This literature review aims to explore the importance of disclosing HIV status to HIV positive children before they reach adolescence. Since the use of paediatric highly active antiretroviral therapy, many HIV positive children are now surviving into adulthood. This faces parents and healthcare workers with the difficult process of disclosing HIV status to children. A review of the literature has revealed discussions of the following themes: barriers to HIV disclosure before adolescence; disclosure as a process, rather than a one-off event; and the benefits of and need for HIV disclosure before adolescence. Parental beliefs and anxieties were found to be the main barrier to HIV disclosure and this needs to be addressed through education and governmental policies (Department of Health (DH), 2007). HIV disclosure before adolescence is vital, as a lack of communication about HIV creates confusion and mistrust, harms psychosocial development, compromises the child's right to autonomy and increases the risk of uknowingly transmitting the disease. PMID:22875352
Two studies were conducted to develop scales for assessing self-efficacy to disclose HIV status to sex partners and negotiate safer sex practices among people living with HIV\\/AIDS. Elicitation research was used to derive 4 sets of scenarios with graduated situational demands that serve as stimulus materials in assessing self-efficacy. Two studies demonstrated that the self-efficacy scales for effective disclosure and
Seth C. Kalichman; David Rompa; Kari DiFonzo; Dolores Simpson; Florence Kyomugisha; James Austin; Webster Luke
Since informed consent became legally required in the therapeutic setting, the risks physicians were to disclose have been limited to the risks of particular procedures. Two recent court decisions in which disclosure of surgeons' alcoholism and positive human immunodeficiency virus status was required may begin to erode that limit. The grounds for this expansion of disclosure requirements were inherent in the 20-year-old "materiality" standard for disclosure; nevertheless, the change they signal is profound. These cases may signal a trend that, in the long term, could result in a shift in physician-patient communication and a significant loss of privacy for physicians. PMID:1497019
Disclosure of HIV status to sexual partners poses a challenge during healthcare provision, highlighting both the responsibility for controlling the epidemic and ensuring the patient's psychosocial well-being. This study's objective was to grasp the strategies used by health professionals for such disclosure. This is a qualitative study based on the discourse of health professionals and patients at specialized STD/AIDS clinics in the city of São Paulo, Brazil, using individual interviews and focus and educational groups. The strategies range from threatening to complicity, and the main focus is to minimize the stigma attached to individuals with HIV. It is believed that an active problem-solving approach to stigma in real situations in the clinic can provide a possible and practical path for dealing with such stigma, by creating argumentative repertoires, allowing the emergence of normative horizons that are technically, ethically, and politically relevant for integrating disclosure of the HIV diagnosis to the sexual partner and healthcare for persons with HIV. PMID:19649421
Silva, Neide Emy Kurokawa E; Ayres, José Ricardo de Carvalho Mesquita
Increasing HIV knowledge is a focus of many HIV education and prevention efforts. While the bivariate relationship of HIV serostatus disclosure with HIV-related knowledge and stigma has been reported in the literature, little is known about the mediation effect of stigma on the relationship of HIV knowledge with HIV serostatus disclosure. Data from 4,208 rural-to-urban migrants in China were analyzed to explore this issue. Overall, 70% of respondents reported willingness to disclose their HIV status if they were HIV-positive. Willingness to disclose was negatively associated with misconceptions about HIV transmission and stigma. Stigma mediated the relationship between misconceptions and willingness to disclose among women but not men. The mediation effect of stigma suggests that stigmatization reduction would be an important component of HIV prevention approaches. Gender inequality needs to be addressed in stigmatization reduction efforts.
YANG, H.; LI, X.; STANTON, B.; FANG, X.; LIN, D.; NAAR-KING, S.
Histoplasmosis is a systemic mycosis endemic in extensive areas of the Americas. The authors report on an urban adult male patient with uncommon oral-cutaneous lesions proven to be histoplasmosis. Additional investigation revealed unnoticed HIV infection with CD4+ cell count of 7/mm3. The treatment was performed with amphotericin B, a 2065 mg total dose followed by itraconazole 200mg/daily plus antiretroviral therapy with apparent cure. Histoplasmosis is an AIDS-defining opportunistic disease process; therefore, its clinical diagnosis must drive full laboratory investigation looking for unnoted HIV-infection.
Marques, Silvio Alencar; Silvares, Maria Regina Cavariani; de Camargo, Rosangela Maria Pires; Marques, Mariangela Esther Alencar
Disclosure of HIV status after HIV voluntary counseling and testing has important implications for the spread of the HIV epidemic and the health of individuals who are HIV positive. Here, we use individual and couples level data for currently married respondents from an ongoing longitudinal study in rural Malawi to (1) examine the extent of HIV status disclosure by HIV serostatus; (2) identify reasons for not sharing one's HIV status with a spouse; and (3) evaluate the reliability of self-reports of HIV status disclosure. We find that disclosure of HIV status is relatively common among rural Malawians, where most have shared their status with a spouse, and many disclose to others in the community. However, there are significant differences in disclosure patterns by HIV status and gender. Factors associated with non-disclosure are also gendered, where women who perceive greater HIV/AIDS stigma and HIV positive are less likely to disclose HIV status to a spouse, and men who are worried about HIV infection from extramarital partners are less likely to disclose their HIV status to a spouse. Finally, we test the reliability of self-reported HIV status disclosure and find that self-reports of HIV-positive men are of questionable reliability. PMID:21390889
Anglewicz, Philip; Chintsanya, Jesman
Thirty-two U.S. states and two territories have statutes that criminalize sexual and other conduct of persons who are HIV-positive. Many of these laws were passed in response to the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, which required states to outlaw intentional transmission of HIV as a condition of federal funding, but almost all of them reach far beyond intentional infection and affect conduct that has not resulted in infection and even conduct that could never result in infection. Hundreds of state courts have also used HIV-positive status as an element of traditional crimes such as assault with a deadly weapon, reckless endangerment, even attempted murder. A defendant's HIV-positive status has also been used as a factor justifying harsher sentences for crimes ranging from prostitution to rape to simple assault. What exactly is wrong with HIV criminalization? Why shouldn't we punish people who recklessly or deliberately expose others to HIV? Why not try to force HIV-positive individuals to disclose their status to potential sexual partners? PMID:24092584
Latham, Stephen R
This study sought to understand how individuals reveal their HIV test results to others and the ways in which social relations affect the disclosure process. The data were collected through open-ended interviews administered in Swahili to informants who had just been tested for HIV and to those who were living with HIV in Dar es Salaam and Iringa regions. Analysis
Joe Lugalla; Stanley Yoder; Huruma Sigalla; Charles Madihi
Disclosure of HIV status is routinely promoted as a public health measure to prevent transmission and enhance treatment adherence support. While studies show a range of positive and negative outcomes associated with disclosure, it has also been documented that disclosing is a challenging and ongoing process. This article aims to describe the role of health-care workers in Central and Nairobi provinces in Kenya in facilitating disclosure in the contexts of voluntary counselling and testing and provider-initiated testing and counselling and includes a discussion on how participants perceive and experience disclosure as a result. We draw on in-depth qualitative research carried out in 2008-2009 among people living with HIV (PLHIV) and the health workers who provide care to them. Our findings suggest that in everyday practice, there are three models of disclosure at work: (1) voluntary-consented disclosure, in alignment with international guidelines; (2) involuntary, non-consensual disclosure, which may be either intentional or accidental; and (3) obligatory disclosure, which occurs when PLHIV are forced to disclose to access services at health facilities. Health-care workers were often caught between the three models and struggled with the competing demands of promoting prevention, adherence, and confidentiality. Findings indicate that as national and global policies shift to normalize HIV testing as routine in a range of clinical settings, greater effort must be made to define suitable best practices that balance the human rights and the public health perspectives in relation to disclosure. PMID:23826931
Moyer, Eileen; Igonya, Emmy Kageha; Both, Rosalijn; Cherutich, Peter; Hardon, Anita
We analyzed data from a multisite study of 1,063 gay or bisexual men attending sexually transmitted disease clinics to evaluate factors predicting failure to disclose human immunodeficiency virus (HIV) risk behaviors to clinic staff and the extent of such failure. We compared data from a brief screening assessment on unprotected anal and oral sex with data on the same behaviors from a subsequent detailed interview. We also compared behavioral data from screening and the interview with data on diagnoses of rectal gonorrhea abstracted from medical charts. Of 523 men reporting unprotected anal sex at interview, 29% failed to report this behavior at screening. Men failing to disclose unprotected anal sex were also less likely to disclose engaging in unprotected oral sex. Among men reporting no unprotected anal sex, either at screening or interview, 1.6% were diagnosed with rectal gonorrhea. Logistic regression analyses comparing men who did and did not disclose at screening having engaged in unprotected anal sex showed that men who failed to disclose reported greater involvement in gay organizations, greater perceived peer support for condoms, fewer episodes of unprotected anal sex in the last four months, and lower rates of substance abuse treatment. Our data suggest that men who failed to disclose may have lower risk levels, and may be more integrated into the gay community. Brief interviews, as opposed to detailed ones, also may underestimate incidence of unsafe sex. Where feasible, HIV risk assessment and counseling and laboratory screening should be routinely provided to all clinic attendees, regardless of self-reports. PMID:7917436
Doll, L S; Harrison, J S; Frey, R L; McKirnan, D; Bartholow, B N; Douglas, J M; Joy, D; Bolan, G; Doetsch, J
Background Directly disclosing a positive HIV serostatus to family members can have psychological and physiological health benefits.\\u000a Perceptions that one is in a supportive family environment may enhance these benefits.\\u000a \\u000a \\u000a \\u000a Purpose We examined a mediated moderation model in which we expected interactions between serostatus disclosure to family members\\u000a and HIV-specific family support to be associated with women’s perceived stress, which in turn
Erin M. Fekete; Michael H. Antoni; Ron Durán; Brenda L. Stoelb; Mahendra Kumar; Neil Schneiderman
Most people living with HIV/AIDS (PLWHA) disclose their serostatus to their sexual partners and take steps to protect their partners from HIV. Prior research indicates that some PLWHA portray themselves to their sexual partners as HIV-negative or otherwise misrepresent their HIV status. The aim of this study was to document the prevalence of misleading sexual partners about HIV status and to identify factors associated with misleading. A sample of 310 PLWHA completed a self-administered questionnaire assessing demographic information, disclosure, HIV knowledge, HIV altruism, psychopathy, and sexual risk behavior. Participants were also asked "Since you were diagnosed as having HIV, have you ever misled a sexual partner about your HIV status?" Overall, 18.6% of participants indicated that they had misled a sexual partner. Those who had misled a partner at some point since their diagnosis reported more current HIV transmission risk behaviors, including unprotected anal or vaginal sex with a partner who was HIV-negative or whose HIV status was unknown. Participants who had misled a partner did not differ from those who had not in terms of demographic characteristics. Individuals who had misled a partner scored significantly lower on a measure of HIV knowledge than those who had not misled a partner. HIV altruism and psychopathy were associated with sexual risk behavior, but did not differ between those who had misled and those who had not. Disclosure of HIV status can reduce HIV transmission, but only if people are candid. Interventions aimed at increasing knowledge and accurate disclosure may reduce the spread of HIV. PMID:22183890
Benotsch, Eric G; Rodríguez, Vivian M; Hood, Kristina; Lance, Shannon Perschbacher; Green, Marisa; Martin, Aaron M; Thrun, Mark
HIV-related stigma, psychological distress, self-esteem, and social support were investigated in a sample comprising people who have concealed their HIV status to all but a selected few (limited disclosers), people who could conceal but chose to be open (full disclosers), and people who had visible symptoms that made concealing difficult (visibly stigmatized). The visibly stigmatized and full disclosers reported significantly more stigma experiences than limited disclosers, but only the visibly stigmatized reported more psychological distress, lower self-esteem, and less social support than limited disclosers. This suggests that having a visible stigma is more detrimental than having a concealable stigma. Differences in psychological distress and self-esteem between the visibly stigmatized and full disclosers were mediated by social support while differences between the visibly stigmatized and limited disclosers were mediated by both social support and stigma. These findings suggest that social support buffers psychological distress in people with HIV. PMID:21861610
Stutterheim, Sarah E; Bos, Arjan E R; Pryor, John B; Brands, Ronald; Liebregts, Maartje; Schaalma, Herman P
|Through a national survey of marriage and family therapists, this study examines what therapists do when their HIV-positive clients disclose that they are engaging in high-risk sexual behavior. Participants (N=309) were more likely to break confidence when their clients were male, young, gay, or African American. Describes characteristic of…
Pais, Shobha; Piercy, Fred; Miller, JoAnn
We describe the frequency of and factors associated with disclosure, knowledge of partner's HIV status, and consistent condom use among 3538 HIV-positive patients attending eighteen HIV care and treatment clinics in Kenya, Namibia, and Tanzania. Overall, 42% of patients were male, and 64% were on antiretroviral treatment. The majority (80%) had disclosed their HIV status to their partners, 64% knew their partner's HIV status, and 77% reported consistent condom use. Of those who knew their partner's status, 18% reported their partner was HIV negative. Compared to men, women were significantly less likely to report disclosing their HIV status to their sex partner(s), to knowing their partner's HIV status, and to using condoms consistently with HIV-negative partners. Other factors negatively associated with consistent condom use include nondisclosure, alcohol use, reporting a casual sex partner, and desiring a pregnancy. Health care providers should target additional risk reduction counseling and support services to patients who report these characteristics. PMID:23829332
Bachanas, Pamela; Medley, Amy; Pals, Sherri; Kidder, Daniel; Antelman, Gretchen; Benech, Irene; DeLuca, Nicolas; Nuwagaba-Biribonwoha, Harriet; Muhenje, Odylia; Cherutich, Peter; Kariuki, Pauline; Katuta, Frieda; Bukuku, May
The privacy of copies of consent forms provided to research participants cannot be guaranteed. Therefore, consent forms that disclose a subject's HIV status may result in breach of confidentiality and cause social harms. Under the ethical principle of beneficence defined in the Belmont Report, we recommend that disclosure of HIV status be through voluntary counseling and testing; however, whenever possible, copies of consent form should not specify HIV status. PMID:16394859
Gray, Ronald H; Sewankambo, Nelson K; Wawer, Maria J; Serwadda, David; Kiwanuka, Noah; Lutalo, Tom
Introduction Evidence shows that some individuals with HIV or diabetes do not report their medical history to the dentist. Disclosure is important because these individuals can be at greater risk of oral disease.Aims and objectives The aim of this study is to provide greater understanding of why some individuals do not disclose HIV or diabetes to the dentist.Methods In-depth interviews were conducted with 20 participants (10 HIV & 10 diabetes) based around the participant's diagnosis and disclosure history. Data were analysed using framework analysis.Results While a lack of disclosure can be found among those with a diagnosis of HIV and diabetes, it appears that the reasons behind disclosure, or lack thereof, are different for each. The reasons are based around: differences in age, understanding of diagnosis, experience of stigma, past disclosure behaviour, trust in dentists and experience of healthcare. Few individuals had discussed the effects of their diagnosis with their dentist or were advised on the importance of seeing a dentist.Discussion Individuals with chronic illness should be advised why it is important for the dentist to know their medical history and should be made to feel comfortable to disclose. PMID:24072302
Introduction Evidence shows that some individuals with HIV or diabetes do not report their medical history to the dentist. Disclosure is important because these individuals can be at greater risk of oral disease.Aims and objectives The aim of this study is to provide greater understanding of why some individuals do not disclose HIV or diabetes to the dentist.Methods In-depth interviews were conducted with 20 participants (10 HIV & 10 diabetes) based around the participant's diagnosis and disclosure history. Data were analysed using framework analysis.Results While a lack of disclosure can be found among those with a diagnosis of HIV and diabetes, it appears that the reasons behind disclosure, or lack thereof, are different for each. The reasons are based around: differences in age, understanding of diagnosis, experience of stigma, past disclosure behaviour, trust in dentists and experience of healthcare. Few individuals had discussed the effects of their diagnosis with their dentist or were advised on the importance of seeing a dentist.Discussion Individuals with chronic illness should be advised why it is important for the dentist to know their medical history and should be made to feel comfortable to disclose. PMID:24072324
Edwards, J; Palmer, G; Osbourne, N; Scambler, S
Abstract For children affected by AIDS, one psychological challenge is whether or how to disclose their parents' HIV status to others (secondary disclosure). The current study, utilizing data from 962 rural children affected by AIDS in central China, examines children's perceptions regarding secondary disclosure (intention of disclosure, openness, and negative feelings) and their association with children's demographic and psychosocial factors. The findings indicated that a high proportion of children preferred not to disclose parental HIV status to others, would not like to tell the truth to others in the situations of having to talk about parental HIV, and also had strong negative feelings about the disclosure. The study findings confirmed that keeping secrecy of parental HIV infection was associated with higher level of negative psychological outcomes (e.g., depression, loneliness, perceived stigma, and enacted stigma), and children's age was strongly associated with both their perceptions of secondary disclosure and psychological measures.
Li, Xiaoming; Zhao, Guoxiang; Zhao, Junfeng; Stanton, Bonita
Young women with HIV and histories of physical and/or sexual abuse in childhood may be vulnerable to difficulties with disclosure to sexual partners. Abuse in childhood is highly prevalent in HIV-positive women, and has been associated with poorer communication, low assertiveness, low self worth, and increased risk for sexual and other risk behaviors that increase the risk of secondary transmission of HIV. HIV disclosure may be an important link between abuse and sexual risk behaviors. Qualitative interviews with 40 HIV-positive young women with childhood physical and/or sexual abuse were conducted; some women had also experienced adult victimization. Results suggest that HIV-positive women with abuse histories use a host of strategies to deal with disclosure of HIV status, including delaying disclosure, assessing hypothetical responses of partners, and determining appropriate stages in a relationship to disclose. Stigma was an important theme related to disclosure. We discuss how these disclosure processes impact sexual behavior and relationships and discuss intervention opportunities based on our findings. PMID:23596649
Clum, Gretchen A; Czaplicki, Lauren; Andrinopoulos, Katherine; Muessig, Kathryn; Hamvas, L; Ellen, Jonathan M
Objective Adult caregivers provide children living with HIV with varying amounts and types of information about their health status that may affect their coping and health care behaviors. We aimed to describe patterns of information-sharing with children and thoughts around disclosure among caregivers in the Democratic Republic of the Congo. Methods 259 primary caregivers of children 5–17 years old in an HIV pediatric care and treatment program were screened; 8 adult caregivers (3%) had informed their child of the child’s HIV status. We conducted structured interviews with 201 caregivers whose children had not yet been told their HIV status. Results Nearly 50% of caregivers provided no information to their child about their health; 15% had given partial information without mentioning HIV, and 33% provided information that deflected attention from HIV, whether deliberately so or otherwise. Almost all caregivers said that the child should be told their status some day, and three-fourths reported having ever thought about what might lead them to tell. However, nearly one-third of caregivers saw no benefits to informing the child of her/his HIV status. A majority of caregivers felt that they themselves were the best to eventually disclose to the child, but some wanted support from health care providers. Conclusion HIV-infected children are given limited information about their health. Health care providers may serve as important sources of support to caregivers as they decide when and how to talk candidly with their children about their health.
Vaz, Lara M. E.; Maman, Suzanne; Eng, Eugenia; Barbarin, Oscar A.; Tshikandu, Tomi; Behets, Frieda
Introduction Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact. Methods MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers. Results Thirty-two articles met the inclusion criteria, with 16 reporting prevalence of disclosure. Of these 16 studies, proportions of disclosed children ranged from 0 to 69.2%. Important factors influencing disclosure included the child's age and perceived ability to understand the meaning of HIV infection and factors related to caregivers, such as education level, openness about their own HIV status and beliefs about children's capacities. Common barriers to disclosure were fear that the child would disclose HIV status to others, fear of stigma and concerns for children's emotional or physical health. Disclosure was mostly led by caregivers and conceptualized as a one-time event, while others described it as a gradual process. Few studies measured the impact of disclosure on children. Findings suggested adherence to antiretroviral therapy (ART) improved post-disclosure but the emotional and psychological effects of disclosure were variable. Conclusions Most studies show that a minority of HIV-infected children in resource-limited settings know his/her HIV status. While caregivers identify many factors that influence disclosure, studies suggest both positive and negative effects for children. More research is needed to implement age- and culture-appropriate disclosure in resource-limited settings.
Vreeman, Rachel C; Gramelspacher, Anna Maria; Gisore, Peter O; Scanlon, Michael L; Nyandiko, Winstone M
We used a grounded theory approach to explore how a sample of caregivers of children on antiretroviral treatment (ART) experience HIV disclosure to their infected children. This paper explores caregivers' barriers to disclosing HIV to infected children. Caregivers of children aged 6–13 years who were receiving ART participated in four focus-group interviews. Three main themes, caregiver readiness to tell, right time to tell, and the context of disclosure, emerged. Disclosure was delayed because caregivers had to first deal with personal fears which influenced their readiness to disclose; disclosure was also delayed because caregivers did not know how to tell. Caregivers lacked disclosure skills because they had not been trained on how to tell their children about their diagnosis, on how to talk to their children about HIV, and on how to deal with a child who reacts negatively to the disclosure. Caregivers feared that the child might tell others about the diagnosis and would be discriminated and socially rejected and that children would live in fear of death and dying. Health care providers have a critical role to play in HIV disclosure to infected children, considering the caregivers' expressed desire to be trained and prepared for the disclosure.
Madiba, Sphiwe; Mokwena, Kebogile
Most people with HIV have disclosed their status to someone, often with mixed results. Most health literature seems to favor disclosure by persons living with acquired immunodeficiency syndrome (AIDS), but it could be that to disclose is not always a good thing. We used a descriptive, qualitative research design to explore the experience of human immunodeficiency virus (HIV) and AIDS stigma of people living with HIV or AIDS and nurses involved in their care in Africa. Focus group discussions were held with respondents. We asked them to relate incidents that they themselves observed, and those that they themselves experienced in the community and in families. Thirty-nine focus groups were conducted in five countries in both urban and rural settings. This article is limited to a discussion of data related to the theme of disclosure only. The sub-themes of disclosure were experiences before the disclosure, the process of disclosure, and responses during and after disclosure. PMID:18235155
Greeff, Minrie; Phetlhu, Rene; Makoae, Lucia N; Dlamini, Priscilla S; Holzemer, William L; Naidoo, Joanne R; Kohi, Thecla W; Uys, Leana R; Chirwa, Maureen L
This paper evaluates an experiment in which individuals in rural Malawi were randomly assigned monetary incentives to learn their HIV results after being tested. Distance to the HIV results centers was also randomly assigned. Without any incentive, 34 percent of the participants learned their HIV results. However, even the smallest incentive doubled that share. Using the randomly assigned incentives and distance from results centers as instruments for the knowledge of HIV status, sexually active HIV-positive individuals who learned their results are three times more likely to purchase condoms two months later than sexually active HIV-positive individuals who did not learn their results; however, HIV-positive individuals who learned their results purchase only two additional condoms than those who did not. There is no significant effect of learning HIV-negative status on the purchase of condoms.
Thornton, Rebecca L.
