses and other work sites in three urban centers were supplemented by focus group discussions and in-depth interviews. The commercial sex establishments were selected from lists provided by local health officials. Social factors associate…
Does biological relatedness affect child survival
Objective: We studied child survival in Rakai, Uganda where many children are fostered out or orphaned. Methods: Biological relatedness is measured as the average of the Wrightâ s coefficients between each household member and the child. Instrumen
Trends and Determinants of Contraceptive Use in Rakai District, Uganda, 1995–98
A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15–49 declined significantly from 15 percent to 13 percent. Women practicing family planning fo…
A Public Health Approach to Intimate Partner Violence Prevention in Uganda
Research from Rakai, Uganda, suggests intimate partner violence (IPV) is common and attitudes condoning it are widespread. We used a public health approach to develop and implement an evidence-based IPV prevention intervention named the Safe Homes and Respect for Everyone (SHARE) Project. SHARE was designed on the Transtheoretical Model of behavior change and adapted IPV prevention strategies from Raising Voices and Stepping Stones. SHARE was imp…
Family structure effects on early sexual debut among adolescent girls in Rakai, Uganda
This study assessed the association between household family structure and early sexual debut among adolescent girls, ages 15-19, in rural Rakai District, Uganda. Early sexual debut is associated with detrimental physical, emotional and social outcomes, including increased risk of HIV. However, research on the family's role on adolescents' sexual risk behaviors in sub-Sahara Africa has been minimal and rarely takes into account the varying family…
Contraceptive Prevalence in the Slums of Rio de Janeiro
A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 per…
A Randomized Community Trial of Enhanced Family Planning Outreach in Rakai, Uganda
A randomized community trial of a family planning outreach program was conducted in Rakai District, Uganda. Five communities received standard services; six intervention communities received additional family planning information, counseling, and contraceptive methods from government service providers and community‐based volunteer agents using social marketing and other strategies. Condom use was promoted in all of the communities. The community‐…
Family Planning Operations Research in Africa
Between 1979 and 1990, Columbia University conducted 26 family planning operations research (OR) projects in 13 sub-Saharan African countries. Most of these projects were implemented in settings where family planning service delivery had not yet been initiated or was new and poorly developed. In keeping with program needs in the early stages of development, the majority of the OR projects were based on demonstration or diagnostic designs. Only fo…
Contextual Barriers and Motivators to Adult Male Medical Circumcision in Rakai, Uganda
Medical male circumcision (MMC) is a central component of HIV prevention. In this study we examined barriers to and facilitators of MMC in Rakai, Uganda. Interviews and focus groups with MMC acceptors, decliners, and community members were collected and analyzed iteratively. Themes were developed based on immersion, repeated reading, sorting, and coding of data using grounded theory. Pain, medical complications, infertility, lack of empirical eff…
Sexually Transmitted Infection Management, Safer Sex Promotion and Voluntary HIV Counselling and Testing in the Male Circumcision Trial, Rakai, Uganda
If circumcised men believe that they are protected from HIV there is a possibility that they will compensate for their perceived risk reduction by engaging in higher risk behaviours thereby mitigating any benefit of circumcision in preventing HIV infection. Some observational studies have shown that circumcised men engage in higher risk behaviours than uncircumcised men and the Orange Farm trial in South Africa found circumcised men to have sligh…
Health and Family Planning in Community-Based Distribution Programs
Health and Family Planning in Community-Based Distribution Programs
Contraceptive Prevalence in the Slums of Rio de Janeiro
A community-based family planning operations research project was undertaken in selected low income communities of Rio de Janeiro; project field work began in February 1982. Prevalence data were collected and service delivery strategies were tested, including home visits promoting family planning, home distribution of condoms, and the introduction of community family planning depots. A high baseline contraceptive prevalence rate (CPR) of 70.1 per…
Family Planning Operations Research in Africa
Between 1979 and 1990, Columbia University conducted 26 family planning operations research (OR) projects in 13 sub-Saharan African countries. Most of these projects were implemented in settings where family planning service delivery had not yet been initiated or was new and poorly developed. In keeping with program needs in the early stages of development, the majority of the OR projects were based on demonstration or diagnostic designs. Only fo…
Bridge populations in the spread of HIV/Aids in Thailand
OBJECTIVE: To determine the extent to which men provide a bridge population between commercial sex workers (CSW) and the general female population in Thailand. DESIGN: Sexual network and serological data were collected from a systematic quota sample of low income men and truckers during 1992 in three Thailand provinces. Completed sample size was 1075 men aged 17-45 years and 330 truckers. METHODS: Sexual network information was used to identify t…
Origins and working conditions of female sex workers in urban Thailand
This paper examines the social origins and working conditions of selected female commercial sex workers in Thailand. Quantitative data gathered from 678 commercial sex workers (CSWs) in low-price brothels, tea houses and other work sites in three urban centers were supplemented by focus group discussions and in-depth interviews. The commercial sex establishments were selected from lists provided by local health officials. Social factors associate…
Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1
BACKGROUND AND METHODS: We examined the influence of viral load in relation to other risk factors for the heterosexual transmission of human immunodeficiency virus type 1 (HIV-1). In a community-based study of 15,127 persons in a rural district of Uganda, we identified 415 couples in which one partner was HIV-1-positive and one was initially HIV-1-negative and followed them prospectively for up to 30 months. The incidence of HIV-1 infection per 1…