In a cross-sectional study of HIV-positive and HIV-negative subjects from the Reaching for Excellence in Adolescent Health (REACH) cohort we examined the relationship of plasma selenium, whole blood glutathione and whole blood glutathione peroxidase to HIV status, disease severity, use of antiretrov...
HIV status disclosure is often characterized as a dilemma. On the one hand, disclosure can promote health, social support, and psychological well-being. On the other, disclosure can lead to stigmatization, rejection, and other negative social interactions. Previous research has shown that HIV status disclosure is a reasoned process whereby the costs and benefits to oneself and to others are weighed.
Sarah E. Stutterheim; Iris Shiripinda; Arjan E. R. Bos; John B. Pryor; Marijn de Bruin; Jeannine F. J. B. Nellen; Gerjo Kok; Jan M. Prins; Herman P. Schaalma
Background Achieving the Millennium Development Goals that aim to reduce malnutrition and child mortality depends in part on the ability\\u000a of governments\\/policymakers to address nutritional status of children in general and those infected or affected by HIV\\/AIDS\\u000a in particular. This study describes HIV prevalence in children, patterns of malnutrition by HIV status and determinants of\\u000a nutritional status.\\u000a \\u000a \\u000a \\u000a \\u000a Methods The study involved 671
Elizabeth W Kimani-Murage; Shane A Norris; John M Pettifor; Stephen M Tollman; Kerstin Klipstein-Grobusch; Xavier F Gómez-Olivé; David B Dunger; Kathleen Kahn
Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic\\u000a status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878\\u000a HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES\\u000a measures and other factors. Mixed effects analyses
James McMahon; Christine Wanke; Norma Terrin; Sally Skinner; Tamsin Knox
Disclosing HIV status and seeking sexual partners with the same serostatus (serosorting) are strategies used by some gay and bisexual men to have unprotected anal intercourse (UAI). This study aims to gain an understanding of the occurrence of disclosure and serosorting with casual sexual partners. A grounded approach was used to analyze 22 interviews with gay men from Barcelona. The
Percy Fernández-Dávila; Cinta Folch; Kati Zaragoza Lorca; Jordi Casabona
Background: Theoretical considerations and experiments in the laboratory suggest that excessive iron stores may have an adverse effect on immunity. If so, high iron stores might be especially a problem in patients with human immunodeficiency virus (HIV) infection. Objective and study design: Review published clinical studies that provide information regarding the effect of iron status on the outcome of HIV
Victor R. Gordeuk; Joris R. Delanghe; Michel R. Langlois; Johan R. Boelaert
Objectives HIV status aware couples with at least one HIV positive partner are characterized by high separation and divorce rates. This phenomenon is often described as a corollary of couples HIV Testing and Counseling (HTC) that ought to be minimized. In this contribution, we demonstrate the implications of partnership dissolution in serodiscordant couples for the propagation of HIV. Methods We develop a compartmental model to study epidemic outcomes of elevated partnership dissolution rates in serodiscordant couples and parameterize it with estimates from population-based data (Rakai, Uganda). Results Via its effect on partnership dissolution, every percentage point increase in HIV status awareness reduces HIV incidence in monogamous populations by 0.27 percent for women and 0.63 percent for men. These effects are even larger when the assumption of monogamy can be relaxed, but are moderated by other behavior changes (e.g., increased condom use) in HIV status aware serodiscordant partnerships. When these behavior changes are taken into account, each percentage point increase in HIV status awareness reduces HIV incidence by 0.13 and 0.32 percent for women and men, respectively (assuming monogamy). The partnership dissolution effect exists because it decreases the fraction of serodiscordant couples in the population and prolongs the time that individuals spend outside partnerships. Conclusion Our model predicts that elevated partnership dissolution rates in HIV status aware serodiscordant couples reduce the spread of HIV. As a consequence, the full impact of couples HTC for HIV prevention is probably larger than recognized to date. Particularly high partnership dissolution rates in female positive serodiscordant couples contribute to the gender imbalance in HIV infections.
Reniers, Georges; Armbruster, Benjamin
The assessment of a person’s quality of life as it relates to health, HIV status and intimate partner violence (IPV) among women has been limited in its scope of investigation. Consequently, little is known about the adjusted and combined effects of IPV and HIV on women’s health status and QOL. 445 women (188 HIV + 257 HIV -) residing in
Karen A. McDonnell; Andrea C. Gielen; Patricia O’Campo; Jessica G. Burke
Morbidity and Mortality Weekly Report, February 7, 2003, Volume 52, Number 5. HIV/STD Risks in Young Men Who Have Sex with Men Who Do Not Disclose Their Sexual Orientation - Six U.S. Cities, 1994-2000.
Contents: HIV/STD Risks in Young Men Who Have Sex with Men Who Do Not Disclose Their Sexual Orientation - Six U.S. Cities, 1994-2000; Hypothermia-Related Deaths - Philadelphia, 2001, and United States, 1999; Outbreaks of Community-Associated Methicillin- ...
South Africa is one of the sub Saharan countries where considerable progress in providing antiretroviral treatment (ART) has been made. The increased access to ART contributes to improvements in the prognosis of HIV and parents are more likely to raise their children than ever before. The study examined the social context influencing disclosure of parental HIV status to children from the perspectives of fathers and mothers accessing ART from an academic hospital in South Africa. Three focus group interviews were conducted with 26 non-disclosed biological parents of children aged between 7 and 18 years. Their ages ranged between 20-60 years and they cared for a total of 60 children. Parental decision not to disclose their HIV status to children was influenced by the fear of death and dying, the influence of television and media, stigma and discrimination. Parents delayed disclosure of their HIV status to children because children believed that AIDS kills. Parents also feared that the child may not be able to keep the parent's HIV status secret and might result in the family being subjected to stigma, discrimination, and isolation. Fear of stigma and discrimination were also responsible for the continuous efforts by parents to protect their HIV status from their children, family and neighbour's. Parents also delayed disclosure to children because they lacked disclosure skills and needed support for disclosure from health care providers. Healthcare providers are in a unique position to provide such support and guidance and assist parents to disclose and children to cope with parental HIV infection. PMID:23445694
This study investigated the relationship between past and current substance use and protected health status in people living with HIV. Past substance use variables were based upon diagnostic categories of use, abuse, dependence and severity derived from the SCID DSM-IV and used to generate a dysfunctional drug use factor for each drug class (alcohol, marijuana, cocaine, opioids, hallucinogens, stimulants, sedatives
Neal Andrew Baker
The brain is assumed to be a sterile organ in the absence of disease although the impact of immune disruption is uncertain in terms of brain microbial diversity or quantity. To investigate microbial diversity and quantity in the brain, the profile of infectious agents was examined in pathologically normal and abnormal brains from persons with HIV/AIDS [HIV] (n?=?12), other disease controls [ODC] (n?=?14) and in cerebral surgical resections for epilepsy [SURG] (n?=?6). Deep sequencing of cerebral white matter-derived RNA from the HIV (n?=?4) and ODC (n?=?4) patients and SURG (n?=?2) groups revealed bacterially-encoded 16 s RNA sequences in all brain specimens with ?-proteobacteria representing over 70% of bacterial sequences while the other 30% of bacterial classes varied widely. Bacterial rRNA was detected in white matter glial cells by in situ hybridization and peptidoglycan immunoreactivity was also localized principally in glia in human brains. Analyses of amplified bacterial 16 s rRNA sequences disclosed that Proteobacteria was the principal bacterial phylum in all human brain samples with similar bacterial rRNA quantities in HIV and ODC groups despite increased host neuroimmune responses in the HIV group. Exogenous viruses including bacteriophage and human herpes viruses-4, -5 and -6 were detected variably in autopsied brains from both clinical groups. Brains from SIV- and SHIV-infected macaques displayed a profile of bacterial phyla also dominated by Proteobacteria but bacterial sequences were not detected in experimentally FIV-infected cat or RAG1?/? mouse brains. Intracerebral implantation of human brain homogenates into RAG1?/? mice revealed a preponderance of ?-proteobacteria 16 s RNA sequences in the brains of recipient mice at 7 weeks post-implantation, which was abrogated by prior heat-treatment of the brain homogenate. Thus, ?-proteobacteria represented the major bacterial component of the primate brain’s microbiome regardless of underlying immune status, which could be transferred into naïve hosts leading to microbial persistence in the brain.
Branton, William G.; Ellestad, Kristofor K.; Maingat, Ferdinand; Wheatley, B. Matt; Rud, Erling; Warren, Rene L.; Holt, Robert A.; Surette, Michael G.; Power, Christopher
The brain is assumed to be a sterile organ in the absence of disease although the impact of immune disruption is uncertain in terms of brain microbial diversity or quantity. To investigate microbial diversity and quantity in the brain, the profile of infectious agents was examined in pathologically normal and abnormal brains from persons with HIV/AIDS [HIV] (n?=?12), other disease controls [ODC] (n?=?14) and in cerebral surgical resections for epilepsy [SURG] (n?=?6). Deep sequencing of cerebral white matter-derived RNA from the HIV (n?=?4) and ODC (n?=?4) patients and SURG (n?=?2) groups revealed bacterially-encoded 16 s RNA sequences in all brain specimens with ?-proteobacteria representing over 70% of bacterial sequences while the other 30% of bacterial classes varied widely. Bacterial rRNA was detected in white matter glial cells by in situ hybridization and peptidoglycan immunoreactivity was also localized principally in glia in human brains. Analyses of amplified bacterial 16 s rRNA sequences disclosed that Proteobacteria was the principal bacterial phylum in all human brain samples with similar bacterial rRNA quantities in HIV and ODC groups despite increased host neuroimmune responses in the HIV group. Exogenous viruses including bacteriophage and human herpes viruses-4, -5 and -6 were detected variably in autopsied brains from both clinical groups. Brains from SIV- and SHIV-infected macaques displayed a profile of bacterial phyla also dominated by Proteobacteria but bacterial sequences were not detected in experimentally FIV-infected cat or RAG1?/? mouse brains. Intracerebral implantation of human brain homogenates into RAG1?/? mice revealed a preponderance of ?-proteobacteria 16 s RNA sequences in the brains of recipient mice at 7 weeks post-implantation, which was abrogated by prior heat-treatment of the brain homogenate. Thus, ?-proteobacteria represented the major bacterial component of the primate brain's microbiome regardless of underlying immune status, which could be transferred into naïve hosts leading to microbial persistence in the brain. PMID:23355888
Branton, William G; Ellestad, Kristofor K; Maingat, Ferdinand; Wheatley, B Matt; Rud, Erling; Warren, René L; Holt, Robert A; Surette, Michael G; Power, Christopher
Disclosing that one is HIV seropositive may reduce the burden of disease by facilitating reduction in risk behaviors and mobilizing network support. Logistic regression and generalized estimating equations (GEE) analyses were used to examine disclosure of HIV positive serostatus to network members among 161 low-income, current, and former injection-drug users living with HIV\\/AIDS. About 14% of the respondents reported they
Carl A. Latkin; Amy R. Knowlton; Valerie L. Forman; Donald R. Hoover; Jennifer R. Schroeder; Mark Hachey; David D. Celentano
Previous research has found that gay men and other men who have sex with men have adopted a variety of HIV risk-reduction strategies to engage in unprotected anal intercourse (UAI). However, whether gay male couples' use these strategies within and out of their relationships remains unknown. The present national cross-sectional study collected dyadic data from an online sample of 275 HIV-negative and 58 discordant gay male couples to assess their use of these strategies, and whether their use of these strategies had differed by partner type and couples' HIV-status. The sample used a variety of risk-reduction strategies for UAI. Some differences and patterns by partner type and couples' HIV-status were detected about men's use of these strategies. Findings indicate the need to bolster HIV prevention and education with gay male couples about their use of these strategies within and outside of their relationships. PMID:23247364
Mitchell, Jason W
Background HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth) and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status. Methods A total of 1229 HIV-infected pregnant women were enrolled (2001–2004) in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal (<28 days) and early mortality (<70 days) were described using Kaplan-Meier methods. Results The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml?=?1.90; 95% confidence interval [CI] 1.10–3.27) and being symptomatic were associated with an increased risk of stillbirth (AOR?=?3.19; 95% CI 1.46–6.97), and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR?=?1.25; 95% CI 1.02–1.54). The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio?=?2.76; 95% CI 1.25–6.08). Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection. Conclusions More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to complement necessary therapeutic and prophylactic antiretroviral interventions.
Despite combination antiretroviral therapy (ART), HIV infected people have higher mortality than non-infected. Lower socioeconomic status (SES) predicts higher mortality in many chronic illnesses but data in people with HIV is limited. We evaluated 878 HIV infected individuals followed from 1995 to 2005. Cox proportional hazards for all-cause mortality were estimated for SES measures and other factors. Mixed effects analyses examined how SES impacts factors predicting death. The 200 who died were older, had lower CD4 counts, and higher viral loads (VL). Age, transmission category, education, albumin, CD4 counts, VL, hunger, and poverty predicted death in univariate analyses; age, CD4 counts, albumin, VL, and poverty in the multivariable model. Mixed models showed associations between (1) CD4 counts with education and hunger; (2) albumin with education, homelessness, and poverty; and (3) VL with education and hunger. SES contributes to mortality in HIV infected persons directly and indirectly, and should be a target of health policy in this population. PMID:20632079
McMahon, James; Wanke, Christine; Terrin, Norma; Skinner, Sally; Knox, Tamsin
Objective To determine if significant differences exist in substance use among people living with HIV/AIDS (PLWHA) before and after establishing their HIV infection status. Method The study participants are HIV positive clients of a community based HIV/AIDS outreach facility located in Montgomery, Alabama. The questionnaire includes demographics, substance use and risky sexual behaviors pertaining to HIV transmission. Each participant completed an anonymous questionnaire. A total of 341 questionnaires were distributed and 326 were fully completed and returned, representing a response rate of 96%. Results Findings revealed a statistically significant difference in alcohol consumption before sex among PLWHA before and after establishing their HIV infection status (p = .001). No significant differences were observed among participants who reported as having used drugs intravenously (p = .89), and among those sharing the same syringe/needle with another person (p = .87) before and after establishing their HIV infection status. Conclusion There is continued substance use and alcohol consumption before sex among PLWHA after establishing their HIV status despite clear evidence of such risky behaviors that could lead to an increase in exposure to HIV.
Gerbi, Gemechu B.; Habtemariam, Tsegaye; Tameru, Berhanu; Nganwa, David; Robnett, Vinaida
As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure. PMID:16933107
Carballo-Diéguez, Alex; Miner, Michael; Dolezal, Curtis; Rosser, B R Simon; Jacoby, Scott
BACKGROUND: The percentages of couples in HIV sero-discordant relationships range from 5 to 31% in the various countries of Africa. Given the importance of procreation and the lack of assisted reproduction to avoid partner transmission, members of these couples are faced with a serious dilemma even after the challenge of disclosing their HIV status to their spouses. Identifying the determinants
Jolly Beyeza-Kashesya; Anna Mia Ekstrom; Frank Kaharuza; Florence Mirembe; Stella Neema; Asli Kulane
The present study examines psychiatric symptomatology and syndromal depression among 174 HIV+ and 760 HIV? homosexual men\\u000a enrolled in the Pittsburgh site of the Multicenter AIDS Cohort Study (MACS). A central study goal was to determine whether\\u000a men's psychosocial status in the areas of demographics, social supports, and coping, in combination with their HIV-infection\\u000a status, was associated with mental health.
W. C. Dickey; M. A. Dew; J. T. Becker; L. Kingsley
Disclosure of the HIV status to infected children is often delayed due to psychosocial problems in their families. We aimed at improving the quality of life in families of HIV-infected children, thus promoting disclosure of the HIV status to children by parents. Parents of 17 HIV-infected children (4.2-18 years) followed at our Center for pediatric HIV, unaware of their HIV status, were randomly assigned to the intervention group (8 monthly sessions of family group psychotherapy, FGP) or to the control group not receiving psychotherapy. Changes in the Psychological General Well-Being Index (PGWB-I) and in the Short-Form State-Trait Anxiety Inventory (Sf-STAI), as well as the HIV status disclosure to children by parents, were measured. Ten parents were assigned to the FGP group, while 7 parents to the controls. Psychological well-being increased in 70% of the FGP parents and none of the control group (p=0.017), while anxiety decreased in the FGP group but not in controls (60% vs. 0%, p=0.03). HIV disclosure took place for 6/10 children of the intervention group and for 1/7 of controls. Family group psychotherapy had a positive impact on the environment of HIV-infected children, promoting psychological well-being and the disclosure of the HIV status to children. PMID:23691925
Nicastro, Emanuele; Continisio, Grazia Isabella; Storace, Cinzia; Bruzzese, Eugenia; Mango, Carmela; Liguoro, Ilaria; Guarino, Alfredo; Officioso, Annunziata
Most HIV treatment guidelines advise people who test positive to disclose their status to improve adherence and garner psychosocial care and support. Similarly, advocacy groups for people living with HIV encourage disclosure as a key component of fighting self- and community-based stigma. Although there is arguably much to be gained by disclosing, there is also much at stake, including issues
Our objective is to review and summarize relevant aspects of the literature regarding human papillomavirus (HPV), the most common sexually transmitted infection in the United States, and to compare how the trajectory of HPV may differ in persons who are and who are not co-infected with HIV. This comparison is particularly important because the literature on HPV has been largely based on individuals who are not co-infected with HIV. Also, HPV findings may differ in HIV-uninfected individuals versus HIV-infected individuals. In addition, many reviews ignore gender differences, although in HIV-uninfected individuals, anal cancers are up to 4 times more prevalent in women than men. Clinical decision making may be problematic if such critical factors as HIV status and gender are neglected. Therefore, we will review existing information on how HIV status and gender may affect the manifestation of HPV, particularly focusing on epidemiology, screening, and treatment issues. PMID:22035525
Míguez, María José; Burbano-Levy, Ximena; Rosenberg, Rhonda; Malow, Robert
In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15-29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood samples for HIV. We calculated weighted frequencies of MC knowledge and attitudes, and MC history and HIV status. Multivariate analysis examined associations between MC and other variables and HIV status. In Botswana, 11% of young men reported MC, 28% in Namibia and 8% in Swaziland; mostly (75% in Botswana, 94% - mostly Herero - in Namibia and 68% in Swaziland) as infants or children. Overall, 6.5% were HIV positive (8.3% Botswana, 2.6% Namibia and 9.1% Swaziland). Taking other variables into account, circumcised men were as likely as uncircumcised men to be HIV positive. Nearly half of the uncircumcised young men planned to be circumcised; two-thirds of young men and women planned to have their sons circumcised. Some respondents had inaccurate beliefs and unhelpful views about MC and HIV, with variation between countries. Between 9 and 15% believed a circumcised man is fully protected against HIV; 20-26% believed men need not be tested for HIV before MC; 14-26% believed HIV-positive men who are circumcised cannot transmit the virus; and 8-34% thought it was "okay for a circumcised man to expect sex without a condom". Inaccurate perceptions about protection from MC could lead to risk compensation and reduce women's ability to negotiate safer sex. More efforts are needed to raise awareness about the limitations of MC protection, especially for women, and to study the interactions between MC roll out programmes and primary HIV prevention programmes. PMID:21933035
Andersson, Neil; Cockcroft, Anne
Persons living with human immunodeficiency virus (HIV) are living longer; therefore, they are more likely to suffer significant morbidity due to potentially treatable liver diseases. Clinical evidence suggests that the growing number of individuals living with HIV and liver disease may have a poorer health-related quality of life (HRQOL) than persons living with HIV who do not have comorbid liver disease. Thus, this study examined the multiple components of HRQOL by testing Wilson and Cleary's model in a sample of 532 individuals (305 persons with HIV and 227 persons living with HIV and liver disease) using structural equation modeling. The model components include biological/physiological factors (HIV viral load, CD4 counts), symptom status (Beck Depression Inventory II and the Medical Outcomes Study HIV Health Survey (MOS-HIV) mental function), functional status (missed appointments and MOS-HIV physical function), general health perceptions (perceived burden visual analogue scale and MOS-HIV health transition), and overall quality of life (QOL) (Satisfaction with Life Scale and MOS-HIV overall QOL). The Wilson and Cleary model was found to be useful in linking clinical indicators to patient-related outcomes. The findings provide the foundation for development and future testing of targeted biobehavioral nursing interventions to improve HRQOL in persons living with HIV and liver disease.
Henderson, Wendy A.; Martino, Angela C.; Kitamura, Noriko; Kim, Kevin H.; Erlen, Judith A.
Background There had been conflicting reports with levels of markers of iron metabolism in HIV infection. This study was therefore aimed at investigating iron status and its possible mediation of severity of HIV- 1 infection and pathogenesis. Method Eighty (80) anti-retroviral naive HIV-1 positive and 50 sero-negative controls were recruited for the study. Concentrations of serum total iron, transferrin, total iron binding capacity (TIBC), CD4+ T -lymphocytes, vitamin C, zinc, selenium and transferrin saturation were estimated. Results The mean CD4+ T-lymphocyte cell counts, serum iron, TIBC, transferrin saturation for the tests and controls were 319 ± 22, 952 ± 57 cells/?l (P < 0.001), 35 ± 0.8, 11.8 ± 0.9??mol/l (P < 0.001), 58.5 ± 2.2, 45.2 ± 2.4??mol/l (P < 0.005) and 68.8 ± 3.3, 27.7 ± 2.2%, (P <0.001), respectively, while mean concentrations of vitamin C, zinc and selenium were 0.03 ± 0.01, 0.3 ± 0.04 (P < 0.001), 0.6 ± 0.05, 11.9 ± 0.26??mol/l (P < 0.001) and 0.1 ± 0.01, 1.2 ± 0.12??mol/l (P < 0.001) respectively. Furthermore, CD4+ T-lymphocyte cell count had a positive correlation with levels of vitamin C (r = 0.497, P < 0.001), zinc (r = 0.737, P < 0.001), selenium (r = 0.639, P < 0.001) and a negative correlation with serum iron levels (r = ?0.572, P < 0.001). Conclusion It could be inferred that derangement in iron metabolism, in addition to oxidative stress, might have contributed to the depletion of CD4+ T cell population in our subjects and this may result in poor prognosis of the disease.
Introduction Breast cancer remains one of the leading causes of morbidity and mortality for all women in the US. Current research has focused\\u000a on the psychological relationship and not the sociological relationship between emotions and the experience of breast cancer\\u000a survivors. This paper focuses on the emotion work involved in self-disclosing a breast cancer diagnosis in a racially or ethnically\\u000a diverse
Grace J. Yoo; Caryn Aviv; Ellen G. Levine; Cheryl Ewing; Alfred Au
Introduction African American women living in Washington, DC have one of the highest Human immunodeficiency virus (HIV) incidence rates in the US. However, this population has been understudied, especially as it relates to factors associated with HIV status. Methods This cross-sectional study examined sociodemographic factors that were associated with having a negative or positive HIV status among a sample of 115 African American women between the ages of 24 and 44 years. We assessed such factors as age, education, sexual orientation, household income, sources of income, number of children, length of residency tenure in Washington, DC, and level of HIV-prevention knowledge. Results Among the overall sample, 53 women self-identified as HIV-positive and 62 as HIV-negative. Compared to their HIV-negative counterparts, women who reported being HIV-positive were less educated, had lower household income, and had longer residency tenure in Washington, DC. There were no differences in HIV knowledge between HIV-positive and -negative study participants. Conclusion These findings may provide important directions for targeting specific subpopulations of African Americans for HIV-prevention/intervention programs.
Perkins, Emory L; Voisin, Dexter R; Stennis, Kesslyn A Brade
|Theorists posit that personal decisions to disclose being HIV positive are made based on the perceived consequences of that disclosure. This study examines the perceived costs and benefits of self-disclosure among African American injection drug users (IDUs). A total of 80 African American IDUs were interviewed in-depth subsequent to testing HIV…
Valle, Maribel; Levy, Judith
Theorists posit that personal decisions to disclose being HIV positive are made based on the perceived consequences of that disclosure. This study examines the perceived costs and benefits of self-disclosure among African American injection drug users (IDUs). A total of 80 African American IDUs were interviewed in-depth subsequent to testing HIV…
Valle, Maribel; Levy, Judith
|Examined how information about another person's HIV status influences self-perceptions and behavioral intentions. Individuals perceived their own personalities and behaviors as more dissimilar to anther's if that person's HIV status was believed positive compared with negative or unknown. Exposure to HIV-positive model produced greater intentions…
Gump, Brooks B.; Kulik, James A.
Objective To determine factors associated with prenatal HIV testing in women who accepted rapid testing at delivery. Methods The mother–infant rapid intervention at delivery (MIRIAD) protocol offered counseling and voluntary HIV testing in six US\\u000a cities including New York City (NYC). These hospitals are required to document the HIV status of pregnant women or their infants.\\u000a From January 2002 to
Mayris P. Webber; Penelope Demas; Nancy Blaney; Mardge H. Cohen; Rosalind Carter; Margaret Lampe; Denise Jamieson; Robert Maupin; Steven Nesheim; Marc Bulterys
This is a longitudinal cohort study investigating the association between maternal HIV status and the reported onset of lactation. The Research to Improve Infant Nutrition and Growth project recruited 442 mothers from 3 antenatal clinics in the eastern region of Ghana, based on positive, negative, and unknown HIV status. Onset of lactation was assessed by maternal perception and validated with 2 subsamples: measurement of infant breast milk intake (n = 40) and daily infant weight measurement for 2 weeks (n = 150). Multivariate logistic regression was used to identify predictors of very early onset of lactation (onset of lactation < 6 hours). Predictors of very early onset of lactation include HIV-negative status (odds ratio = 2.68; P = .014), multiparity (odds ratio = 2.93; P = .009), vaginal delivery (odds ratio = 2.55; P = .035), and having a male child (odds ratio = 1.86; P = .032). The findings indicate an association between maternal HIV status and very early onset of lactation.
Otoo, Gloria E.; Marquis, Grace S.; Sellen, Daniel W.; Chapman, Donna J.; Perez-Escamilla, Rafael
Voluntary Counseling and Testing (VCT) remains low among men in sub-Saharan Africa. The factors associated with previous HIV testing and knowledge of partner's HIV status are described for 9,107 men who visited the Muhimbili University College of Health Sciences' VCT site in Dar es Salaam, Tanzania, between 1997 and 2008. Data are from intake forms administered to clients seeking VCT services. Most of the men (64.5%) had not previously been tested and 75% were unaware of their partner's HIV status. Multivariate logistic regression revealed that age, education, condom use, and knowledge of partner's HIV status were significant predictors of previous HIV testing. Education, number of sexual partners, and condom use were also associated with knowledge of partner's HIV status. The low rate of VCT use among men underscores the need for more intensive initiatives to target men and remove the barriers that prevent HIV disclosure. PMID:23221684
Conserve, Donaldson; Sevilla, Luis; Mbwambo, Jessie; King, Gary
Objective To investigate the characteristics of South African men who have sex with men (MSM) who (1) have been tested for HIV and (2) are HIV-positive. Methods Data were collected among 1045 MSM in community surveys using questionnaires which were administered either face-to-face, mail, or on the internet. The mean age of the men was 29.9 years. The racial distribution was as follows: 35.3% black, 17.0% coloured, 5.3% Indian, and 41.1% white. Results The proportion of MSM that were HIV-tested was 69.7%; having been tested was independently associated with being older, being more open about one's homosexuality, and being homosexually instead of bisexually attracted; black MSM, students, and MSM living in KwaZulu-Natal were less likely to have been tested. Of the 728 MSM who had ever been tested, 14.1% (n=103) reported to be HIV-positive (9.9% of the total sample). Being HIV-positive is independently associated with two factors: men who were positive were more likely to have a lower level of education and to know other persons who were living with HIV/AIDS; race was not independently associated with HIV status among those who had been tested. Conclusions The likelihood of having been tested for HIV seems to decrease with increasing social vulnerability. Racially, the distribution of HIV among MSM seems to differ from that of the general South African population, suggesting that while intertwined with the heterosexual epidemic, there is also an epidemic among South African MSM with specific dynamics. These findings suggest that in-depth research is urgently needed to address the lack of understanding of HIV testing practices and HIV prevalence in South African MSM.
Sandfort, Theo G. M.; Nel, Juan; Rich, Eileen; Reddy, Vasu; Yi, Huso
We examined the risk and protective factors and mental health problems of 105 low SES, urban adolescents whose mothers were coping with alcohol abuse and other drug problems. Approximately half of the mothers were also HIV-infected. As hypothesized, there were few differences between adolescents of HIV-infected and HIV-uninfected mothers in…
Leonard, Noelle R.; Gwadz, Marya Viorst; Cleland, Charles M.; Vekaria, Pooja C.; Ferns, Bill
Despite the current emphasis in the US on HIV testing and serostatus disclosure as HIV-prevention strategies, little is known about men who have sex with men's (MSM) perceptions of serostatus disclosure by sexual partners. This study used conversation analysis to examine recordings of HIV-test counseling sessions in order to understand how counselors and clients conceptualize and discuss sex partners' disclosure of HIV status. Of 50 test sessions audio-recorded in four publicly funded sites in Northern California, 47 sessions included a discussion about sexual partners' serostatus disclosure, in the vast majority of these (91.5%), counselors and clients avoided directly asserting their knowledge of partners' serostatus. Throughout the discussions, counselors and clients co-constructed the sense of distrust, uncertainty and unknowability of partners' serostatus. The implications of our findings for evaluating the effectiveness of HIV status disclosure as a prevention strategy are discussed.
Sheon, Nicolas; Lee, Seung-Hee
Our recent studies have demonstrated that in early HIV-1 infection, elevation of plasma immunoglobulin E (IgE) levels precedes the decline of CD4 cell count and is influenced by vitamin E status. In order to further investigate the role of IgE elevation in HIV-1 infection, we determined IgE levels in HIV-1-seropositive and -seronegative intravenous drug users (IDUs) (n = 38), in relationship to cellular and humoral immune function, liver enzymes, and vitamin E status. To examine the possible impact of the route of HIV-1 infection on IgE levels, comparisons between the cohorts of the HIV-1-seropositive and -seronegative IDUs and homosexual men (n = 45) were also conducted. All HIV-1-seropositive participants had significantly higher (P = 0.003) IgE levels than the HIV-1-seronegative subjects. The HIV-1-seropositive IDUs, moreover, demonstrated significantly higher (P = 0.01) IgE levels than HIV-1-seropositive homosexual men, despite similar CD4 cell counts. Stepwise regression analysis was used to evaluate the possible variables contributing to the IgE variation. HIV-1 status (P = 0.0009), intravenous drug use (P = 0.014), CD8 cell counts (P = 0.0001), plasma level of vitamin E (P = 0.006), and alcohol intake (P = 0.047) were significant, accounting for 71% of the IgE elevation. These findings suggest that IgE may serve as a sensitive marker to reflect the evolution of HIV-1 disease in individuals from different risk groups. PMID:7604939
Miguez-Burbano, M J; Shor-Posner, G; Fletcher, M A; Lu, Y; Moreno, J N; Carcamo, C; Page, B; Quesada, J; Sauberlich, H; Baum, M K
Background? With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non-disclosure to children. Methods? A preliminary study was conducted using open-ended questions in Guangxi, China in 2011 with 39 parents living with HIV. Results? A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non-disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children. Conclusions? Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China. PMID:22676417
Zhou, Y; Zhang, L; Li, X; Kaljee, L
Introduction Continuous evaluation of child survival is needed in sub-Saharan Africa where HIV prevalence among women of reproductive age continues to be high. We examined mortality levels and trends over a period of ~20 years among HIV-unexposed and exposed children in Blantyre, Malawi. Methods Data from five prospective cohort studies conducted at a single research site from 1989-2009 were analyzed. In these studies, children born to HIV-infected and uninfected mothers were enrolled at birth and followed longitudinally for at least two years. Information on socio-demographic, HIV infection status, survival and associated risk factors was collected in all studies. Mortality rates were estimated using birth-cohort analyses stratified by maternal and infant HIV status. Multivariate Cox regression models were used to determine risk factors associated with mortality. Results The analysis included 8,286 children. From 1989-1995, overall mortality rates (per 100 person-years) in these clinic-based cohorts remained comparable among HIV-uninfected children born to HIV-uninfected mothers (range 3.3-6.9) or to HIV-infected mothers (range 2.5-7.5). From 1989-2009, overall mortality remained high among all children born to HIV-infected mothers (range 6.3-19.3), and among children who themselves became infected (range 15.6-57.4, 1994-2009). Only lower birth weight was consistently and significantly (P<0.05) associated with higher child mortality. Conclusions HIV infection among mothers and children contributed to high levels of child mortality in the African setting in the pre-treatment era. In addition to services that prevent mother-to-child transmission of HIV, other programs are needed to improve child survival by lowering HIV-unrelated mortality through innovative interventions that strengthen health infrastructure.
Taha, Taha E.; Dadabhai, Sufia S.; Sun, Jin; Rahman, M. Hafizur; Kumwenda, Johnstone; Kumwenda, Newton
Objective We assessed the protective effect of medical male circumcision (MMC) against HIV, herpes simplex virus type 2 (HSV-2), and genital ulcer disease (GUD) incidence. Design Two thousand, seven hundred and eighty-seven men aged 18–24 years living in Kisumu, Kenya were randomly assigned to circumcision (n=1391) or delayed circumcision (n =1393) and assessed by HIV and HSV-2 testing and medical examinations during follow-ups at 1, 3, 6, 12, 18, and 24 months. Methods Cox regression estimated the risk ratio of each outcome (incident HIV, GUD, HSV-2) for circumcision status and multivariable models estimated HIV risk associated with HSV-2, GUD, and circumcision status as time-varying covariates. Results HIV incidence was 1.42 per 100 person-years. Circumcision was 62% protective against HIV [risk ratio =0.38; 95% confidence interval (CI) 0.22–0.67] and did not change when controlling for HSV-2 and GUD (risk ratio =0.39; 95% CI 0.23–0.69). GUD incidence was halved among circumcised men (risk ratio =0.52; 95% CI 0.37–0.73). HSV-2 incidence did not differ by circumcision status (risk ratio =0.94; 95% CI 0.70–1.25). In the multivariable model, HIV seroconversions were tripled (risk ratio =3.44; 95% CI 1.52–7.80) among men with incident HSV-2 and seven times greater (risk ratio =6.98; 95% CI 3.50–13.9) for men with GUD. Conclusion Contrary to findings from the South African and Ugandan trials, the protective effect of MMC against HIV was independent of GUD and HSV-2, and MMC had no effect on HSV-2 incidence. Determining the causes of GUD is necessary to reduce associated HIV risk and to understand how circumcision confers protection against GUD and HIV
Mehta, Supriya D.; Moses, Stephen; Parker, Corette B.; Agot, Kawango; Maclean, Ian; Bailey, Robert C.
Of 170 Western Australian patients who had their first AIDS-defining illness between 1 January 1983 and 31 December 1991, 61 (36%) were of unknown HIV antibody status (AIDS presenters), while 109 (64%) were of known HIV antibody status (HIV presenters). Pneumocystis carinii pneumonia (PCP) was less common as the AIDS-defining illness in HIV presenters (41% versus 62%, p = 0.005). In this study of 70 patients with PCP as the index AIDS diagnosis, 36 were HIV presenters and 34 were AIDS presenters. Ten HIV presenters were taking prophylaxis at the time PCP manifested. The duration of symptoms of cough or dyspnea before the diagnosis of PCP was shorter, and the arterial PO2 measurement on admission was higher in those on prophylaxis, and a lower proportion of patients on prophylaxis required hospital admission (p < or = 0.05 for all comparisons). Furthermore, the CD4 counts at diagnosis of PCP were lower in patients taking PCP prophylaxis (mean 26 x 10(6)/L) than in patients who were not (mean 94 x 10(6)/L, p = 0.007). Of seven patients who died of PCP, none were receiving treatment for HIV disease before AIDS presentation. These findings suggest that PCP is prevented or deferred in patients receiving care for HIV disease and is less severe as a result of early diagnosis and treatment. PMID:7905524
Mallal, S A; Martinez, O P; French, M A; James, I R; Dawkins, R L
Background Most estimates of HIV prevalence have been based on sentinel surveillance of pregnant women which may either under-estimate or over-estimate the actual prevalence in adult female population. One situation which can lead to either an underestimate or an overestimate of the actual HIV prevalence is where there is a significant difference in fertility rates between HIV-positive and HIV-negative women. Our aim was to compare the fertility rates of HIV-infected and HIV-uninfected women in Cameroon in order to make recommendations on the appropriate adjustments when using antenatal sentinel data to estimate HIV prevalence Methods Cross-sectional, population-based study using data from 4493 sexually active women aged15 to 49 years who participated in the 2004 Cameroon Demographic and Health Survey. Results In the rural area, the age-specific fertility rates in both HIV positive and HIV negative women increased from 15–19 years age bracket to a maximum at 20–24 years and then decreased monotonically till 35–49 years. Similar trends were observed in the urban area. The overall fertility rate for HIV positive women was 118.7 births per 1000 woman-years (95% Confidence Interval [CI] 98.4 to 142.0) compared to 171.3 births per 1000 woman-years (95% CI 164.5 to 178.2) for HIV negative women. The ratio of the fertility rate in HIV positive women to the fertility rate of HIV negative women (called the relative inclusion ratio) was 0.69 (95% CI 0.62 to 0.75). Conclusion Fertility rates are lower in HIV-positive than HIV-negative women in Cameroon. The findings of this study support the use of summary RIR for the adjustment of HIV prevalence (among adult female population) obtained from sentinel surveillance in antenatal clinics.
Kongnyuy, Eugene J; Wiysonge, Charles S
Tanzania has a generalised AIDS epidemic but the estimated adult HIV prevalence of 6% is much lower than in many countries in Southern Africa. HIV infection rates are reportedly higher in urban areas, among women and among those with more education. Stigma has been found to be more common in poorer, less-educated people, and those in rural areas. We examined
Mbaraka Amuri; Steve Mitchell; Anne Cockcroft; Neil Andersson
This paper examines the relationship between housing status and HIV risk using longitudinal, qualitative data collected in 2004-2005, from a purposeful sample of 65 active drug users in a variety of housed and homeless situations in Hartford, Connecticut. These data were supplemented with observations and in-depth interviews regarding drug use behavior collected in 2001-2005 to evaluate a peer-led HIV prevention intervention. Data reveal differences in social context within and among different housing statuses that affect HIV risky or protective behaviors including the ability to carry drug paraphernalia and HIV prevention materials, the amount of drugs in the immediate environment, access to subsidized and supportive housing, and relationships with others with whom drug users live. Policy implications of the findings, limitations to the data and future research are discussed.
Dickson-Gomez, Julia; Hilario, Helena; Convey, Mark; Corbett, A. Michelle; Weeks, Margaret; Martinez, Maria
BACKGROUND: Although the impact of Aboriginal status on HIV incidence, HIV disease progression, and access to treatment has been investigated previously, little is known about the relationship between Aboriginal ethnicity and outcomes associated with highly active antiretroviral therapy (HAART). We undertook the present analysis to determine if Aboriginal and non-Aboriginal persons respond differently to HAART by measuring HIV plasma viral
Viviane D Lima; Patricia Kretz; Anita Palepu; Simon Bonner; Thomas Kerr; David Moore; Mark Daniel; Julio SG Montaner; Robert S Hogg
Background Disclosing HIV test results to one's sexual partner allows the partner to engage in preventive behaviors as well as the access of necessary support for coping with serostatus or illness. It may motivate partners to seek testing or change behavior, and ultimately decrease the transmission of HIV. The present study was undertaken to determine the rate, outcomes and factors associated with HIV positive status disclosure in Southwest Ethiopia among HIV positive service users. Methods A cross-sectional study was carried out from January 15, 2007 to March 15, 2007 in Jimma University Specialized Hospital. Data were collected using a pre-tested interviewer-administered structured questionnaire. Results A total of 705 people (353 women and 352 men), participated in the study of which 71.6% were taking ART. The vast majority (94.5%) disclosed their result to at least one person and 90.8% disclosed to their current main partner. However, 14.2% of disclosure was delayed and 20.6% did not know their partner's HIV status. Among those who did not disclose, 54% stated their reason as fear of negative reaction from their partner. Among those disclosures however, only 5% reported any negative reaction from the partner. Most (80.3%) reported that their partners reacted supportively to disclosure of HIV status. Disclosure of HIV results to a sexual partner was associated with knowing the partner's HIV status, advanced disease stage, low negative self-image, residing in the same house with partner, and discussion about HIV testing prior to seeking services. Conclusion Although the majority of participants disclosed their test results, lack of disclosure by a minority resulted in a limited ability to engage in preventive behaviors and to access support. In addition, a considerable proportion of the participants did not know their partner's HIV status. Programmatic and counseling efforts should focus on mutual disclosure of HIV test results, by encouraging individuals to ask their partner's HIV status in addition to disclosing their own.
Deribe, Kebede; Woldemichael, Kifle; Wondafrash, Mekitie; Haile, Amaha; Amberbir, Alemayehu
Detection of recent HIV infections is a prerequisite for reliable estimations of transmitted HIV drug resistance (t-HIVDR) and incidence. However, accurately identifying recent HIV infection is challenging due partially to the limitations of current serological tests. Ambiguous nucleotides are newly emerged mutations in quasispecies, and accumulate by time of viral infection. We utilized ambiguous mutations to establish a measurement for detecting recent HIV infection and monitoring early HIVDR development. Ambiguous nucleotides were extracted from HIV-1 pol-gene sequences in the datasets of recent (HIVDR threshold surveys [HIVDR-TS] in 7 countries; n=416) and established infections (1 HIVDR monitoring survey at baseline; n=271). An ambiguous mutation index of 2.04×10-3 nts/site was detected in HIV-1 recent infections which is equivalent to the HIV-1 substitution rate (2×10-3 nts/site/year) reported before. However, significantly higher index (14.41×10-3 nts/site) was revealed with established infections. Using this substitution rate, 75.2% subjects in HIVDR-TS with the exception of the Vietnam dataset and 3.3% those in HIVDR-baseline were classified as recent infection within one year. We also calculated mutation scores at amino acid level at HIVDR sites based on ambiguous or fitted mutations. The overall mutation scores caused by ambiguous mutations increased (0.54×10-23.48×10-2/DR-site) whereas those caused by fitted mutations remained stable (7.50-7.89×10-2/DR-site) in both recent and established infections, indicating that t-HIVDR exists in drug-naïve populations regardless of infection status in which new HIVDR continues to emerge. Our findings suggest that characterization of ambiguous mutations in HIV may serve as an additional tool to differentiate recent from established infections and to monitor HIVDR emergence.