Trends and Determinants of Contraceptive Use in Rakai District, Uganda, 1995–98
A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15–49 declined significantly from 15 percent to 13 percent. Women practicing family planning fo…
Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda
Polygyny, maternal HIV status and child survival
Age Differences in Sexual Partners and Risk of HIV-1 Infection in Rural Uganda
OBJECTIVES: To assess whether differences in age between sexual partners affect the risk of HIV infection in female adolescents and young adults. METHODS: A total of 6177 ever sexually active women aged 15 to 29 years completed a sociodemographic and sexual behavior questionnaire and provided a blood sample for HIV-1 serology. The age difference between partners was categorized as men 0 to 4 years older (referent group), 5 to 9 years older and 10…
Does biological relatedness affect child survival
Objective: We studied child survival in Rakai, Uganda where many children are fostered out or orphaned. Methods: Biological relatedness is measured as the average of the Wrightâ s coefficients between each household member and the child. Instrumen
Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda
To examine self-reported quality of life and health status of HIV-infected women and a comparison sample of HIV-uninfected women in rural Uganda, we culturally adapted a Lugandan version of the Medical Outcomes Survey-HIV (MOS-HIV). We administered a cross-sectional survey among 803 women (239 HIV-positive and 564 HIV-negative) enrolled in a community study to evaluate maternal and child health in Rakai District, Uganda. The interview took 20 min…
Burden of infection among heads and non-head of rural households in Rakai, Uganda
The objective was to determine HIV prevalence, symptomatology and mortality among adult heads and non-heads of households, in order to assess the burden of HIV on households. It was a community study of 11,536 adults aged 15-59, residing in 4,962 households in 56 villages, Rakai district, Uganda. First, 4,962 heads and 6,574 non-heads of households were identified from censuses. Interviews were then used to determine socio-demographic/behavioural…
HIV status and union dissolution in Sub-saharan Africa
Little is known about the impact of HIV infection on the disruption of families through separation, divorce, and widowhood. Using life tables and multinomial logistic regression, this research examined the influence of HIV status on the risk of separation or divorce and widowhood among women in Rakai, Uganda. The multivariate results revealed that dissolution is more common among HIV-infected women and that infected women in HIV-discordant couple…
Coercive sex in rural Uganda
Rates of HIV‐1 Transmission per Coital Act, by Stage of HIV‐1 Infection, in Rakai, Uganda
BACKGROUND: We estimated rates of human immunodeficiency virus (HIV)-1 transmission per coital act in HIV-discordant couples by stage of infection in the index partner. METHODS: We retrospectively identified 235 monogamous, HIV-discordant couples in a Ugandan population-based cohort. HIV transmission within pairs was confirmed by sequence analysis. Rates of transmission per coital act were estimated by the index partner's stage of infection (rece…
Immunisation coverage among children born to HIV-infected women in Rakai district, Uganda
To evaluate the impact of maternal HIV-infection on routine childhood Immunisation coverage, we compared the Immunisation status of children born to HIV-infected and HIV-uninfected women in rural Uganda. The study population was 214 HIV(+) and 578 HIV(-) women with children aged 6 to 35 months previously enrolled in a community study to evaluate maternal and child health in Rakai District, Uganda. Sampling of subjects for interview was stratified…
Uganda’s HIV Prevention Success
The paper by Green et al. (vol. 10, this issue, AIDS and Behavior). on "Uganda's HIV Prevention Success" concludes that "a decline in multipartner sexual behavior" is the most likely explanation for the declines in HIV prevalence. However, this article neither addresses the inconsistencies in the available behavioral data, nor considers epidemiologic factors that may affect HIV prevalence. The latter include the fact that prevalence is a product …
Repeat Voluntary HIV Counseling and Testing (VCT), Sexual Risk Behavior and HIV Incidence in Rakai, Uganda
Male circumcision for HIV prevention in men in Rakai, Uganda
Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda
Sexually Transmitted Infection Management, Safer Sex Promotion and Voluntary HIV Counselling and Testing in the Male Circumcision Trial, Rakai, Uganda
If circumcised men believe that they are protected from HIV there is a possibility that they will compensate for their perceived risk reduction by engaging in higher risk behaviours thereby mitigating any benefit of circumcision in preventing HIV infection. Some observational studies have shown that circumcised men engage in higher risk behaviours than uncircumcised men and the Orange Farm trial in South Africa found circumcised men to have sligh…
Disclosure of HIV results among discordant couples in Rakai, Uganda
Disclosure of HIV sero-positive results among HIV-discordant couples in sub-Saharan Africa is generally low. We describe a facilitated couple counselling approach to enhance disclosure among HIV-discordant couples. Using unique identifiers, 293 HIV-discordant couples were identified through retrospective linkage of married or cohabiting consenting adults individually enrolled into a cohort study and into two randomised trials of male circumcision…
A Randomized Community Trial of Enhanced Family Planning Outreach in Rakai, Uganda
A randomized community trial of a family planning outreach program was conducted in Rakai District, Uganda. Five communities received standard services; six intervention communities received additional family planning information, counseling, and contraceptive methods from government service providers and community‐based volunteer agents using social marketing and other strategies. Condom use was promoted in all of the communities. The community‐…
Non-enrollment for free community HIV care
Improved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, a…
Medicine (50 works) · Environmental health (34 works) · Demography (33 works) · Population (33 works) · HIV/AIDS Research and Interventions (31 works) · Adolescent Sexual and Reproductive Health (30 works) · Family medicine (18 works) · Sociology (17 works) · Sex work and related issues (15 works) · Demography (14 works)