Zheng, Du-Ping; Rodrigues, Margarida; Bile, Ebi; Nguyen, Duc B.; Diallo, Karidia; DeVos, Joshua R.; Nkengasong, John N.; Yang, Chunfu
This study assessed whether social cognitive constructs, situational factors, and individual characteristics were associated with communicating HIV status and whether communication was related to sexual risk behavior. A quota-sampling method stratified by age, race, and township was used to recruit 300 men who have sex with men to participate in a community-based survey in Pretoria in 2008. Participants reported characteristics of their last sexual encounter involving anal sex, including whether they or their partner had communicated their HIV status. Fifty-nine percent of participants reported that they or their partner had communicated their HIV status. HIV communication self-efficacy (aOR = 1.2, 95 % CI: 1.04-1.68), being with a steady partner (aOR = 0.36, 95 % CI: 0.19-0.67), and being Black (versus White; aOR = 0.08, 95 % CI: 0.03-0.27) were independently associated with communicating HIV status. Communicating HIV status was not associated with unprotected anal intercourse. HIV communication self-efficacy increases men's likelihood of communicating HIV status. Being with a steady partner and being Black reduces that likelihood. Communication about HIV status did not lead to safer sex. PMID:23065127
Knox, Justin; Reddy, Vasu; Kaighobadi, Farnaz; Nel, Dawie; Sandfort, Theo
Matrix metalloproteinases (MMPs) have been implicated in human immunodeficiency virus (HIV)-associated neurological injury; however, this relationship has not been studied early in infection. Plasma levels of MMP-1, MMP-2, MMP-7, MMP-9, and MMP-10 measured using Luminex technology (Austin, TX, USA) were compared in 52 HIV and 21 seronegative participants of the Chicago Early HIV Infection study. MMP levels were also examined in HIV subgroups defined by antibody reactivity, viremia, and antiretroviral status, as well as in available cerebrospinal fluid (CSF) samples (n?=?9). MMPs were evaluated for patterns of relationship to cognitive function and to quantitative magnetic resonance measurements of the brain derived in vivo. Plasma MMP-2 levels were significantly reduced in early HIV infection and correlated with altered white matter integrity and atrophic brain changes. MMP-9 levels were higher in the treated subgroup than in the naïve HIV subgroup. Only MMP-2 and MMP-9 were detected in the CSF; CSF MMP-2 correlated with white matter integrity and with volumetric changes in basal ganglia. Relationships with cognitive function were also identified. MMP-2 levels in plasma and in CSF correspond to early changes in brain structure and function. These findings establish a link between MMPs and neurological status previously unidentified in early HIV infection. PMID:23979706
Li, Suyang; Wu, Ying; Keating, Sheila M; Du, Hongyan; Sammet, Christina L; Zadikoff, Cindy; Mahadevia, Riti; Epstein, Leon G; Ragin, Ann B
Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV 'risk' actually means in different cultures and contexts. A 'socially situated' approach to HIV risk moves beyond its scientific conceptualisation as an objective 'fact', revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of 'difference', a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of 'risk' arise and, thus, where couples' sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk. PMID:23043414
HIV is rising rapidly among Chinese men who have sex with men (MSM). Discussion of HIV status between sexual partners is potentially a key prevention behavior. It is unclear if HIV-negative Chinese MSM talk about HIV and disclose their HIV status with sexual partners. Understanding the correlates of disclosure among this population could provide insight into developing disclosure-based interventions. We conducted a respondent driven sampling based study of 500 MSM in Beijing. A total of 332 men had a previous HIV-negative test result and thus considered themselves to be HIV-negative and were included in our analysis of disclosure. Equal numbers of these men reported talking about HIV and disclosing their HIV status to at least one sexual partner. MSM who disclosed were more likely to be living with a main partner. No other demographic characteristics were associated with disclosure in bivariate analysis. We also used data on up to three sexual partners per participant to examine disclosure on the partnership level. Main partnerships, meeting partners at bars/clubs, sometimes using alcohol before sex in a partnership, and usually having sex at home compared to other venues were associated with disclosure. Using generalized estimating equation analysis to characterize individuals from their partnership data, we found only having at least one main partnership and knowing people who were infected with HIV to be associated with a participant being a discloser. Interventions that wish to harness discussion of HIV and HIV status among Chinese MSM will need to focus on moving these discussions towards having them with casual partners. PMID:22562616
Li, Guiying; Lu, Hongyan; Li, Xuefeng; Sun, Yanming; He, Xiong; Fan, Song; McFarland, Willi; Jia, Yujiang; Raymond, H F; Xiao, Yan; Ruan, Yuhua; Shao, Yiming
Micronutrient deficiencies are widely prevalent in developing regions, especially in vulnerable groups such as HIV-infected\\u000a pregnant women. Micronutrient supplementation is considered one of the most cost-effective strategies to reduce malnutrition\\u000a and improve health outcomes.\\u000a \\u000a Maternal multivitamin supplementation (vitamins B-complex, C, and E) has been shown to reduce the incidence of adverse pregnancy\\u000a outcomes in HIV-infected pregnant women, such as fetal
Saurabh Mehta; Julia L. Finkelstein; Wafaie W. Fawzi
This study assessed psychological distress (PD) in men who have sex with men (MSM) accessing primary health clinics in Australia. Relationships between PD, HIV status and substance use were explored. A cross-sectional convenience sample of 250 MSM completed the Personality Assessment Screener (PAS). One-third (n = 83) scored in the PAS clinically significant range, suggesting significant mental health symptoms. Negative Affect (27 per cent clinically significant), Suicidal Thinking (29 per cent clinically significant) and Amphetamine use significantly positively correlated with PD. There were no significant differences between HIV diagnostic groups on PD. A third of MSM displayed PD. Psychological screening may provide valuable information for improving the psychological well-being of MSM, regardless of their HIV status. PMID:22044914
Gibbie, Tania M; Mijch, Anne; Hay, Margaret
Background Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients\\u000a is unknown.\\u000a \\u000a \\u000a \\u000a Objective To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association\\u000a with health care use and health status.\\u000a \\u000a \\u000a \\u000a Design Prospective cohort study.\\u000a \\u000a \\u000a \\u000a Participants Two hundred twenty HIV-infected persons recruited from
Mitchell D. Wong; Catherine A. Sarkisian; Cynthia Davis; Janni Kinsler; William E. Cunningham
The prevalence of HIV infection among male prison inmates is significantly higher than in the U.S. population. Adequate planning to ensure continued medication adherence and continuity of care after release is important for this population. This study describes the prerelease characteristics of 162 incarcerated HIV-positive men (40 from jails and 122 from prisons). The results include a demographic description of the sample and the participants' sexual risk behaviors, substance use, health status and HIV medication adherence, health care utilization, mental health, and family and social support. The results highlight a potentially high level of need for services and low levels of support and social connectedness. Postrelease planning should include support for improving HIV medication adherence as well as reducing both sexual and injection drug-related transmission risk for these individuals. PMID:24078623
Feaster, Daniel J; Reznick, Olga Grinstead; Zack, Barry; McCartney, Kathleen; Gregorich, Steven E; Brincks, Ahnalee M
The common-sense construction of Buddhism is that of a general power for good; the less positive aspects of Buddhism's power, especially when reinforced by folklore and ancient superstition, is infrequently recognised. In this article we make explicit Buddhism's less positive power, particularly as it relates to the status of women and, by implication, its role in the human immunodeficiency (HIV)\\/acquired
AREEWAN KLUNKLIN; JENNIFER GREENWOOD
This study examines the relationship between religiosity and the affective and immune status of 106 HIV-seropositive mildly symptomatic gay men (CDC stage B). All men completed an intake interview, a set of psychosocial questionnaires, and provided a venous blood sample. Factor analysis of 12 religiously oriented response items revealed two distinct aspects to religiosity: religious coping and religious behavior. Religious
Teresa E. Woods; Michael H. Antoni; Gail H. Ironson; David W. Kling
BackgroundAlthough the Brazilian national reporting system for tuberculosis cases (SINAN) has enormous potential to generate data for policy makers, formal assessments of treatment outcomes and other aspects of TB morbidity and mortality are not produced with enough depth and rigor. In particular, the effect of HIV status on these outcomes has not been fully explored, partly due to incomplete recording
Mauro Sanchez; Patricia Bartholomay; Denise Arakaki-Sanchez; Donald Enarson; Karen Bissell; Draurio Barreira; Anthony Harries; Afrânio Kritski
This report outlines a menu of testing algorithms, for both point-of-contact and laboratory settings based on the testing technology and data available in 2009. Since its publication, there have been several developments in the field of HIV diagnostics in...
This paper explores how perceived stigma and layered stigma related to injection drug use and being HIV-positive influence the decision to disclose one's HIV status to family and community and experiences with stigma following disclosure among a population of HIV-positive male injection drug users (IDUs) in Thai Nguyen, Vietnam. In qualitative interviews conducted between 2007 and 2008, 25 HIV-positive male
A. E. Rudolph; W. W. Davis; V. M. Quan; T. V. Ha; N. L. Minh; A. Gregowski; M. Salter; D. D. Celentano; V. Go
This paper explores how perceived stigma and layered stigma related to injection drug use and being HIV-positive influence the decision to disclose one's HIV status to family and community and experiences with stigma following disclosure among a population of HIV-positive male injection drug users (IDUs) in Thai Nguyen, Vietnam. In qualitative interviews conducted between 2007 and 2008, 25 HIV-positive male
A. E. Rudolph; W. W. Davis; V. M. Quan; T. V. Ha; N. L. Minh; A. Gregowski; M. Salter; D. D. Celentano; V. Go
Objective To examine whether HIV status affects participation in a population-based longitudinal HIV surveillance in the context of an expanding HIV treatment and care programme in rural South Africa. Method We regressed consent to participate in the HIV surveillance during the most recent fieldworker visit on HIV status (based on previous surveillance participation or enrolment in pre-antiretroviral treatment (pre-ART) care or ART in the local HIV treatment and care programme), controlling for sex, age and year of the visit (N = 25 940). We then repeated the regression using the same sample but, in one model, stratifying HIV-infected persons into three groups (neither enrolled in pre-ART care nor receiving ART; enrolled in pre-ART care but not receiving ART; receiving ART) and, in another model, additionally stratifying the group enrolled in pre-ART and the group receiving ART into those with CD4 count ?200/?l (i.e. the ART eligibility threshold at the time) vs. those with CD4 count >200/?l. Results HIV-infected individuals were significantly less likely to consent to participate in the surveillance than HIV-uninfected individuals [adjusted odds ratio (aOR), 0.74; 95% confidence interval, 0.70–0.79, P < 0.001], controlling for other factors. Persons who were receiving ART were less likely to consent to participate (aOR, 0.75, 0.68–0.84, P < 0.001) than those who had never sought HIV treatment or care (aOR, 0.82, 0.75–0.89, P < 0.001), but more likely to consent than persons enrolled in pre-ART care (aOR 0.62, 0.56–0.69, P < 0.001). Those with CD4 count ?200/?l were significantly less likely to consent to participate than those with CD4 count >200/?l in both the group enrolled in pre-ART and the group receiving ART. Conclusion As HIV test results are not made available to participants in the HIV surveillance, our findings agree with the hypothesis that HIV-infected persons are less likely than HIV-uninfected persons to participate in HIV surveillance because they fear the negative consequences of others learning about their HIV infection. Our results further suggest that the increased knowledge of HIV status that accompanies improved ART access can reduce surveillance participation of HIV-infected persons, but that this effect decreases after ART initiation, in particular in successfully treated patients.
Barnighausen, T; Tanser, F; Malaza, A; Herbst, K; Newell, M -L
Abstract The objective of this study was to examine the incidence of fractures in HIV-infected children and comparable HIV-exposed, uninfected (HEU) children in a multicenter, prospective cohort study (PACTG 219/219C) in the United States. The main outcome was first fracture during the risk period. Nine fractures occurred in 7 of 1326 HIV-infected and 2 of 649 HEU children, corresponding to incidence rates of 1.2 per 1000 person-years and 1.1 per 1000 person-years, respectively. The incidence rate ratio was 1.1 (95% CI 0.2, 5.5). There was no evidence of a substantially increased risk of fracture in HIV-infected compared to HEU children.
Li, Hong; Jacobson, Denise
Since the introduction of highly active antiretroviral therapy (ART) in 1996, HIV-infected children often survive beyond adolescence. To assess worldwide trends in disclosure since ART was introduced, we reviewed articles that refer to disclosure of their status to HIV-infected children, and which described patient, health care provider and/or caregiver opinions about disclosure and/or reported the proportion of children who knew their diagnosis. Most studies (17 [55%]) were performed in low- or middle-income (LMI) countries. In the 21 articles that included information on whether the children knew their status, the proportion who knew ranged from 1.2 to 75.0% and was lower in LMI (median = 20.4%) than industrialized countries (43%; p = 0.04). LMI country study participants who knew their status tended to have learned it at older ages (median = 9.6 years) than industrialized country participants (median = 8.3 years; p = 0.09). The most commonly reported anticipated risks (i.e. emotional trauma to child and child divulging status to others) and benefits (i.e. improved ART adherence) of disclosure did not vary by the country's economic development. Only one article described and evaluated a disclosure process. Despite recommendations, most HIV-infected children worldwide do not know their status. Disclosure strategies addressing caregiver concerns are urgently needed. PMID:23070738
Pinzón-Iregui, María C; Beck-Sagué, Consuelo M; Malow, Robert M
Disclosure to HIV-infected children regarding their diagnosis is important as expanding numbers of HIV-infected children attain adolescence and may become sexually active. In order to define correlates of pediatric disclosure and facilitate development of models for disclosure, we conducted a cross-sectional survey of primary caregivers of HIV-1 infected children aged 6-16 years attending a pediatric HIV treatment program in Nairobi, Kenya. We conducted focus group discussions with a subset of caregivers to further refine perceptions of disclosure. Among 271 caregiver/child dyads in the cross-sectional survey, median child age was 9 years (interquartile range: 7-12 years). Although 79% of caregivers believed children should know their HIV status, the prevalence of disclosure to the child was only 19%. Disclosure had been done primarily by health workers (52%) and caregivers (33%). Caregivers reported that 5 of the 52 (10%) who knew their status were accidentally disclosed to. Caregivers of older children (13 vs. 8 years; p<0.001), who were HIV-infected and had disclosed their own HIV status to the child (36% vs. 4%; p=0.003), or who traveled frequently (29% vs. 16%, p=0.03) were more likely to have disclosed. Children who had been recently hospitalized (25% vs. 44%, p=0.03) were less likely to know their status, and caregivers with HIV were less likely to have disclosed (p=0.03). Reasons for disclosure included medication adherence, curiosity or illness while reasons for nondisclosure included age and fear of inadvertent disclosure. Our study found that disclosure rates in this Kenyan setting are lower than observed rates in the USA and Europe but consistent with rates from other resource-limited settings. Given these low rates of disclosure and the potential benefits of disclosure, strategies promoting health worker trainings and caregiver support systems for disclosure may benefit children with HIV. PMID:23256520
John-Stewart, Grace C; Wariua, Grace; Beima-Sofie, Kristin M; Richardson, Barbra A; Farquhar, Carey; Maleche-Obimbo, Elizabeth; Mbori-Ngacha, Dorothy; Wamalwa, Dalton
Baseline data were collected to evaluate the effectiveness of interventions on completion of the hepatitis A and B vaccine series among 664 sheltered and street-based homeless adults who were: (a) homeless; (b) recently (<1 year) discharged from prison; (c) discharged 1 year or more; and (d) never incarcerated. Group differences at baseline were assessed for socio-demographic characteristics, drug and alcohol use, sexual activity, mental health and public assistance. More than one-third of homeless persons (38%) reported prison time and 16% of the sample had been recently discharged from prison. Almost half of persons who were discharged from prison at least 1 year ago reported daily use of drugs and alcohol over the past 6 months compared to about 1 in 5 among those who were recently released from prison. As risk for HCV and HIV co-infection continues among homeless ex-offenders, HIV/HCV prevention efforts are needed for this population. PMID:19455412
Hudson, Angela L; Nyamathi, Adeline; Bhattacharya, Debika; Marlow, Elizabeth; Shoptaw, Steven; Marfisee, Mary; Leake, Barbara
Baseline data were collected to evaluate the effectiveness of interventions on completion of the hepatitis A and B vaccine series among 664 sheltered and street-based homeless adults who were: (a) homeless; (b) recently (<1 year) discharged from prison; (c) discharged 1 year or more; and (d) never incarcerated. Group differences at baseline were assessed for socio–demographic characteristics, drug and alcohol use, sexual activity, mental health and public assistance. More than one-third of homeless persons (38%) reported prison time and 16% of the sample had been recently discharged from prison. Almost half of persons who were discharged from prison at least 1 year ago reported daily use of drugs and alcohol over the past 6 months compared to about 1 in 5 among those who were recently released from prison. As risk for HCV and HIV co-infection continues among homeless ex-offenders, HIV/HCV prevention efforts are needed for this population.
Hudson, Angela L.; Bhattacharya, Debika; Marlow, Elizabeth; Shoptaw, Steven; Marfisee, Mary; Leake, Barbara
|There are students and staff in many schools with hepatitis B, hepatitis C, or HIV infections. Should parents or guardians be expected to disclose students' bloodborne infections to school officials? Can infected students play contact sports given the increased risk of blood spills? What type of response plan should schools develop in the event…
This study sought to examine the association between maternal HIV/AIDS infection and neonatal neurologic conditions in the state of Florida. We analyzed all births in the state of Florida from 1998 to 2007 using hospital discharge data linked to birth certificate records. The main outcomes of interest included selected neonatal neurologic complications, namely: fetal distress, cephalohematoma, intracranial hemorrhage, seizure, feeding difficulties, and other central nervous system complications. The sample size for this study was 1,645,515 records. All forms of substance abuse as well as cesarean section deliveries were more frequent in mothers with HIV/AIDS. Infants born to HIV-infected mothers showed higher proportions of feeding difficulties and seizures whereas HIV-negative mothers had a greater proportion of cases of fetal distress and cephalohematoma. Seizures and feeding difficulties are common among infants born to HIV/AIDS infected mothers. This population-based retrospective cohort study provides further understanding of the association between maternal HIV/AIDS status and neonatal neurological outcomes. PMID:21505772
Salihu, Hamisu M; August, Euna M; Aliyu, Muktar; Stanley, Kara M; Weldeselasse, Hanna; Mbah, Alfred K
OBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults.\\u000a \\u000a \\u000a DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997.\\u000a \\u000a \\u000a \\u000a \\u000a MAIN RESULTS: Six percent of study participants were homeless, 24.5% were “doubled-up,” and 69.5% were stably housed. Compared with the\\u000a stably housed, doubled-up and homeless
Meredith Y. Smith; Bruce D. Rapkin; Gary Winkel; Carolyn Springer; Rosy Chhabra; Ira S. Feldman
In France, numerous HIV patients still discover their HIV status as a result of AIDS-related symptoms. We investigated factors related to the absence of any HIV testing in men and women separately, using the data from the SIRS cohort, which includes 3023 households representative of the Paris metropolitan area in 2005. The failure to use HIV testing services was studied
Veronique Massari; Annabelle Lapostolle; Emmanuelle Cadot; Isabelle Parizot; Rosemary Dray-Spira; Pierre Chauvin
In the third decade of the HIV/AIDS epidemic, empirically based HIV transmission risk reduction interventions for HIV infected persons are still needed. As part of a Health Resources Services Administration/Special Projects of National Significance initiative to increase prevention services among HIV infected persons, we implemented SHAPE (Supporting Healthy Alternatives through Patient Education). SHAPE is a behavioral HIV prevention intervention delivered to HIV infected persons receiving primary medical care at El Rio Health Center in Tucson, Arizona. The SHAPE intervention is based on Kalichman's "Healthy Relationships for Men and Women Living with HIV-AIDS." The intervention is interactive and uses a video discussion intervention format where educational activities, movie clips, and discussions are used to provide participants with information and skills to increase their comfort in disclosing their HIV status and in reducing HIV transmission. This paper describes the intervention in sufficient detail to replicate it in other settings. PMID:17265144
Estrada, Barbara D; Trujillo, Stephen; Estrada, Antonio L
Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a sample…
Lewis, Ione R.
|Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a…
Lewis, Ione R.
Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a sample of
Ione R. Lewis
This review provides an overview of the current status of the global HIV pandemic and strategies to bring it under control. It updates numerous preventive approaches including behavioral interventions, male circumcision (MC), pre- and post-exposure prophylaxis (PREP and PEP), vaccines, and microbicides. The manuscript summarizes current anti-retroviral treatment options, their impact in the western world, and difficulties faced by emerging and resource-limited nations in providing and maintaining appropriate treatment regimens. Current clinical and pre-clinical approaches toward a cure for HIV are described, including new drug compounds that target viral reservoirs and gene therapy approaches aimed at altering susceptibility to HIV infection. Recent progress in vaccine development is summarized, including novel approaches and new discoveries.
Demberg, Thorsten; Robert-Guroff, Marjorie
Selenium deficiency has been implicated in accelerated disease progression and poorer survival among populations infected with HIV in developed countries, yet these associations remain unexamined in developing countries. Among 949 HIV-1-infected Tanzanian women who were pregnant, we prospectively examined the association between plasma selenium levels and survival and CD4 counts over time. Over the 5.7-y median follow-up time, 306 of 949 women died. In a Cox multivariate model, lower plasma selenium levels were significantly associated with an increased risk of mortality (P-value, test for trend = 0.01). Each 0.1 micromol/L increase in plasma selenium levels was related to a 5% (95% CI = 0%-9%) decreased risk of mortality. Plasma selenium levels were not associated with time to progression to CD4 cell count < 200 cells/mm(3) but were weakly and positively related to CD4 cell count in the first years of follow up. Selenium status may be important for clinical outcomes related to HIV disease in sub-Saharan Africa. PMID:15465747
Kupka, Roland; Msamanga, Gernard I; Spiegelman, Donna; Morris, Steve; Mugusi, Ferdinand; Hunter, David J; Fawzi, Wafaie W
This study found that African American males living with HIV/AIDS in rural southwest Alabama who did not disclose their HIV/AIDS seropositive status were more likely to engage in unprotected sex. Because much of the recent research is slanted to address homosexual behavior, which is still a taboo within the African American community, efforts to…
Clark, Eddie, Jr.
This article draws on biomarker data from Demographic and Health Surveys (2003-2007) in 10 sub-Saharan African countries to examine differences in fertility preferences and contraceptive behaviors by HIV status for women and men, taking into account whether or not they probably know their HIV status. The objective is to determine if there are common patterns in the associations between these variables across several countries. Women's and men's fertility preferences and contraceptive behaviors are relatively similar across HIV status and probable knowledge of that status. However, two consistent differences emerge in some of the countries: HIV-positive women who probably know their status are less likely to want more children and are more likely to be using male condoms than women who are HIV-negative and probably know it. A similar association is observed for men for condom use but not for limiting childbearing. Other factors unrelated to HIV status seem to be shaping women's and men's unmet demand for contraception and use of methods other than the condom. PMID:21861606
Bankole, Akinrinola; Biddlecom, Ann E; Dzekedzeke, Kumbutso
Objective: To examine HIV status and sociodemographic variables as correlates of body size (height, body mass index (BMI), and mid-upper-arm circumference (MUAC)) and wasting (MUAC <22 cm) in pregnant women.Design: Cross-sectional study.Setting: Four antenatal clinics in Dar es Salaam, Tanzania.Subjects: Women presenting for first prenatal visit before the 23rd week of gestation, between April 1995 and July 1997 (n=13 760).Results:
E Villamor; G Msamanga; D Spiegelman; J Coley; DJ Hunter; KE Peterson; WW Fawzi
OBJECTIVES: (a) To assess the impact of HIV status (HIV negative, HIV positive, AIDS) on the outcome of patients admitted to intensive care units for diseases unrelated to HIV; (b) to decide whether a positive test result for HIV should be a criterion for excluding patients from intensive care for diseases unrelated to HIV. DESIGN: A prospective double blind study of all admissions over six months. HIV status was determined in all patients by enzyme linked immunosorbent assay (ELISA), immunofluorescence assay, western blotting, and flow cytometry. The ethics committee considered the clinical implications of the study important enough to waive patients' right to informed consent. Staff and patients were blinded to HIV results. On discharge patients could be advised of their HIV status if they wished. SETTING: A 16 bed surgical intensive care unit. SUBJECTS: All 267 men and 135 women admitted to the unit during the study period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: APACHE II score (acute physiological, age, and chronic health evaluation), organ failure, septic shock, durations of intensive care unit and hospital stay, and intensive care unit and hospital mortality. RESULTS: No patient had AIDS. 52 patients were tested positive for HIV and 350 patients were tested negative. The two groups were similar in sex distribution but differed significantly in age, incidence of organ failure (37 (71%) v 171 (49%) patients), and incidence of septic shock (20 (38%) v 54 (15%)). After adjustment for age there were no differences in intensive care unit or hospital mortality or in the durations of stay in the intensive care unit or hospital. CONCLUSIONS: Morbidity was higher in HIV positive patients but there was no difference in mortality. In this patient population a positive HIV test result should not be a criterion for excluding a patient from intensive care.
Bhagwanjee, S.; Muckart, D. J.; Jeena, P. M.; Moodley, P.
Diffuse large B cell lymphoma (DLBCL) and plasmablastic lymphoma (PBL) represent aggressive non-Hodgkin lymphomas, particularly in the setting of HIV infection. Since the introduction of highly active antiretroviral therapy (HAART), recent studies have documented improved survival outcome in patients with AIDS-related lymphomas. This study contributes a South African perspective by correlating the HIV status and prognosis of DLBCL and PBL with differentiation profiles assessed by immunophenotyping. Analysis of the morphologic, immunophenotypic and clinicopathologic features of 52 cases of DLBCL and 9 cases of de novo PBL was performed. The overall survival of patients with PBL was poorer than that of DLBCL (logrank p value 0.002). Despite HAART, the overall survival with DLBCL and HIV infection was significantly poorer than HIV negative patients with DLBCL (p value <0.001). Profound immunosuppression was evident in the HIV positive group as the mean CD4 count was 151 cells/mm(3) in DLBCL and 61 cells/mm(3) in PBL. HIV positive patients were significantly younger at presentation with greater likelihood of extranodal lymphoma. When Hans' and Muris' algorithmic stratification of DLBCL were applied, no statistical significance was demonstrated (p values 0.188 and 0.399 respectively). However, when Bcl-2 expression occurred in germinal center-type DLBCL (Hans' defined), improved survival was conferred by the germinal center immunophenotype (p value 0.007). The study demonstrates that DLBCL and PBL have significant potential for aggressive behaviour and poor outcome in the setting of profound immunosuppression due to HIV infection. Further studies are required to assess the effect of targeted-immunotherapy (Rituximab) in combination with recent amendment of the South African national antiretroviral treatment guidelines which has created tremendous potential for improved survival in patients with AIDS-related non-Hodgkin B-cell lymphomas. PMID:23670212
Pather, Sugeshnee; Mohamed, Zainab; McLeod, Heather; Pillay, Komala
Objectives: A high incidence of HIV continues among men who have sex with men (MSM) in industrialised nations and research indicates many MSM do not disclose their HIV status to sex partners. Themes as to why MSM attending sexually transmitted infection (STI) clinics in Los Angeles and Seattle do and do not disclose their HIV status are identified. Methods: 55 HIV positive MSM (24 in Seattle, 31 in Los Angeles) reporting recent STI or unprotected anal intercourse with a serostatus negative or unknown partner from STI clinics underwent in-depth interviews about their disclosure practices that were tape recorded, transcribed verbatim, coded, and content analysed. Results: HIV disclosure themes fell into a continuum from unlikely to likely. Themes for "unlikely to disclose" were HIV is "nobody's business," being in denial, having a low viral load, fear of rejection, "it's just sex," using drugs, and sex in public places. Themes for "possible disclosure" were type of sex practised and partners asking/disclosing first. Themes for "likely to disclose" were feelings for partner, feeling responsible for partner's health, and fearing arrest. Many reported non-verbal disclosure methods. Some thought partners should ask for HIV status; many assumed if not asked then their partner must be positive. Conclusions: HIV positive MSM's decision to disclose their HIV status to sex partners is complex, and is influenced by a sense of responsibility to partners, acceptance of being HIV positive, the perceived transmission risk, and the context and meaning of sex. Efforts to promote disclosure will need to address these complex issues.
Gorbach, P; Galea, J; Amani, B; Shin, A; Celum, C; Kerndt, P; Golden, M
Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy has reduced mortality among HIV-infected children, and as they survive into adolescence, disclosing to them their diagnosis has emerged as a difficult issue, with many adolescents unaware of their diagnosis. There is a need to build an empirical foundation for strategies to appropriately inform infected children of their diagnosis, particularly in South Africa, which has the largest number of HIV-positive people in the world. As a step toward developing such strategies, we conducted a study in Eastern Cape Province, South Africa to identify beliefs about disclosing HIV diagnosis to HIV-infected children among caregivers, health-care providers, and HIV-positive children who knew their diagnosis. We implemented 7 focus groups with 80 participants: 51 caregivers in 4 groups, 24 health-care providers in 2 groups, and 5 HIV-positive children in 1 group. We found that although the participants believed that children from age 5 years should begin to learn about their illness, with full disclosure by age 12, they suggested that many caregivers fail to fully inform their children. The participants said that the primary caregiver was the best person to disclose. The main reasons cited for failing to disclose were (a) lack of knowledge about HIV and its treatment, (b) the concern that the children might react negatively, and (c) the fear that the children might inappropriately disclose to others, which would occasion gossip, stigmatization, and discrimination towards them and the family. We discuss the implications for developing interventions to help caregivers appropriately disclose HIV status to HIV-infected children and, more generally, communicate effectively with the children to improve their health outcomes. PMID:22468145
Heeren, G Anita; Jemmott, John B; Sidloyi, Lulama; Ngwane, Zolani
The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding. PMID:23777716
Madiba, Sphiwe; Letsoalo, Rosemary
Stigma profoundly affects the lives of people with HIV\\/AIDS. Fear of being identified as having HIV or AIDS may discourage\\u000a a person from getting tested, from accessing medical services and medications, and from disclosing their HIV status to family\\u000a and friends. In the present study, we use focus groups to identify the most salient domains of stigma and the coping
Jennifer N. Sayles; Gery W. Ryan; Junell S. Silver; Catherine A. Sarkisian; William E. Cunningham
HIV-infected mothers face the challenging decision of whether to disclose their serostatus to their children. From the perspective\\u000a of both mother and child, we explored the process of disclosure, providing descriptive information and examining the relationships\\u000a among disclosure, demographic variables, and child adjustment. Participants were 23 mothers and one of their noninfected children\\u000a (9 to 16 years of age). Sixty-one
Tanya L. Tompkins
This paper explores how perceived stigma and layered stigma related to injection drug use and being HIV-positive influence the decision to disclose one's HIV status to family and community and experiences with stigma following disclosure among a population of HIV-positive male injection drug users (IDUs) in Thai Nguyen, Vietnam. In qualitative interviews conducted between 2007 and 2008, 25 HIV-positive male IDUs described layered stigma in their community but an absence of layered stigma within their families. These findings suggest the importance of community-level HIV prevention interventions that counter stigma and support families caring for HIV-positive relatives. PMID:21777075
Rudolph, A E; Davis, W W; Quan, V M; Ha, T V; Minh, N L; Gregowski, A; Salter, M; Celentano, D D; Go, V
A cross-sectional survey, using self-sampled finger-prick blood on blotting paper and anonymous behavioral self-administrated questionnaires was conducted in Paris in 2009 among MSM attending gay venues. Paired biological results and questionnaires were available for 886 participants. HIV seroprevalence was 17.7 % (95 % CI: 15.3-20.4). Four groups were identified according to their knowledge of their HIV biological status. Among the 157 found to be seropositive, 31 (19.7 %) were unaware of their status and reported high levels of sexual risk behaviors and frequent HIV testing in the previous 12 months. Among the 729 MSM diagnosed HIV-negative, 183 were no longer sure whether they were still HIV-negative, or had never been tested despite the fact that they engaged in at-risk sexual behaviors. This study provides the first estimate of HIV seroprevalence among MSM in Paris and underlines the specific need for combined prevention of HIV infection in this MSM population. PMID:22968398
Velter, Annie; Barin, Francis; Bouyssou, Alice; Guinard, Jérôme; Léon, Lucie; Le Vu, Stéphane; Pillonel, Josiane; Spire, Bruno; Semaille, Caroline
People who are HIV-positive must make decisions about disclosing their status to others but do so in the context of stigma and social isolation reported by many with the disease. Disclosing an HIV-positive diagnosis is necessary to seek social support, to manage health care, and to negotiate sexual encounters, but fear of how others will respond is a strong barrier to revealing that information. This investigation focuses on various ways that HIV can be disclosed. Using a multiple-goals perspective, 24 disclosure messages (representing 6 different types) were created. Participants (N = 548) were asked to imagine one of their siblings revealing an HIV-positive diagnosis, using 1 of the 24 messages. Participants' reactions to the disclosures differed substantially across the various message types. The discussion focuses on theoretical explanations for the variations in responses and the utility of these findings for practical interventions concerning HIV disclosures. PMID:19415559
Caughlin, John P; Bute, Jennifer J; Donovan-Kicken, Erin; Kosenko, Kami A; Ramey, Mary E; Brashers, Dale E
Background Ghana has an estimated one million orphans, 250,000 are due to AIDS parental deaths. This is the first study that examined the impact of parental HIV/AIDS status and death on the mental health of children in Ghana. Methods In a cross-sectional survey, 4 groups of 200 children (children whose parents died of AIDS, children whose parents died of causes other than AIDS, children living with parents infected with HIV/AIDS, and non-orphaned children whose parents are not known to be infected with HIV/AIDS) aged between 10 and 19 were interviewed on their hyperactivity, emotional, conduct, and peer problems using the Strengths and Difficulties Questionnaire. Results Children whose parents died of AIDS showed very high levels of peer problems [F (3,196) = 7.34, p < .001] whilst both orphaned groups scored similarly high on conduct problems [F (3, 196) = 14.85, p < .001]. Hyperactivity showed no difference and was very low in the entire sample. Emotional problems were very high in all the groups except among the non-orphaned children [F (3, 196) = 5.10, p < .001]. Conclusion Orphans and children living with parents infected with HIV/AIDS are at heightened risks for emotional and behavioural disorders and that efforts to address problems in children affected by HIV/AIDS must focus on both groups of children. Parallel to this, researchers should see these findings as generated hypotheses (rather than conclusions) calling for further exploration of specific causal linkages between HIV/AIDS and children's mental health, using more rigorous research tools and designs.
Disclosure of HIV seropositive 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 randomized trials of male circumcision in Rakai, Uganda. HIV discordant couples and a random sample of HIV-infected concordant and HIV-negative concordant couples (to mask HIV status) were invited to sensitization meetings to discuss the benefits of disclosure and couple counselling. HIV-infected partners were subsequently contacted to encourage HIV disclosure to their HIV uninfected partners. If the index positive partner agreed, the counsellor facilitated the disclosure of HIV results, and provided ongoing support. The proportion of disclosure was determined. 81% of HIV-positive partners in discordant relationships disclosed their status to their HIV-uninfected partners in the presence of the counsellor. The rates of disclosure were 81.3% in male HIV-positive and 80.2% in female HIV-positive discordant couples. Disclosure did not vary by age, education or occupation. In summary, disclosure of HIV-positive results in discordant couples using facilitated couple counselling approach is high, but requires a stepwise process of sensitization and agreement by the infected partner.
Kairania, Robert M.; Gray, Ronald H.; Kiwanuka, Noah; Makumbi, Fredrick; Sewankambo, Nelson K.; Serwadda, David; Nalugoda, Fred; Kigozi, Godfrey; Semanda, John; Wawer, Maria J.
Introduction The objectives of this study are to address if and how albumin can be used as an indication of malnutrition in HIV infected and uninfected Africans. Methods In 2005, 710 HIV-infected and 226 HIV-uninfected women enrolled in a cohort study. Clinical/demographic parameters, CD4 count, albumin, liver transaminases; anthropometric measurements and Bioelectrical Impedance Analysis (BIA) were performed. Malnutrition outcomes were defined as body mass index (BMI), Fat-free mass index (FFMI) and Fat mass index (FMI). Separate linear predictive models including albumin were fit to these outcomes in HIV negative and HIV positive women by CD4 strata (CD4>350,200–350 and <200 cells/µl). Results In unadjusted models for each outcome in HIV-negative and HIV positive women with CD4>350 cells/µl, serum albumin was not significantly associated with BMI, FFMI or FMI. Albumin was significantly associated with all three outcomes (p<0.05) in HIV+ women with CD4 200–350 cells/µl, and highly significant in HIV+ women with CD4<200 cells/µl (P<0.001). In multivariable linear regression, albumin remained associated with FFMI in women with CD4 count<200 cells/µl (p<0.01) but not in HIV+ women with CD4>200. Discussion While serum albumin is widely used to indicate nutritional status it did not consistently predict malnutrition outcomes in HIV- women or HIV+ women with higher CD4. This result suggests that albumin may measure end stage disease as well as malnutrition and should not be used as a proxy for nutritional status without further study of its association with validated measures.
Dusingize, Jean-Claude; Hoover, Donald R.; Shi, Qiuhu; Mutimura, Eugene; Kiefer, Elizabeth; Cohen, Mardge; Anastos, Kathryn
Background We analyzed HIV testing rates, prevalence of undiagnosed HIV, and predictors of testing in the Kenya AIDS Indicator Survey (KAIS) 2007. Methods KAIS was a nationally representative sero-survey that included demographic and behavioral indicators and testing for HIV, HSV-2, syphilis, and CD4 cell counts in the population aged 15–64 years. We used gender-specific multivariable regression models to identify factors independently associated with HIV testing in sexually active persons. Results Of 19,840 eligible persons, 80% consented to interviews and blood specimen collection. National HIV prevalence was 7.1% (95% CI 6.5–7.7). Among ever sexually active persons, 27.4% (95% CI 25.6–29.2) of men and 44.2% (95% CI 42.5–46.0) of women reported previous HIV testing. Among HIV-infected persons, 83.6% (95% CI 76.2–91.0) were unaware of their HIV infection. Among sexually active women aged 15–49 years, 48.7% (95% CI 46.8–50.6) had their last HIV test during antenatal care (ANC). In multivariable analyses, the adjusted odds ratio (AOR) for ever HIV testing in women ?35 versus 15–19 years was 0.2 (95% CI: 0.1–0.3; p<0.0001). Other independent associations with ever HIV testing included urban residence (AOR 1.6, 95% CI: 1.2–2.0; p?=?0.0005, women only), highest wealth index versus the four lower quintiles combined (AOR 1.8, 95% CI: 1.3–2.5; p?=?0.0006, men only), and an increasing testing trend with higher levels of education. Missed opportunities for testing were identified during general or pregnancy-specific contacts with health facilities; 89% of adults said they would participate in home-based HIV testing. Conclusions The vast majority of HIV-infected persons in Kenya are unaware of their HIV status, posing a major barrier to HIV prevention, care and treatment efforts. New approaches to HIV testing provision and education, including home-based testing, may increase coverage. Targeted interventions should involve sexually active men, sexually active women without access to ANC, and rural and disadvantaged populations.
Cherutich, Peter; Kaiser, Reinhard; Galbraith, Jennifer; Williamson, John; Shiraishi, Ray W.; Ngare, Carol; Mermin, Jonathan; Marum, Elizabeth; Bunnell, Rebecca
Background Zimbabwe is a Southern African country with a high HIV-TB burden and is ranked 19th among the 22 Tuberculosis high burden countries worldwide. Recurrent TB is an important problem for TB control, yet there is limited information about treatment outcomes in relation to HIV status. This study was therefore conducted in Chitungwiza, a high density dormitory town outside the capital city, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. Methods Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. The Chi-square and Fischer's exact tests were used to establish associations between categorical variables. Multivariate relative risks for associations between the various TB treatment outcomes and HIV status, type of recurrent TB, sex and age were calculated using Poisson regression with robust error variance. Results Of 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). There were 103 (46%) with relapse TB, 32 (14%) with treatment after default, and 90 (40%) with "retreatment other" TB. There was one failure patient. HIV-testing and HIV-positivity were similar between patients with different types of TB. Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to "retreatment other" TB patients, (adjusted RR 0.81; 95% CI 0.68 - 0.97, p = 0.02). Conclusions No differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes "retreatment other" TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.
Background Religion shapes everyday beliefs and activities, but few studies have examined its associations with attitudes about HIV. This exploratory study in Tanzania probed associations between religious beliefs and HIV stigma, disclosure, and attitudes toward antiretroviral (ARV) treatment. Methods A self-administered survey was distributed to a convenience sample of parishioners (n = 438) attending Catholic, Lutheran, and Pentecostal churches in both urban and rural areas. The survey included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about ARVs. Multivariate logistic regression analysis was performed to assess how religion was associated with perceptions about HIV, HIV treatment, and people living with HIV/AIDS. Results Results indicate that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God (p < 0.01) or that people living with HIV/AIDS (PLWHA) have not followed the Word of God (p < 0.001). Most participants (84.2%) said that they would disclose their HIV status to their pastor or congregation if they became infected. Although the majority of respondents (80.8%) believed that prayer could cure HIV, almost all (93.7%) said that they would begin ARV treatment if they became HIV-infected. The multivariate analysis found that respondents' hypothetical willingness to begin ARV treatme was not significantly associated with the belief that prayer could cure HIV or with other religious factors. Refusal of ARV treatment was instead correlated with lack of secondary schooling and lack of knowledge about ARVs. Conclusion The decision to start ARVs hinged primarily on education-level and knowledge about ARVs rather than on religious factors. Research results highlight the influence of religious beliefs on HIV-related stigma and willingness to disclose, and should help to inform HIV-education outreach for religious groups.
Zou, James; Yamanaka, Yvonne; John, Muze; Watt, Melissa; Ostermann, Jan; Thielman, Nathan
This was an exploratory, qualitative study of contextual cultural and social realities of the sexual interactions of a representative sample of African American women of unidentified HIV status. The study expanded our understanding of family and gender role variables by exploring influences of family of origin and idealistic perceptions of roles on sexual relationships. Data was collected on 51 African
S. L. Jarama; F. Z. Belgrave; J. Bradford; M. Young; J. A. Honnold
Currently, there are millions of female sex workers (FSWs) in China and these women play a critical role in the escalating HIV epidemic in the country. Existing studies revealed high mobility of this population, but data on the relationship of FSWs’ migratory status and their HIV\\/AIDS-related sexual risks are limited. A cross-sectional survey was administered among 454 FSWs in a
Yan Hong; Xiaoming Li; Hongmei Yang; Xiaoyi Fang; Ran Zhao
Background. Nutritional status is an important determinant of HIV outcomes. Objective. To assess the nutrient intake and nutrient status of HIV seropositive patients attending an AIDS outpatient clinic, to improve the nutritional management of HIV-infected patients. Design. Prospective cohort study. Setting. Comprehensive care clinic in Chulaimbo Sub-District Hospital, Kenya. Subjects. 497 HIV sero-positive adults attending the clinic. Main Outcome Measures. Evaluation of nutrient intake using 24-hour recall, food frequency checklist, and nutrient status using biochemical assessment indicators (haemoglobin, creatinine, serum glutamate pyruvate (SGPT) and mean corpuscular volume (MCV)). Results. Among the 497 patients recruited (M?:?F sex ratio: 1.4, mean age: 39?years ± 10.5?y), Generally there was inadequate nutrient intake reported among the HIV patients, except iron (10.49?±?3.49?mg). All the biochemical assessment indicators were within normal range except for haemoglobin 11.2?g/dL (11.4?±?2.60 male and 11.2?±?4.25 female). Conclusions. Given its high frequency, malnutrition should be prevented, detected, monitored, and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.
Onyango, Agatha Christine; Walingo, Mary Khakoni; Mbagaya, Grace; Kakai, Rose
Background.?Serology is the mainstay for syphilis diagnosis and treatment monitoring. We investigated serological response to treatment of syphilis according to disease stage and HIV status. Methods.?A retrospective cohort study of 264 patients with syphilis was conducted, including 90 primary, 133 secondary, 33 latent, and 8 tertiary syphilis cases. Response to treatment as measured by the Venereal Disease Research Laboratory (VDRL) test and a specific IgM (immunoglobulin M) capture enzyme-linked immunosorbent assay (ELISA; Pathozyme-IgM) was assessed by Cox regression analysis. Results.?Forty-two percent of primary syphilis patients had a negative VDRL test at their diagnosis. Three months after treatment, 85%–100% of primary syphilis patients had reached the VDRL endpoint, compared with 76%–89% of patients with secondary syphilis and 44%–79% with latent syphilis. In the overall multivariate Cox regression analysis, serological response to treatment was not influenced by human immunodeficiency virus (HIV) infection and reinfection. However, within primary syphilis, HIV patients with a CD4 count of <500 cells/?L had a slower treatment response (P = .012). Compared with primary syphilis, secondary and latent syphilis showed a slower serological response of VDRL (P = .092 and P < .001) and Pathozyme-IgM tests (P < .001 and P = .012). Conclusions.?The VDRL should not be recommended as a screening test owing to lack of sensitivity. The syphilis disease stage significantly influences treatment response whereas HIV coinfection only within primary syphilis has an impact. VDRL test titers should decline at least 4-fold within 3–6 months after therapy for primary or secondary syphilis, and within 12–24 months for latent syphilis. IgM ELISA might be a supplement for diagnosis and treatment monitoring.
Knaute, Damaris Frohlich; Graf, Nicole; Lautenschlager, Stephan; Weber, Rainer; Bosshard, Philipp P.
As access to HIV\\/AIDS treatment increases in sub-Saharan Africa, greater attention is being paid to HIV-infected youth. Little is known about how HIV-positive youth are informed of their HIV infection. As part of a larger formative study informing a treatment program in Kinshasa, Democratic Republic of the Congo, semi-structured interviews were conducted with 19 youth (10–21 years) who had previously
L. Vaz; A. Corneli; J. Dulyx; S. Rennie; S. Omba; F. Kitetele; F. Behets
Introduction We sought to compare risk of death among children aged under-2 years born to HIV positive mother (HIV-exposed) and to HIV negative mother (HIV non-exposed), and identify determinants of under-2 mortality among the two groups in Rwanda. Methods In a stratified, two-stage cluster sampling design, we selected mother-child pairs using national Antenatal Care (ANC) registers. Household interview with each mother was conducted to capture socio-demographic data and information related to pregnancy, delivery and post-partum. Data were censored at the date of child death. Using Cox proportional hazard model, we compared the hazard of death among HIV-exposed children and HIV non-exposed children. Results Of 1,455 HIV-exposed children, 29 (2.0%; 95% CI: 1.3%-2.7%) died by 6 months compared to 18 children of the 1,565 HIV non-exposed children (1.2%; 95% CI: 0.6%-1.7%). By 9 months, cumulative risks of death were 3.0% (95%; CI: 2.2%-3.9%) and 1.3% (96%; CI: 0.7%-1.8%) among HIV-exposed and HIV non-exposed children, respectively. By 2 years, the hazard of death among HIV-exposed children was more than 3 times higher (aHR:3.5; 95% CI: 1.8-6.9) among HIV-exposed versus non-exposed children. Risk of death by 9-24 months of age was 50% lower among mothers who attended 4 or more antenatal care (ANC) visits (aHR: 0.5, 95% CI: 0.3-0.9), and 26% lower among families who had more assets (aHR: 0.7, 95% CI: 0.5-1.0). Conclusion Infant mortality was independent of perinatal HIV exposure among children by 6 months of age. However, HIV-exposed children were 3.5 times more likely to die by 2 years. Fewer antenatal visits, lower household assets and maternal HIV seropositive status were associated with increased mortality by 9-24 months.
Mugwaneza, Placidie; Umutoni, Nadine Wa Shema; Ruton, Hinda; Rukundo, Alphonse; Lyambabaje, Alexandre; Bizimana, Jean de Dieu; Tsague, Landry; Wagner, Claire M; Nyankesha, Elevanie; Muita, Jane; Mutabazi, Vincent; Nyemazi, Jean Pierre; Nsanzimana, Sabin; Karema, Corine; Binagwaho, Agnes
The current study addresses fertility desires and considerations among 143 HIV serodiscordant, opposite-sex couples (in which only the male partner is HIV positive) in the Northeastern U.S. Couples responded to questionnaires during their initial consultation for assisted reproduction, and data were collected over 7 years and analyzed retrospectively. Results indicated that a majority of the male participants had HIV when they met their partner, and a majority also disclosed their HIV status upon meeting. Most couples reported that they had previously discussed or considered a host of fertility-related issues, including the potential risk of HIV infection to the mother and the fetus during the process of fertility treatment. The majority of couples had also discussed the possibility that the male partner could die prematurely due to HIV/AIDS and had considered making arrangements for third-party parenting in the event of the male partner's death. If their fertility treatment were to be successful in the future, most couples desired additional children, and most believed that their future child should be told of the male partner's HIV status. Predictors of the desire for additional children after successful fertility treatment included: younger age, shorter relationship duration, being childless currently, and beginning their relationship after the male partner had already been diagnosed as HIV positive. Future research on fertility desires should include perspectives of HIV positive men on fatherhood, as well as concerns and issues specific to HIV serodiscordant couples. PMID:20960049
Gosselin, Jennifer T; Sauer, Mark V
Introduction HIV stigma is a contributing factor to poor patient outcomes. Although HIV stigma has been documented, its impact on patient well-being in the southern US is not well understood. Methods Thirty-two adults participated in cognitive interviews after completing the Berger HIV or the Van Rie stigma scale. Participant responses were probed to ensure the scales accurately measured stigma and to assess the impact stigma had on behavior. Results Three main themes emerged regarding HIV stigma: (1) negative attitudes, fear of contagion, and misperceptions about transmission; (2) acts of discrimination by families, friends, health care providers, and within the workplace; and (3) participants’ use of self-isolation as a coping mechanism. Overwhelming reluctance to disclose a person’s HIV status made identifying enacted stigma with a quantitative scale difficult. Discussion Fear of discrimination resulted in participants isolating themselves from friends or experiences to avoid disclosure. Participant unwillingness to disclose their HIV status to friends and family could lead to an underestimation of enacted HIV stigma in quantitative scales.
Audet, Carolyn M.; McGowan, Catherine C.; Wallston, Kenneth A.; Kipp, Aaron M.
The objective of our study was to investigate factors associated with postpartum physical and mental morbidity among women in Lusaka, Zambia with particular reference to known HIV status. Our study was part of the Breastfeeding and Postpartum Health (BFPH) longitudinal cohort study conducted between June 2001 and July 2003. Women were recruited at 34 weeks gestation and followed up to
S. M. Collin; M. M. Chisenga; L. Kasonka; A. Haworth; C. Young; S. Filteau; S. F. Murray
OBJECTIVES: It has been shown that socioeconomic status (SES) is associated with adherence to treatment of patients with several chronic diseases. However, there is a controversy regarding the impact of SES on adherence among patients with the human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). Thus, we sought to perform a systematic review of the evidence regarding the
Matthew E Falagas; Efstathia A Zarkadoulia; Paraskevi A Pliatsika; George Panos
Objective: To examine the role of antiretroviral treatment related perceptions relative to other clinical and psychosocial factors associated with sexual risk taking in HIV positive men who have sex with men (MSM). Methods: Participants were recruited from ambulatory HIV clinics in Montreal. Information on sociodemographic factors, health status, antiretroviral treatment related perceptions, and sexual behaviours was collected using a self administered questionnaire. At-risk sexual behaviour was defined as at least one occurrence of unprotected insertive or receptive anal intercourse in the past 6 months. Multivariate logistic regression was performed to evaluate the associations between at-risk sexual behaviour and covariates. Results: 346 subjects participated in the study. Overall, 34% of subjects were considered at risk; 43% of sexually active subjects (n = 274). At-risk sexual behaviour was associated with two antiretroviral treatment related perceptions: (1) taking antiretroviral treatment reduces the risk of transmitting HIV (adjusted odds ratio (OR), 2.10; 95% confidence interval (CI), 1.16 to 3.80); and (2) there is less safer sex practised by MSM because of HIV treatment advances (OR, 1.82; CI, 1.14 to 2.90). Other factors, however, were more strongly associated with risk. These were: (1) safer sex fatigue (OR, 3.23; CI, 1.81 to 5.78); (2) use of "poppers" during sexual intercourse (OR, 6.28; CI, 2.43 to 16.21); and (3) reporting a greater proportion of HIV positive anal sex partners, compared with reporting no HIV positive anal sex partners: (a) <50% HIV positive (OR, 16.79; CI, 4.70 to 59.98); (b) ?50% HIV positive (OR, 67.67; CI, 15.43 to 296.90). Conclusion: Despite much emphasis on HIV treatment related beliefs as an explanation for sexual risk taking in MSM, this concern may play a relatively minor part in the negotiation of risk by HIV positive MSM. Serosorting, safer sex fatigue, and the use of poppers appear to be more important considerations in understanding the sexual risk behaviours of HIV positive MSM.
Cox, J; Beauchemin, J; Allard, R
Men who have sex with men (MSM) in China face a rapidly expanding HIV epidemic. Anal sex role plays a significant role in HIV infection. Research has already begun in China investigating the potential for circumcision-based interventions to slow the rise of HIV among Chinese MSM. Using peer referral recruitment, we sampled 491 men who reported anal sex role preference. We analyzed preferred anal sex role, enacted sex role during recent sexual behavior, and circumcision status and HIV infection among MSM in one Chinese city. Men reported on their anal sex role preference and reported on up to three male sexual partners. Men were asked to report on whether they were "top" or "bottom" with each of the partners. Those that preferred being bottom and versatile were significantly younger than those who preferred being top. Men who preferred bottoming and those that preferred the versatile role were significantly more likely to be HIV-infected than those who preferred to be tops. There was no significant association between circumcision and HIV infection among men who maintained their preferred top role. In terms of anal sex role behavior, prevalence was not statistically different across anal sex roles. Circumcision conferred no additional protection to men who preferred and who engaged the top role during anal sex. HIV interventions will need to address anal sex roles in more sophisticated ways than perhaps originally thought. Simplistic assumptions that anal sex role is a fixed behavior undermines interventions such as circumcision among MSM. PMID:23070532
Zhou, Chao; Raymond, H Fisher; Ding, Xianbin; Lu, Rongrong; Xu, Jing; Wu, Guohui; Feng, Liangui; Fan, Song; Li, Xuefeng; McFarland, Willi; Xiao, Yan; Ruan, Yuhua; Shao, Yiming
While cell suspension immunophenotypic studies are widely used as an aid in the diagnosis and classification of lymphomas and leukemias, much less attention has been directed toward interpretation of the results in reactive lymphoid proliferations. Cell suspension immunophenotypic data were therefore analyzed for 119 lymph nodes with reactive lymphoid proliferations which were divided into five major histologic categories: follicular hyperplasia, marked (FH,M), or moderate (FH); dermatopathic lymphadenopathy (DL); diffuse hyperplasia (DH); or "other." With the aid of a computer-assisted morphometer, the following were also measured and calculated: proportion of node occupied by follicles, mean relative follicle size, and mean follicle shape factor. Finally, in 57 cases, the influence of human immunodeficiency (HIV) status on the findings was analyzed. Although individual cases varied widely, cases of DL had significantly more CD3+ (T) cells, higher CD4:CD8 ratios, and fewer CD19+ (B) cells than other categories. Cases of FH,M had significantly lower CD4:CD8 ratios and more CD19+, CD10+, and transferrin receptor positive cells. Cases of FH,M and FH known to be HIV-negative had higher CD4:CD8 ratios than the HIV-positive cases. Peripheral blood CD4:CD8 ratios performed in 38 patients showed a strong correlation with nodal ratios. Morphometric data supported the correlation between follicular hyperplasia and increased proportions of CD19+, CD10+, and transferrin receptor-positive cells. Rare cases had CD5:CD2 or CD3 ratios of greater than 1 or "monoclonal" kappa to lambda ratios. CD4:CD8 ratios varied widely, but aberrant T cell phenotypes were not identified. These studies demonstrate that, although great variation exists, there are certain associations between types of reactive lymphoid hyperplasia and cell suspension immunophenotypic findings.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2106678
Westermann, C D; Hurtubise, P E; Linnemann, C C; Swerdlow, S H
Background Access to HIV testing and subsequent care among health care workers (HCWs) form a critical component of TB infection control measures for HCWs. Challenges to and gaps in access to HIV services among HCWs may thus compromise TB infection control. This study assessed HCWs HIV and TB screening uptake and explored their preferences for provision of HIV and TB care. Methods A cross-sectional mixed-methods study involving 499 HCWs and 8 focus group discussions was conducted in Mukono and Wakiso districts in Uganda between October 2010 and February 2011. Results Overall, 5% of the HCWs reported a history of TB in the past five years. None reported routine screening for TB disease or infection, although 89% were willing to participate in a TB screening program, 77% at the workplace. By contrast, 95% had previously tested for HIV; 34% outside their workplace, and 27% self-tested. Nearly half (45%) would prefer to receive HIV care outside their workplace. Hypothetical willingness to disclose HIV positive status to supervisors was moderate (63%) compared to willingness to disclose to sexual partners (94%). Older workers were more willing to disclose to a supervisor (adjusted prevalence ratio [APR]?=?1.51, CI?=?1.16–1.95). Being female (APR?=?0.78, CI?=?0.68–0.91), and working in the private sector (APR?=?0.81, CI?=?0.65–1.00) were independent predictors of unwillingness to disclose a positive HIV status to a supervisor. HCWs preferred having integrated occupational services, versus stand-alone HIV care. Conclusions Discomfort with disclosure of HIV status to supervisors suggests that universal TB infection control measures that benefit all HCWs are more feasible than distinctions by HIVstatus, particularly for women, private sector, and younger HCWs. However, interventions to reduce stigma and ensuring confidentiality are also essential to ensure uptake of comprehensive HIV care including Isoniazid Preventive Therapy among HCWs.
Buregyeya, Esther; Nuwaha, Fred; Wanyenze, Rhoda K.; Mitchell, Ellen M. H.; Criel, Bart; Verver, Suzanne; Kasasa, Simon; Colebunders, Robert
To understand how awareness of HIV-positivity and the use of antiretroviral therapy associated with syphilis infection, 361 MSM attending 16 Hong-Pa (drug-and-sex parties) in Taiwan were studied. The syphilis rate of individuals within their first 2 years after HIV diagnosis (awareness) was lower than that in individuals who had not been diagnosed HIV infection prior to Hong-Pa (unawareness) (Adj OR = 0.24, P < 0.05). Notably, there was a decrease in the beneficial effect of HIV-positive status awareness on syphilis prevention with an increase in time since notification. Moreover, antiretroviral therapy was not associated with a lower incidence of syphilis, and syphilis infection peaked during the treatment dropout period. In conclusion, the duration of a protective effect of knowing one's HIV-positivity against syphilis infection was short, and the highest risk of syphilis infection was observed when patients discontinued antiretroviral therapy. Future research should examine the behavioral mechanisms involved in this prevention failure. PMID:23297086
Huang, Yen-Fang; Nelson, Kenrad E; Lin, Yu-Ting; Yang, Chin-Hui; Chang, Feng-Yee; Lew-Ting, Chih-Yin
Introduction of highly active antiretroviral therapy (HAART) has improved the prognosis of human immunodeficiency virus (HIV) infection. The social burden of HIV infection in Nigeria is well appreciated, but the consequences of this infection and HAART on micro mineral status are unknown in Nigeria. We evaluated these effects in Orlu, Imo State, Nigeria. This prospective study involved 51 adult HIV positive patients (18-56 years). Serum selenium, magnesium and zinc were measured using atomic absorption spectrophotometry before and after 6 months on HAART. Results are presented as means while comparison of variables was done using paired t-tests. P-value < 0.05 was considered significant. Selenium, magnesium and zinc levels in the participants before HAART were 0.23±0.08 mmol/L, 104.61±24.16 mmol/L and 9.04±1.26 mmol/L respectively. Mineral levels 6 months after HAART were 0.25±0.08 mmol/L, 115.57±27.98 mmol/L and 9.41±1.23 mmol/L respectively. Selenium and magnesium levels significantly increased after 6 months on HAART (p < 0.05) while zinc level did not increase significantly (p> 0.05). HAART improved selenium and magnesium status of HIV patients but their zinc status remained the same. PMID:23955416
Okwara, E C; Meludu, S C; Okwara, J E; Enwere, O O; Diwe, K C; Amah, U K; Ezeugwunne, I P; Okwara, E I
World Health Organization and United Nations International Children's Emergency Fund have strongly recommended a sustained coverage of universal immunisation among all children against tuberculosis, polio, diphtheria, pertussis, tetanus and measles. In India, these vaccines under the universal immunisation programme are made available absolutely free of cost to all children through the public health system. Information regarding immunisation coverage among HIV exposed children in India is still very limited. The objective of this study was to estimate the proportion of children of people living with HIV who had been completely immunised by the age of 12 months and to find predictors of complete immunisation. A community-based cross-sectional survey was conducted in the Kolkata Metropolitan Area between 15 June and 14 September 2009 using a pre-structured interview schedule. Data were analysed from 256 care-givers of children (85.5% response rate) whose parents were randomly selected from the Bengal Network of HIV-positive people. Multiple logistic regression was used to estimate and test associations of predictors with complete immunisation. The percentage of children of people living with HIV completely immunised at the age of 12 months was 73.0% (67.3% to 78.1%), which was not significantly different from that for all children at 12 months. Mothers having received antenatal care [OR (odds ratio): 7.29; 95% confidence intervals (CI): 2.39-22.25], mothers having postprimary education (OR: 3.37; 95% CI: 1.45-7.81), children of Hindu and Christian religion (OR: 3.74; 95% CI: 1.63-8.62), children not belonging to scheduled castes, tribes and 'other backward classes' (OR: 2.08; 95% CI: 1.02-4.25) were significant independent predictors of complete immunisation status of these children. This emphasises the imperative need for up-scaling of antenatal care among the pregnant mothers to ensure complete immunisation among their children. A special focus on girl child education should also be implemented to empower future mothers for a sustained improvement of child immunisation in the long-run. The current national immunisation programme should focus on the children from the Muslim community and those belonging to scheduled castes, tribes and other backward classes to improve coverage. PMID:22813078
Sensarma, Pinaki; Bhandari, Subhasis; Kutty, V Raman
In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15–29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood
Neil Andersson; Anne Cockcroft
In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15–29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood
Neil Andersson; Anne Cockcroft
In Senegal, where HIV prevalence is less than 1% and stigma remains important, 40% of marriages are polygamic. The purpose of this article is to describe and analyze the motivations, benefits and constraints related to HIV disclosure, and to explore specific situations related to polygamy. Data were collected through qualitative research based on in-depth repeated interviews on the experience of antiretroviral therapy and its social effects, conducted over a period of 10 years with people on antiretroviral treatment and their caregivers. Health professionals encourage people to disclose their HIV status, especially in certain circumstances such as preventing mother-to-child transmission of HIV. Nevertheless they are aware of the social risks for some patients, particularly women. Some health workers insist on disclosure, while others do not interfere with women who do not disclose to their partner, while highlighting their ethical dilemma. Interviews trace the changing attitudes of caregivers regarding disclosure. The majority of married women begin by sharing their HIV status with their mother, waiting for her to confirm that the contamination is not due to immoral behavior and to participate in implementing a strategy to maintain secrecy. In polygamous households, women try to disclose to their partner, keeping the secret beyond the couple. Some women fear disclosure by their husbands to co-spouses, whose attitudes can be very diverse: some stories relate collective rejection from the household; sometimes disclosure is made in a progressive way following the hierarchy of positions of each person in the household; another person reported the solidarity shown by her co-spouses who kept her HIV status a secret outside the household. The article shows the diversity of situations and their dynamics regarding both disclosure practices and their social effects. PMID:23844800
|Reviews the workplace experiences of 18 individuals who are HIV+ and 14 people who have cancer. Questions in the study addressed the following issues: the impact of the illness on their work life; whether they disclosed their health status and, if so, the reactions of co-workers and supervisors; and what accommodations, if any, they received.…
Fesko, Shelia Lynch
This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES. PMID:15688569
Wojcicki, Janet Maia
As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online
Alex Carballo-Diéguez; Michael Miner; Curtis Dolezal; B. R. Simon Rosser; Scott Jacoby
Objective To understand the health status of HIV orphans in a well-structured institutional facility in India. Method Prospective longitudinal analysis of growth and anaemia prevalence among these children, between June 2008 and May 2011. Results A total of 85 HIV-infected orphan children residing at Sneha Care Home, Bangalore, for at least 1 year, were included in the analysis. Prevalence of anaemia at entry into the home was 40%, with the cumulative incidence of anaemia during the study period being 85%. At baseline, 79% were underweight and 72% were stunted. All children, irrespective of their antiretroviral therapy (ART) status, showed an improvement in nutritional status over time as demonstrated by a significant increase in weight (median weight-for-age Z-score: ?2.75 to ?1.74, P < 0.001) and height Z-scores (median height-for-age Z-score: ?2.69 to ?1.63, P < 0.001). Conclusion These findings suggest that good nutrition even in the absence of ART can bring about improvement in growth. The Sneha Care Home model indicates that the holistic approach used in the Home may have been helpful in combating HIV and poor nutritional status in severely malnourished orphaned children.
Kapavarapu, Prasanna K.; Bari, Omar; Perumpil, Mathew; Duggan, Christopher; Dinakar, Chitra; Krishnamurthy, Shubha; Arumugam, Karthika; Shet, Anita
Vitamin D has a potential role in preventing HIV-related complications, based on its extensive involvement in immune and metabolic function, including preventing osteoporosis and premature cardiovascular disease. However, this association has not been examined in large studies or in resource-limited settings. Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation (excluding vitamin D) in Tanzania. Information on HIV related complications was recorded during follow-up (median, 70 months). Proportional hazards models and generalized estimating equations were used to assess the relationship of vitamin D status with these outcomes. Women with low vitamin D status (serum 25-hydroxyvitamin D<32 ng/mL) had 43% higher risk of reaching a body mass index (BMI) less than 18 kg/m(2) during the first 2 years of follow-up, compared to women with adequate vitamin D levels (hazard ratio [HR]: 1.43; 95% confidence intervals: [1.03-1.99]). The relationship between continuous vitamin D levels and risk of BMI less than 18 kg/m(2) during follow-up was inverse and linear (p=0.03). Women with low vitamin D levels had significantly higher incidence of acute upper respiratory infections (HR: 1.27 [1.04-1.54]) and thrush (HR: 2.74 [1.29-5.83]) diagnosed during the first 2 years of follow-up. Low vitamin D status was a significant risk factor for wasting and HIV-related complications such as thrush during follow-up in this prospective cohort in Tanzania. If these protective associations are confirmed in randomized trials, vitamin D supplementation could represent a simple and inexpensive method to improve health and quality of life of HIV-infected patients, particularly in resource-limited settings. PMID:21916603
Mehta, Saurabh; Mugusi, Ferdinand M; Spiegelman, Donna; Villamor, Eduardo; Finkelstein, Julia L; Hertzmark, Ellen; Giovannucci, Edward L; Msamanga, Gernard I; Fawzi, Wafaie W
HIV-related stigma negatively affects the lives of persons living with HIV\\/AIDS (PLWHA). Homeless\\/unstably housed PLWHA experience\\u000a myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless\\/unstably housed PLWHA\\u000a from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical\\u000a utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external
Richard J. Wolitski; Sherri L. Pals; Daniel P. Kidder; Cari Courtenay-Quirk; David R. Holtgrave
Currently, there are millions of female sex workers (FSWs) in China and these women play a critical role in the escalating HIV epidemic in the country. Existing studies revealed high mobility of this population, but data on the relationship of FSWs' migratory status and their HIV/AIDS-related sexual risks are limited. A cross-sectional survey was administered among 454 FSWs in a rural county of Guangxi, China. Sexual risks and current infections of sexually transmitted disease (STD) were compared among local FSWs (i.e. those who were the county residents or from other parts of Guangxi) and those FSWs who migrated from outside Guangxi. Data reveal that local FSWs were younger, less educated and newer to the sex industry, and had more sexual risks and higher rates of STDs compared to migrant FSWs. This relationship remains significant after controlling for potential confounders. A higher level of sexual risks and STDs among local FSWs than migrant FSWs in the rural Chinese county suggests the need to examine the relationship between migratory status and HIV/AIDS-related risks within specific social and cultural contexts. The data also underscore an urgent need for culturally appropriate HIV/AIDS-prevention intervention efforts among FSWs in rural or less developed areas in China. PMID:19229691
Hong, Yan; Li, Xiaoming; Yang, Hongmei; Fang, Xiaoyi; Zhao, Ran
A growing body of evidence demonstrates a significant relationship between spirituality and health. HIV-infected individuals often find new meaning and purpose for their lives while establishing new connections and strengthening old ones. This descriptive, correlational study examined the relationships among spiritual well-being, sleep quality, and health status in 107 HIV-infected men and women. Spiritual well-being was found to be a significant factor related to both sleep quality and mental and physical health status. Every study participant reported sleep disturbance. The findings suggest that spiritual well-being and sleep quality need to be assessed so appropriate interventions can be implemented to improve health outcomes in this population. PMID:16418075
Phillips, Kenneth D; Mock, Kathryn S; Bopp, Christopher M; Dudgeon, Wesley A; Hand, Gregory A
Previous researchers have comprehensively documented rates of HIV disclosure to family at discrete time periods yet none have taken a dynamic approach to this phenomenon. The purpose of this study is to address the trajectory of HIV serostatus disclosure to family members over time. Time to disclosure was analyzed from data provided by 125 primarily single (48.8%), HIV-positive African American (68%) adult women. Data collection occurred between 2001 and 2006. Results indicated that women were most likely to disclose their HIV status within the first seven years after diagnosis, and mothers and sisters were most likely to be told. Rates of disclosure were not significantly impacted by indicators of disease progression, frequency of contact, physical proximity, or relationship satisfaction. The results of this study are discussed in comparison to previous disclosure research, and clinical implications are provided.
SEROVICH, JULIANNE M.; CRAFT, SHONDA M.; YOON, HAE-JIN
Objectives It has been shown that socioeconomic status (SES) is associated with adherence to treatment of patients with several chronic diseases. However, there is a controversy regarding the impact of SES on adherence among patients with the human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). Thus, we sought to perform a systematic review of the evidence regarding the association of SES with adherence to treatment of patients with HIV/AIDS. Methods We searched the PubMed database to identify studies concerning SES and HIV/AIDS and collected data regarding the association between various determinants of SES (income, education, occupation) and adherence. Findings We initially identified 116 potentially relevant articles and reviewed in detail 17 original studies, which contained data that were helpful in evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. No original research study has specifically focused on the possible association between SES and adherence to treatment of patients with HIV/AIDS. Among the reviewed studies that examined the impact of income and education on adherence to antiretroviral treatment, only half and less than a third, respectively, found a statistically significant association between these main determinants of SES and adherence of patients infected with HIV/AIDS. Conclusion Our systematic review of the available evidence does not provide conclusive support for existence of a clear association between SES and adherence among patients infected with HIV/AIDS. There seemed to be a positive trend among components of SES (income, education, occupation) and adherence to antiretroviral treatment in many of the reviewed studies, however most of the studies did not establish a statistically significant association between determinants of SES and adherence.
Falagas, Matthew E; Zarkadoulia, Efstathia A; Pliatsika, Paraskevi A; Panos, George
Background: In HIV infection T-cell dysfunction resulting in anergy and hypersensitivity reactions precedes T-cell depletion. A shift in the cytokine profile from a type 1 to a type 2 response has been postulated. Objective: We sought to examine the cytokine expression patterns in HIV infection and the relationship to allergy, stage of HIV disease, and other laboratory parameters. Methods: A
Marianne Empson; G. Alex Bishop; Brian Nightingale; Roger Garsia
OBJECTIVE: To describe nutritional status, body composition and lipid profile in children and adolescents receiving protease inhibitors. METHODS: Fifty-nine patients, 23 treated with protease inhibitors (group 1) and 36 not using protease inhibitors (group 2). Their dietary intake, anthropometry, bioimpedance analysis and lipid profile variables were measured. RESULTS: There was no difference in nutritional status or body composition between groups at the beginning of the study. After 6 months of follow-up, there was an increase in weight and height in both groups, as well as in waist circumference and subscapular skinfold thickness. In group 2, body mass index and triceps skinfold thickness adequacy were significantly higher after 6 months of follow-up. The groups had similar energy and macronutrient intake at any time point. After 6 months, group 1 had a higher cholesterol intake and group 2 had a higher fiber intake. Triglyceride serum levels were significantly different between the groups, with higher values in G1, at any time point [G1: 153 mg/dl (30–344); 138 (58–378) versus G2: 76 mg/dl (29–378); 76 (29–378)]. After 6 months of follow-up, G1 had higher LDL-cholesterol than G2 [104 mg/dl (40–142) versus 82 (42–145)]. CONCLUSION: The use of protease inhibitors, per se, does not seem to significantly interfere with anthropometric measures, body composition and food intake of HIV-infected children and adolescents. However, this antiretroviral therapy was associated with a significant increase in triglyceride and LDL-cholesterol in our subjects.
Contri, Patricia Vigano; Berchielli, Erica Miranda; Tremeschin, Marina Hjertquist; de Moura Negrini, Bento Vidal; Salomao, Roberta Garcia; Monteiro, Jacqueline Pontes
The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1–5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one’s viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men.
Wei, Chongyi; Lim, Sin How; Guadamuz, Thomas E.; Koe, Stuart
The relationship between HIV disclosure and sexual transmission behaviors, and factors that influence disclosure are unknown among HIV-positive men who have sex with men (MSM) in Asia. We describe disclosure practices and sexual transmission behaviors, and correlates of disclosure among this group of MSM in Asia. A cross-sectional multi-country online survey was conducted among 416 HIV-positive MSM. Data on disclosure status, HIV-related risk behaviors, disease status, and other characteristics were collected. Multivariable logistic regression was used to identify significant correlates of disclosure. Only 7.0% reported having disclosed their HIV status to all partners while 67.3% did not disclose to any. The majority (86.5%) of non-disclosing participants had multiple partners and unprotected insertive or receptive anal intercourse with their partners (67.5%). Non-disclosure was significantly associated with non-disclosure from partners (AOR = 37.13, 95% CI: 17.22, 80.07), having casual partners only (AOR = 1.91, 95% CI: 1.03, 3.53), drug use before sex on a weekly basis (AOR: 6.48, 95% CI: 0.99, 42.50), being diagnosed with HIV between 1 and 5 years ago (AOR = 2.23, 95% CI: 1.05, 4.74), and not knowing one's viral load (AOR = 2.80, 95% CI: 1.00, 7.83). Given the high HIV prevalence and incidence among MSM in Asia, it is imperative to include Prevention with Positives for MSM. Interventions on disclosure should not solely focus on HIV-positive men but also need to include their sexual partners and HIV-negative men. PMID:22198313
Wei, Chongyi; Lim, Sin How; Guadamuz, Thomas E; Koe, Stuart
This is the first report examining vitamin D status and bone mass in African women with HIV infection using dual-energy X-ray absorptiometry (DXA) with an appropriate HIV-negative control group. Unlike previous publications, it demonstrates no difference in bone mineral density (BMD) or vitamin D status in HIV-positive patients, at different disease stages, vs. HIV-negative subjects. INTRODUCTION: Low bone mass and poor vitamin D status have been reported among HIV-positive patients; suggesting HIV or its treatment may increase the risk of osteoporosis, a particular concern for women in countries with high HIV prevalence such as South Africa. We describe bone mass and vitamin D status in urban premenopausal South African women, who were HIV positive but not on antiretroviral therapy (ARV). METHODS: This study is a cross-sectional measurement of BMD and body composition by DXA and vitamin D status by serum 25-hydroxyvitamin D (25(OH)D) concentration. Subjects were recruited into three groups: HIV negative (n?=?98) and HIV positive with preserved CD4 cell count (non-ARV; n?=?74) or low CD4 cell counts prior to ARV initiation (pre-ARV; n?=?75). RESULTS: The mean (standard deviation (SD)) age of women was 32.1 (7.2) years. Mean CD4 (SD) counts (×10(6)/l) were 412 (91) and 161 (69) in non-ARV and pre-ARV groups (p?0.0001). Pre-ARV women were significantly lighter and had lower mean BMI than the other two groups (p?0.002). The pre-ARV group also had significantly less fat and lean mass compared with non-ARV and HIV-negative subjects (p???0.05). After full adjustment, there were no significant differences in BMD at any site (p?>?0.05) between the groups, nor was vitamin D status significantly different between groups (p?>?0.05); the mean (SD) cohort 25(OH)D being 60 (18) nmol/l. CONCLUSION: Contrary to previous studies, these HIV-positive women did not have lower BMD or 25(OH)D concentrations than HIV-negative controls, despite the pre-ARV group being lighter with lower BMI. PMID:23719859
Hamill, M M; Ward, K A; Pettifor, J M; Norris, S A; Prentice, A
This paper examines the extent to which under five children in households or communities adversely affected by HIV/AIDS are disadvantaged, in comparison with other children in less affected households/communities. The study is based on secondary analysis of the Demographic and Health Survey (DHS) data collected during 2003–2008 from 18 countries in sub-Saharan Africa, where the DHS has included HIV test data for adults of reproductive age. We apply multilevel logistic regression models that take into account the effect of contextual community/country level HIV/AIDS factors on child malnutrition. The outcome variable of interest is child undernutrition: stunting, wasting and underweight. The results suggest that across countries in sub-Saharan Africa, children whose mothers are infected with HIV are significantly more likely to be stunted, wasted or underweight compared to their counterparts of similar demographic and socio-economic background whose mothers are not infected. However, the nutritional status of children who are paternal orphans or in households where other adults are HIV positive are not significantly different from non-orphaned children or those in households where no adult is infected with HIV. Other adult household members being HIV positive is, however, associated with higher malnutrition among younger children below the age of one. Further analysis reveals that the effect of mothers’ HIV status on child nutritional status (underweight) varies significantly across communities within countries, the effect being lower in communities with generally higher levels of malnutrition. Overall, the findings have important implications for policy and programme efforts towards improved integration of HIV/AIDS and child nutrition services in affected communities and other sub-groups of the population made vulnerable by HIV/AIDS. In particular, children whose mothers are infected with HIV deserve special attention.
Magadi, Monica A.
Background Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents. Methods Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior. Results Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations. Conclusions Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.
Background The percentages of couples in HIV sero-discordant relationships range from 5 to 31% in the various countries of Africa. Given the importance of procreation and the lack of assisted reproduction to avoid partner transmission, members of these couples are faced with a serious dilemma even after the challenge of disclosing their HIV status to their spouses. Identifying the determinants of the decision to have children among sero-discordant couples will help in setting reproductive intervention priorities in resource-poor countries. Methods We conducted a survey among 114 mutually disclosed sero-discordant couples (228 individuals) receiving HIV care at four centres in Greater Kampala, between June and December 2007. The data we collected was classified according to whether the man or the woman was HIV-positive. We carried out multivariate logistic regression modelling to determine factors (age, gender, and the influences of relatives and of health workers, ART knowledge, and disclosure) that are independently associated with a desire for children. Results The majority, 59%, of the participants, desired to have children. The belief that their partner wanted children was a major determinant of the desire to have children, irrespective of the HIV sero-status (adjusted odds ratio 24.0 (95% CI 9.15, 105.4)). Among couples in which the woman was HIV-positive, young age and relatives' expectations for children were significantly associated with increased fertility desire, while among couples in which the man was positive; knowledge of ART effectiveness was associated with increased fertility desire. Availability of information on contraception was associated with decreased fertility desire. Conclusions The gender of the positive partner affects the factors associated with a desire for children. Interventions targeting sero-discordant couples should explore contraceptive choices, the cultural importance of children, and partner communication.
The present investigation evaluates the relationship between HIV infection and victimization with regard to the interplay of these two factors as they relate to mental and physical health. Eighty eight inner-city low income African-American women who are HIV-infected and a demographically similar comparison group of women who were not HIV-infected were assessed for victimization experiences (rape, physical assault, robbery\\/attack) via
Rachel Kimerling; Lisa Armistead; Rex Forehand
Spirituality is a resource some HIV-positive women use to cope with HIV, and it also may have positive impact on physical health. This cross-sectional study examined associations of spiritual well-being, with depressive symptoms, and CD4 cell count and percentages among a non-random sample of 129 predominantly African-American HIV-positive women. Significant inverse associations were observed between depressive symptoms and spiritual well-being
Safiya George Dalmida; Marcia McDonnell Holstad; Colleen Diiorio; Gary Laderman
Abstract Recommendations suggest that older children and adolescents perinatally infected with HIV (PHIV+) be informed of their HIV diagnosis; however, delayed disclosure is commonly reported. This study examined the prevalence and timing of HIV disclosure to PHIV+ adolescents and the associations between the timing of disclosure and psychological functioning and other behavioral outcomes. Recruitment took place at four medical centers in New York City between December 2003 and December 2008. This sample included data from 196 PHIV+ youth and their caregivers: 50% of youth were male, 58% African American, 42% Hispanic, with a mean age of 12.71 years. According to caregiver reports, 70% of the PHIV+ youth knew their HIV diagnosis. Youths who had been told were more likely to be older; youths with a Spanish-speaking Latino caregiver and whose caregivers had a grade school education were told at an older age. Youths who had been told their HIV status were significantly less anxious than those who had not been told; there were no other differences in psychological functioning. Youths who knew their status for longer reported higher intentions to self-disclose to potential sex partners. In multivariate analyses only demographic differences associated with timing of disclosure remained. In summary, PHIV+ youth who had been told their HIV status did not show an increase of psychological problems and were more likely to have intentions to self-disclose to sexual partners. Yet, almost one third was entering puberty without important information regarding their illness. Caregivers need support to address factors impeding HIV disclosure.
Dolezal, Curtis; Marhefka, Stephanie L.; Hoffman, Susie; Ahmed, Yasmeen; Elkington, Katherine; Mellins, Claude A.
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
Rizza, Stacey A.; MacGowan, Robin J.; Purcell, David W.; Branson, Bernard M.; Temesgen, Zelalem
Background The Federal Ministry of Health of Ethiopia is implementing an ambitious and rapid scale-up of health care services for the prevention, care and treatment of HIV/AIDS in public facilities. With support from the United States President's Emergency Plan for AIDS Relief, 38 830 service providers were trained, from early 2005 until December 2007, in HIV-related topics. Anecdotal evidence suggested high attrition rates of providers, but reliable quantitative data have been limited. Methods With that funding, Jhpiego supports a Training Information Monitoring System, which stores training information for all HIV/AIDS training events supported by the same funding source. Data forms were developed to capture information on providers' working status and were given to eight partners who collected data during routine site visits on individual providers about working status; if not working at the facility, date of and reason for leaving; and source of information. Results Data were collected on 1744 providers (59% males) in 53 hospitals and 45 health centres in 10 regional and administrative states. The project found that 32.6% of the providers were no longer at the site, 57.6% are still working on HIV/AIDS services at the same facility where they were trained and 10.4% are at the facility, but not providing HIV/AIDS services. Of the providers not at the facility, the two largest groups were those who had left for further study (27.6%) and those who had gone to another public facility (17.6%). Of all physicians trained, 49.2% had left the facility. Regional and cadre variation was found, for example Gambella had the highest percent of providers no longer at the site (53.7%) while Harari had the highest percentage of providers still working on HIV/AIDS (71.6%). Conclusion Overall, the project found that the information in the Training Information Monitoring System can be used to track the working status of trained providers. Data generated from the project are being shared with key stakeholders and used for planning and monitoring the workforce, and partners have agreed to continue collecting data. The attrition rates found in this project imply an increased need to continue to conduct in-service training for HIV/AIDS in the short term. For long-term solutions, retention strategies should be developed and implemented, and opportunities to accelerate the incorporation of HIV/AIDS training in pre-service institutions should be explored. Further study on reasons why providers leave sites and why providers are not working on HIV at the sites where they were trained, in addition to our project findings, can provide valuable data for development of national and regional strategies and retention schemes. Project findings suggest that the development of national and region-specific human resources for health strategy and policies could address important human resources issues found in the project.
McNabb, Marion E; Hiner, Cynthia A; Pfitzer, Anne; Abduljewad, Yassir; Nadew, Mesrak; Faltamo, Petros; Anderson, Jean
Greater understanding of barriers to risk reduction among incarcerated HIV+ persons reentering the community is needed to inform culturally tailored interventions. This qualitative study elicited HIV prevention-related information, motivation and behavioral skills (IMB) needs of 30 incarcerated HIV+ men and women awaiting release from state prison. Unmet information needs included risk questions about viral loads, positive sexual partners, and transmission through casual contact. Social motivational barriers to risk reduction included partner perceptions that prison release increases sexual desirability, partners’ negative condom attitudes, and HIV disclosure-related fears of rejection. Personal motivational barriers included depression and strong desires for sex or substance use upon release. Behavioral skills needs included initiating safer behaviors with partners with whom condoms had not been used prior to incarceration, disclosing HIV status, and acquiring clean needles or condoms upon release. Stigma and privacy concerns were prominent prison context barriers to delivering HIV prevention services during incarceration.
Thibodeau, Laura; BlueSpruce, June; Yard, Samantha S.; Seal, David W.; Amico, K. Rivet; Bogart, Laura M.; Mahoney, Christine; Balderson, Benjamin H. K.; Sosman, James M.
Purpose – This paper seeks to explore what disclosing illness and disability in the workplace means to workers with chronic illness and disabilities. It aims to argue that beginning analysis from the meanings of these workers contributes to a nuanced understanding of their situations; gaining this view requires knowing how individuals define their health as well as their meanings, risks,
We examined whether orphaned and fostered children and children of HIV-infected parents are disadvantaged in schooling, nutrition, and health care. We analyzed data on 2,756 children aged 0-4 years and 4,172 children aged 6-14 years included in the 2003 Kenya Demographic and Health Survey, with linked anonymous HIV testing, using multivariate…
Mishra, Vinod; Arnold, Fred; Otieno, Fredrick; Cross, Anne; Hong, Rathavuth
Abstract Objective To estimate the association between vitamin D deficiency and bacterial vaginosis (BV) among nonpregnant HIV-infected and uninfected women. Methods In a substudy of the Women's Interagency HIV Study, including women from Chicago and New York, the association between BV and vitamin D deficiency, demographics, and disease characteristics was tested using generalized estimating equations. Deficiency was defined as <20?ng/mL 25 (OH) vitamin D and insufficiency as >20 and ?30?ng/mL. BV was defined by the Amsel criteria. Results Among 602 observations of nonpregnant women (480 HIV infected and 122 uninfected), BV was found in 19%. Vitamin D deficiency was found in 59.4%, and insufficiency was found in 24.4%. In multivariable analysis, black race was the most significant predictor of BV (adjusted odds ratio [AOR] 5.90, (95% confidence interval [CI] 2.52-13.8). Vitamin D deficiency was independently associated with BV among HIV-infected women (AOR 3.12, 95% CI 1.16-8.38) but not among HIV-uninfected women. There was a negative linear correlation between vitamin D concentration and prevalence of BV in HIV-infected women (r=?0.15, p=0.001). Conclusions Vitamin D deficiency was very common in this cohort and significantly associated with BV among HIV-infected women. These preliminary findings suggest that further epidemiologic and mechanistic exploration of the relationship between vitamin D and BV in HIV-infected women is warranted.
Adeyemi, Oluwatoyin M.; Agniel, Denis M.; Evans, Charlesnika T.; Yin, Michael T.; Anastos, Kathryn; Cohen, Mardge H.
Progress in developing effective gene transfer approaches to treat HIV-1 infection has been steady. Many different transgenes have been reported to inhibit HIV-1 in vitro. However, effective translation of such results to clinical practice, or even to animal models of AIDS, has been challenging. Among the reasons for this failure are uncertainty as to the most effective cell population(s) to
David S. Strayer; Ramesh Akkina; Bruce A. Bunnell; Boro Dropulic; Vicente Planelles; Roger J. Pomerantz; John J. Rossi; John A. Zaia
As the HIV epidemic evolves, researchers are devoting increased attention to the infection’s effect on various life-course activities, including marriage and reproduction. The impact of HIV on decisions about childbearing is particularly important, given the role that vertical transmission plays in the persistence of the epidemic. Previous studies on HIV and fertility intentions have yielded inconsistent results. This article expands on prior research by taking into account preferred timing of childbearing. Using data from a population-based survey in rural Mozambique, we show that higher perceived risk of HIV is associated with greater likelihood of both wanting to speed up childbearing and wanting to stop having children. The “now or never” approach to childbearing is shown to be consistent with the widely held belief that HIV infection is incompatible with childbearing in the long term.
Hayford, Sarah R.; Agadjanian, Victor; Luz, Luciana
Nearly three decades after its discovery, HIV infection remains the number one killer disease in Sub- Saharan Africa where up to 67% of the world's 33 million infected people live. In Cameroon, based on a Demographic Health Survey carried out in 2004, the national HIV prevalence is estimated at 5.5% with women and youths being predominantly infected. Orphans and vulnerable children (OVC) from the HIV and AIDS pandemic have increased steadily over the years; hospital occupancy is estimated at about 30%, hence stretching the health system; co-infections like HIV/tuberculosis have been reported to reach 40-50% of infected cases and 95% of teachers are said not to be productive on several counts. Thus, the impact is multi-sectorial. Furthermore, the HIV epidemic in Cameroon is peculiar because of the wide HIV-1 genetic diversity of HIV-1 Group M observed with several subtypes reported (A, B, C, D, F, G, H, J, K), predominantly subtype A. There are also circulating recombinant forms, mainly CRF02_AG. In addition, HIV-1 Groups O and N have all been noted in Cameroon. These findings have great implications not only for HIV diagnosis, but also for responsiveness to therapy as well as for vaccine development. In 1986, the initial response of the Cameroon government to the increasing trends in the HIV/AIDS infection was to create a National AIDS Control Committee to coordinate a national AIDS programme. By 2000, the first National Strategic Plan was drawn for 2000-2005. The second National Strategic Plan for 2006-2010 is currently being implemented and covers various axes. Some results obtained show that there has been significantly positive outcomes noted in the various arms of intervention by the Cameroon government. PMID:19151432
Mbanya, Dora; Sama, Martyn; Tchounwou, Paul
Due to stable incidence and improved survival rates, there are an increasing number of patients living with HIV/AIDS in the USA. Although highly effective, current antiretroviral therapies are associated with a variety of side effects. The role side effects play on health outcomes has not been fully examined. The current study assessed the association of medication side effects with (1) self-assessed health status; (2) work productivity and activity impairment; and (3) healthcare resource utilization. Data were from a cross-sectional patient-reported survey fielded in the USA using a dual methodology of Internet and paper questionnaires. A total of 953 patients living with HIV/AIDS who were currently taking a medication for their condition were included in the analyses. The most frequent side effects reported by patients were fatigue (70.72%), diarrhea (62.96%), insomnia (58.97%), dizziness (52.78%), neuropathy (52.68%), joint pain (52.36%), nausea (51.63%), and abdominal pain (50.37%). The presence of each side effect was associated with reduced self-assessed health status, increased productivity loss, increased activity impairment, and increased healthcare resource use. Controlling for CD4 cell counts in regression modeling did little to diminish the impact of side effects. Although not all side effects were associated with all outcomes, every side effect was associated with worse health status, some measure of increased work productivity loss, and/or some measure of increased healthcare resource use. Patients are living longer with HIV and, therefore, spending a greater length of time on treatment. The results of the current study suggest that many of these patients are experiencing a wide array of side effects from these therapies. These side effects have demonstrated a profound association with self-assessed health, work productivity, and healthcare resource use. Improved management of these side effects or development of treatments with a better side effect profile may have a substantial humanistic and economic benefit. PMID:22292729
daCosta DiBonaventura, Marco; Gupta, Shaloo; Cho, Michelle; Mrus, Joseph
BACKGROUND: Immunological alterations are implicated in the increased prevalence of high-grade squamous intraepithelial lesions (HG-SIL) and persistent human papillomavirus (HPV) infection. This study evaluated the expression of CD4, CD8, CD25 (IL-2R?) and CD28 antigens from SIL biopsies, stratified by HIV status and HPV-type. Biopsies specimens from 82 (35 HIV+) women with a normal cervix, low-grade (LG-SIL) or high-grade lesions (HG-SIL)
Maria Alice G Gonçalves; Edson G Soares; Eduardo A Donadi
The 11th U.S. Circuit Court of Appeals ruled that the Miami Beach Police Department did not violate the Americans with Disabilities Act by requiring police officer William Watson to undergo a fitness-for-duty examination and to disclose his HIV status when undergoing a routine tuberculosis screening. The court agreed that the exam was job-related and consistent with business necessity. All officers are required to undergo periodic TB screenings because of possible occupational exposure. The disclosure of one's HIV status is necessary for proper diagnosis and treatment of tuberculosis. PMID:11366623
Spirituality is a resource some HIV-positive women use to cope with HIV, and it also may have positive impact on physical health. This cross-sectional study examined associations of spiritual well-being (SWB), with depressive symptoms, and CD4 cell count and percentages among a non-random sample of 129 predominantly African-American (AA) HIV-positive women. Significant inverse associations were observed between depressive symptoms and SWB (r=-.55, p=.0001), and its components, existential well-being (EWB) (r=-.62, p=.0001) and religious well-being (RWB) (r=-.36, p=.0001). Significant positive associations were observed between EWB and CD4 cell count (r=.19, p< .05) and also between SWB (r=.24, p<.05), RWB (r=.21, p<.05), and EWB (r=.22, p<.05) and CD4 cell percentages. In this sample of HIV-positive women SWB, EWB, and RWB accounted for a significant amount of variance in depressive symptoms and CD4 cell percentages, above and beyond that explained by demographic variables, HIV medication adherence, and HIV viral load (log). Depressive symptoms were not significantly associated with CD4 cell counts or percentages. A significant relationship was observed between spiritual/religious practices (prayer/meditation and reading spiritual/religious material) and depressive symptoms. Further research is needed to examine relationships between spirituality, mental and physical health among HIV-positive women.
Dalmida, Safiya George; Holstad, Marcia McDonnell; DiIorio, Colleen; Laderman, Gary
The aim of this study was to examine online profile and in-person communication patterns and their associations with unprotected anal intercourse (UAI) in online and offline partnerships between men who have sex with men (MSM) who have never tested for HIV (“Never Tested”), had been tested at least once for HIV (“Tested”), and had tested positive for HIV. Between September and November 2005, 2,716 MSM participated in a one-time online survey. Although 75% and 72% of the Tested and Never Tested groups disclosed a HIV-negative status in all of their online profiles, 17% of HIV-positive participants did so. Exchanging HIV status information was highest among the Tested group, while HIV-positive men were most likely to negotiate UAI. Serodisclosure was not an independent predictor of UAI, although making an explicit agreement to engage in UAI was. Sexual communication and risk-taking patterns differed by testing status. Explicit agreements to avoid UAI were associated with reduced sexual risk-taking. Misrepresentation of HIV status is an identified challenge for HIV prevention.
Oakes, J. Michael; Rosser, B. R.Simon
Large-scale internal migration in China may be an important mechanism for the spread of HIV/sexually transmitted infections (STIs) because of the risk behaviours of migrants. We conducted a self-administered survey among 724 employees of a high-end entertainment centre in Kunshan, Jiangsu Province, China. Using logistic regression, we examined the association of hometown of origin (Kunshan city, elsewhere in Jiangsu Province, or another province in China) and consecutive years living in Kunshan with measures of HIV/STI risk behaviour. We found that increased time living in Kunshan was associated with lower odds of using condoms as contraception [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64–0.95] and consistent condom use with a casual partner (OR = 0.66, 95% CI: 0.47–0.93), after controlling for gender, marital status age and income. The odds of having had an STI were significantly lower for Kunshan natives than those originally from outside provinces (OR = 0.25, 95% CI: 0.07–0.96), but increasing years living in Kunshan was not related to lower risk for an STI. Our findings do not support the hypothesis that migrants living far from home participate in higher risk behaviour than locals. Findings suggest that adaptation to local culture over time may increase HIV/STI risk behaviours, a troublesome finding.
Mantell, Joanne E.; Kelvin, Elizabeth A.; Sun, Xiaoming; Zhou, Jianfang; Exner, Theresa M.; Hoffman, Susie; Zhou, Feng; Sandfort, Theo G. M.; Leu, Cheng-Shiun
Large-scale internal migration in China may be an important mechanism for the spread of HIV/sexually transmitted infections (STIs) because of the risk behaviours of migrants. We conducted a self-administered survey among 724 employees of a high-end entertainment centre in Kunshan, Jiangsu Province, China. Using logistic regression, we examined the association of hometown of origin (Kunshan city, elsewhere in Jiangsu Province, or another province in China) and consecutive years living in Kunshan with measures of HIV/STI risk behaviour. We found that increased time living in Kunshan was associated with lower odds of using condoms as contraception [odds ratio (OR) = 0.78, 95% confidence interval (CI): 0.64-0.95] and consistent condom use with a casual partner (OR = 0.66, 95% CI: 0.47-0.93), after controlling for gender, marital status age and income. The odds of having had an STI were significantly lower for Kunshan natives than those originally from outside provinces (OR = 0.25, 95% CI: 0.07-0.96), but increasing years living in Kunshan was not related to lower risk for an STI. Our findings do not support the hypothesis that migrants living far from home participate in higher risk behaviour than locals. Findings suggest that adaptation to local culture over time may increase HIV/STI risk behaviours, a troublesome finding. PMID:21389063
Mantell, Joanne E; Kelvin, Elizabeth A; Sun, Xiaoming; Zhou, Jianfang; Exner, Theresa M; Hoffman, Susie; Zhou, Feng; Sandfort, Theo G M; Leu, Cheng-Shiun
Background Methadone treatment was introduced in Taiwan in 2006 as a harm-reduction program in response to the human immunodeficiency virus (HIV), which is endemic among Taiwanese heroin users. The present study was aimed at examining the clinical and behavioral characteristics of methadone patients in northern Taiwan according to their HIV status. Methods The study was conducted at four methadone clinics. Participants were patients who had undergone methadone treatment at the clinics and who voluntarily signed a consent form. Between August and November 2008, each participant completed a face-to-face interview that included questions on demographics, risk behavior, quality of life, and psychiatric symptoms. Data on HIV and hepatitis C virus (HCV) infections, methadone dosage, and morphine in the urine were retrieved from patient files on the clinical premises, with permission of the participants. Results Of 576 participants, 71 were HIV positive, and 514 had hepatitis C. There were significant differences between the HIV-positive and HIV-negative groups on source of treatment payment, HCV infection, urine test results, methadone dosage, and treatment duration. The results indicate that HIV-negative heroin users were more likely to have sexual intercourse and not use condoms during the 6 months prior to the study. A substantial percent of the sample reported anxiety (21.0%), depression (27.2%), memory loss (32.7%), attempted suicide (32.7%), and administration of psychiatric medications (16.1%). There were no significant differences between the HIV-positive and HIV-negative patients on psychiatric symptoms or quality of life. Conclusions HIV-positive IDUs were comorbid with HCV, indicating the need to refer both HIV- and HCV-infected individuals for treatment in methadone clinics. Currently, there is a gap between psychiatric/psychosocial services and patient symptoms, and more integrated medical services should be provided to heroin-using populations.
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
Mosack, Katie E.; Weinhardt, Lance S.; Kelly, Jeffrey A.; Gore-Felton, Cheryl; McAuliffe, Timothy L.; Johnson, Mallory O.; Remien, Robert H.; Rotheram-Borus, Mary Jane; Ehrhardt, Anke A.; Chesney, Margaret A.; Morin, Stephen F.
Background.?Biomarkers of inflammation, altered coagulation, and monocyte activation are associated with mortality and cardiovascular disease (CVD) in the general population and among human immunodeficiency virus (HIV)–infected people. We compared biomarkers for inflammation, altered coagulation, and monocyte activation between HIV-infected and uninfected people in the Veterans Aging Cohort Study (VACS). Methods.?Biomarkers of inflammation (interleukin-6 [IL-6]), altered coagulation (d-dimer), and monocyte activation (soluble CD14 [sCD14]) were measured in blood samples from 1525 HIV-infected and 843 uninfected VACS participants. Logistic regression was used to determine the association between HIV infection and prevalence of elevated (>75th percentile) biomarkers, adjusting for confounding comorbidities. Results.?HIV-infected veterans had less prevalent CVD, hypertension, diabetes, obesity, hazardous drinking, and renal disease, but more dyslipidemia, hepatitis C, and current smoking than uninfected veterans. Compared to uninfected veterans, HIV-infected veterans with HIV-1 RNA ?500 copies/mL or CD4 count <200 cells/µL had a significantly higher prevalence of elevated IL-6 (odds ratio [OR], 1.54; 95% confidence interval [CI],1.14–2.09; OR, 2.25; 95% CI, 1.60–3.16, respectively) and d-dimer (OR, 1.97; 95% CI, 1.44–2.71, OR, 1.68; 95% CI, 1.22–2.32, respectively) after adjusting for comorbidities. HIV-infected veterans with a CD4 cell count <200 cells/µL had significantly higher prevalence of elevated sCD14 compared to uninfected veterans (OR, 2.60; 95% CI, 1.64–4.14). These associations still persisted after restricting the analysis to veterans without known confounding comorbid conditions. Conclusions.?These data suggest that ongoing HIV replication and immune depletion significantly contribute to increased prevalence of elevated biomarkers of inflammation, altered coagulation, and monocyte activation. This contribution is independent of and in addition to the substantial contribution from comorbid conditions.
Armah, Kaku A.; McGinnis, Kathleen; Baker, Jason; Gibert, Cynthia; Butt, Adeel A.; Bryant, Kendall J.; Goetz, Matthew; Tracy, Russell; Oursler, Krisann K.; Rimland, David; Crothers, Kristina; Rodriguez-Barradas, Maria; Crystal, Steve; Gordon, Adam; Kraemer, Kevin; Brown, Sheldon; Gerschenson, Mariana; Leaf, David A.; Deeks, Steven G.; Rinaldo, Charles; Kuller, Lewis H; Justice, Amy; Freiberg, Matthew
The District of Columbia (DC) has among the highest HIV/AIDS rates in the United States, with 3.2% of the population and 7.1% of black men living with HIV/AIDS. The purpose of this study was to examine HIV risk behaviors in a community-based sample of men who have sex with men (MSM) in DC. Data were from the National HIV Behavioral Surveillance system. MSM who were 18 years were recruited via venue-based sampling between July 2008 and December 2008. Behavioral surveys and rapid oral HIV screening with OraQuick ADVANCE ½ (OraSure Technologies, Inc., Bethlehem, PA) with Western blot confirmation on positives were collected. Factors associated with HIV positivity and unprotected anal intercourse were identified. Of 500 MSM, 35.6% were black. Of all men, 14.1% were confirmed HIV positive; 41.8% of these were newly identified HIV positive. Black men (26.0%) were more likely to be HIV positive than white (7.9%) or Latino/Asian/other (6.5%) men (p<0.001). Black men had fewer male sex partners than non-black, fewer had ever engaged in intentional unprotected anal sex, and more used condoms at last anal sex. Black men were less likely to have health insurance, have been tested for HIV, and disclose MSM status to health care providers. Despite significantly higher HIV/AIDS rates, black MSM in DC reported fewer sexual risks than non-black. These findings suggest that among black MSM, the primary risk of HIV infection results from nontraditional sexual risk factors, and may include barriers to disclosing MSM status and HIV testing. There remains a critical need for more information regarding reasons for elevated HIV among black MSM in order to inform prevention programming. PMID:20863246
Magnus, Manya; Kuo, Irene; Phillips, Gregory; Shelley, Katharine; Rawls, Anthony; Montanez, Luz; Peterson, James; West-Ojo, Tiffany; Hader, Shannon; Greenberg, Alan E
Traumatic experiences are common among populations living with HIV; furthermore, the minority stress model indicates that sexual minority group members, such as men who have sex with men (MSM), are more likely to experience negative psychological outcomes after exposure to trauma, given the stress of minority stigma. The current study examined the prevalence of traumatic events and the impact of these events on trauma symptoms in a sample of 113 MSM and 51 men who have sex with women (MSW) who are living with HIV/AIDS. Rates of experiencing trauma were similar for both MSM and MSW. However, MSM, as sexual minority group members, were more likely to report symptoms of trauma and dissociation than MSW. The current study indicates that MSM may experience additional negative psychological outcomes after exposure to trauma. Findings are discussed in the context of implications for HIV prevention with sexual minority group members. PMID:21344319
Kamen, Charles; Flores, Sergio; Taniguchi, Stacy; Khaylis, Anna; Lee, Susanne; Koopman, Cheryl; Gore-Felton, Cheryl
This study compares immigrant (i.e., foreigner) with non-immigrant (i.e., local/native) HIV-related risk behaviors among female sex workers (FSW) in South America. A total of 1,845 FSW were enrolled in Argentina, Bolivia, Ecuador, and Uruguay. According to their nationality, 10.1% of participants were immigrant FSW. Immigrant FSW were more likely to be younger in Argentina; to work in a disco/bar in Bolivia; to be single and use illegal drugs in Ecuador; and to work in a brothel, consume alcohol, and have sex with foreign clients in Uruguay. HIV-related sexual and drug use behaviors were more common among immigrant FSW in Bolivia, Ecuador, and Uruguay. Country-specific HIV/STI prevention and control programs should be developed for immigrant FSW populations in South America. PMID:17587171
Bautista, Christian T; Mosquera, Carlos; Serra, Margarita; Gianella, Alberto; Avila, Maria M; Laguna-Torres, Victor; Carr, Jean K; Montano, Silvia M; Sanchez, José L
CONTEXT Both perinatally and behaviorally infected HIV-positive youth engage in sexually risky behaviors, and a better understanding of the perceptions of these youth and of health care providers regarding disclosure of HIV status and risk reduction would aid in the development of behavioral interventions for such youth. METHODS In spring 2007, some 20 HIV-positive inner-city youth (aged 13–24) and 15 health care providers who work with HIV-infected youth participated in in-depth, semistructured interviews. Youth were recruited at an HIV clinic, AIDS clinics and an AIDS service organization, and had received care from participating providers. Detailed contextual and thematic discourse analysis was performed on interview transcriptions. RESULTS Eighteen of the 20 youth had disclosed their HIV status to another individual at least once. Eleven reported being sexually active, and three of these had been perinatally infected. Qualitative analysis revealed four subthemes related to disclosure: stigma and emotions, trust issues, reasons for disclosing and strategies for addressing disclosure. Five subthemes were identifi ed related to sexual risk reduction: dating challenges, attitudes toward condom use, self-effi cacy for condom use negotiation, pregnancy attitudes and sexual risk reduction strategies. Providers reported that access to more engaging and interactive educational tools within the clinic setting could enhance their risk reduction counseling with HIV-positive youth. CONCLUSIONS HIV-positive youth experience multiple challenges regarding disclosure and sexual risk reduction, and health care providers need innovative tools that can be used in clinic settings to improve adolescents’ skills in reducing risky sexual behavior.
Markham, Christine M.; Bui, Thanh; Shegog, Ross; Paul, Mary E.
The stress of co-infection with HIV and Human Papillomavirus (HPV), in race/ethnic minority women, may increase depression and immune decrements. Compromised immunity in HIV+ HPV+ women may increase the odds of cervical dysplasia. Thus we tested the efficacy of a 10-wk cognitive behavioral stress management (CBSM) group intervention and hypothesized that CBSM would decrease depression and improve immune status (CD4+ T-cells, natural killer [NK] cells). HIV+HPV+ women (n=71) completed the Beck Depression Inventory (BDI) and provided blood samples, were randomized to CBSM or a control condition, and were re-assessed post-intervention. Women in CBSM revealed less depression, greater NK cells, and marginally greater CD4+ T-cells post-intervention vs. controls. Stress management may improve mood and immunity in HIV+HPV+ lower income minority women. PMID:23526866
Lopez, Corina R; Antoni, Michael H; Pereira, Deirdre; Seay, Julia; Whitehead, Nicole; Potter, Jonelle; O'Sullivan, Maryjo; Fletcher, Mary Ann
Between 1995 and 1997, 1,675 HIV-positive men and women using complementary and alternative medicine (CAM) were enrolled into the Bastyr University AIDS Research Center's Alternative Medicine Care Outcomes in AIDS (AMCOA) study. Funded by the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) and National Institute of Allergy and Infectious Diseases (NIAID), the AMCOA study collected information on
L. J. Standish; K. B. Greene; S. Bain; C. Reeves; F. Sanders; R. C. M. Wines; P. Turet; J. G. Kim; C. Calabrese
|Elementary school principals' decisions about disclosure of school age children's confidential medical information was empirically studied. Participants included a stratified sample of 339 elementary school principals from the seven largest school districts in Florida. Each participant received one of six vignettes describing a student with HIV,…
OBJECTIVES: To determine the prevalence of sexually transmitted infections (STIs) and other reproductive tract infections (RTIs) among pregnant women in Moshi, Tanzania and to compare the occurrence of STIs\\/RTIs among human immunodeficiency virus (HIV)-infected and uninfected women. METHODS: Pregnant women in their 3rd trimester (N = 2654) were recruited from two primary health care clinics between June 2002 and March
Sia E Msuya; Jacqueline Uriyo; Akhtar Hussain; Elizabeth M Mbizvo; Stig Jeansson; Noel E Sam; Babill Stray-Pedersen
A house to house survey was conducted in December 2005 in the Railway Colony of Shamli, located in the state of Uttar Pradesh, India using a semistructured questionnaire to study the awareness level regarding HIV/AIDS among Indian Railway's employees and their family members. Information regarding demographic characteristics and knowledge about various aspects of HIV/AIDS was recorded by a trained staff nurse of the local Railway Medical Unit from at least one person, aged 15 years to 59 years, from each household. Among 293 individuals interviewed, majority were males (61.8%), aged > 30 years (56.6%) and literate (85.3%). Majority were aware about existence of HIV infection in India (92.5%), AIDS is a fatal disease (92.8%) and laboratory tests are available for detecting HIV infection (89.4%). Although most of them knew the correct routes of HIV transmission viz. sexual (91.50%), parentral (90.8%), perinatal route (86.3%) and blood transfusion (86.0%), misconceptions such as transmission through shaking hands (89.1%), hugging (88.4%), sharing utensils (82.6%), mosquito bite (74.1%) and using public toilets (73.4%) were also observed. Most of them were also aware about preventive measures. Knowledge about various aspects was observed to be significantly higher among females, among individuals aged <45 years and literate individuals. The findings highlight the need of intensified health education focusing on removal of misconceptions and further improvement in awareness level of the study population. PMID:19579724
Chauhan, Himanshu; Lal, Panna; Kumar, Vijay; Malhotra, Rahul; Ingle, G K
South Africa has one of the highest HIV-infection rates in the world, yet few studies have examined disclosure of maternal HIV status and its influence on children. This study provides descriptive information about HIV disclosure among South African mothers and explores whether family context variables interact with maternal HIV disclosure to affect children's functioning. A total of 103 mothers, who self-identified as living with HIV and who were the primary caregivers of a child between the ages of 11 and 16, were interviewed. A total of 44% of mothers had disclosed, and those who had most typically perceived children's reactions to disclosure to be sadness and worry. Widows and married mothers were more likely than single mothers to disclose their HIV status. Disclosure to children significantly predicted externalizing, but not internalizing, behaviors. Family variables had direct but not interactive effects on child functioning. This study highlights the complexity of disclosure-related decisions and the importance of addressing the family context. PMID:18770026
Palin, Frances L; Armistead, Lisa; Clayton, Alana; Ketchen, Bethany; Lindner, Gretchen; Kokot-Louw, Penny; Pauw, Analie
The Indiana Supreme Court has ruled that an employee cannot be held liable for invasion of privacy for disclosing a co-worker's HIV-positive status to another employee. The ruling in Doe v. Methodist Hospital complicates Indiana tort law. The employee, Cathy Duncan, learned of Doe's HIV status from a co-worker, who learned about it from his wife, a hospital employee with access to Doe's chart. The ruling for Duncan says that since she only disclosed the fact to two employees, one of whom already knew, it could not have led to embarrassment with the public. The hospital and its employee will probably escape liability on the invasion of privacy issue, but still face claims that they violated State medical records laws. No date has been set for the trial. PMID:11365107
OBJECTIVE: To examine ethnic, relationship, health, and mental health factors for a cohort of women with HIV infection attending an inner London clinic. DESIGN AND METHODS: Structured schedules were utilised to analyse ethnic group, family, and reproduction issues, mental and physical health for 100 women drawn consecutively from attenders at an inner London HIV clinic RESULTS: 51% of the women were non-ethnic minority groups and 49% were from ethnic groups. HIV testing was often as a result of symptoms or partner illness. One in five had disclosed their status to one person only or no one. Ethnic minority women were more likely to restrict disclosure. Forty seven per cent of the women had 100 children with more children reported in ethnic minority families; 28% of the children had been tested for HIV and five were confirmed HIV positive; 9% of children were born after HIV diagnosis. Nineteen women reported one or more termination of pregnancy, the majority before HIV diagnosis. Three quarters had a partner of whom 56 knew the partner's status. Women with HIV positive partners were more likely to have children. Women kept in ignorance of partner status were more likely to be ethnic minority women. Thirty two per cent had an AIDS diagnosis, diagnosed mostly in the UK. Medical and counselling service uptake was high. Gynaecological problems were common (49% had one or more problem) and 34% had at least one hospital admission. A wide range of counselling issues were recorded, with variations over time. Suicidal issues were relevant for 13% of women (69% ideation, 31% attempts). Significant life events were noted for many women with allied coping demands. CONCLUSIONS: There are a wide range of issues for women with HIV and systematic differences between ethnic and non-ethnic women and those with or without children.
Sherr, L; Barnes, J; Elford, J; Olaitan, A; Miller, R; Johnson, M
The first nationwide nucleic acid amplification testing (NAT) for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus type 1 (HIV-1) of voluntarily donated blood after serological pre-screening and before release of cellular components and plasma for fractionation was implemented by the Japanese Red Cross Blood Transfusion Services. The NAT screening assay using multiplex reagent is time-saving, cost effective, and labour-saving procedure for all blood and blood products including short-shelf life platelets. During the 50-mini-pool NAT screening of serologically negative donations (February 1, 2001-April 30, 2001), we were able to screen out 112 HBV-positive, 25 HCV-positive, and 4 HIV-1 positive units from blood and blood components. PMID:12220140
Tomono, T; Murokawa, H; Minegishi, K; Yamanaka, R; Lizuka, H Y; Miyamoto, M; Satoh, S; Nakahira, S; Murozuka, T; Emura, H; Doi, Y; Mine, H; Yokoyama, S; Ohnuma, H; Tanaka, T; Yoshikawa, A; Nishioka, K
The study aim was to determine whether prostaglandin E2 (PGE2) in gingival crevicular fluid (GCF) could serve as a risk factor for periodontitis in human immunodeficiency virus-positive (HIV+) patients.Clinical measurements, including gingival index (GI), plaque index, bleeding index, probing depth (PD), attachment loss (AL) and GCF samples were taken from two healthy sites (including sites with gingival recession, GI=0; PD?3mm;
Tamer Alpagot; John Remien; Mouchumi Bhattacharyya; Krystyna Konopka; William Lundergan; Nejat D?zg?ne?
This study sought to examine the association between maternal HIV\\/AIDS infection and neonatal neurologic conditions in the\\u000a state of Florida. We analyzed all births in the state of Florida from 1998 to 2007 using hospital discharge data linked to\\u000a birth certificate records. The main outcomes of interest included selected neonatal neurologic complications, namely: fetal\\u000a distress, cephalohematoma, intracranial hemorrhage, seizure, feeding
Hamisu M. SalihuEuna; Euna M. August; Muktar Aliyu; Kara M. Stanley; Hanna Weldeselasse; Alfred K. Mbah
HIV\\/AIDS is one of the most serious public health challenges globally. Despite the great efforts that are being devoted to\\u000a prevent, treat and to better understand the disease, it is one of the main causes of morbidity and mortality worldwide. Currently,\\u000a there are 30 drugs or combinations of drugs approved by FDA. Because of the side-effects, price and drug resistance,
Ren-rong Tian; Qing-jiao Liao; Xu-lin Chen
Purpose To evaluate in vivo imaging parameters for summarizing brain involvement in HIV infection. Materials and Methods A multiparametric neuroimaging protocol was implemented at 1.5 Tesla in 10 HIV+ and 24 controls. Various summary parameters were calculated based on Diffusion Tensor Imaging (DTI), Magnetization Transfer imaging (MT) and automated brain volumetry. The magnitude of the difference, as well as the between-group discrimination, was determined for each measure. Bivariate correlations were computed and redundancy among imaging parameters was examined by principal factor analysis. Results Significant or nearly significant differences were found for most measures. Large Cohen’s D effect sizes were indicated for mean diffusivity (MD), fractional anisotropy (FA), magnetization transfer ratio (MTR) and gray matter volume fraction (GM). Between-group discrimination was excellent for FA and MTR and acceptable for MD. Correlations among all imaging parameters could be explained by three factors, possibly reflecting general atrophy, neuronal loss, and alterations. Conclusion This investigation supports the utility of summary measurements of brain involvement in HIV infection. The findings also support assumptions concerning the enhanced sensitivity of DTI and MT to atrophic as well as alterations in the brain. These findings are broadly generalizable to brain imaging studies of physiological and pathological processes.
Du, Hongyan; Wu, Ying; Ochs, Renee; Edelman, Robert R.; Epstein, Leon G.; McArthur, Justin; Ragin, Ann
Purpose. To determine the effects of concurrent strength and endurance training (concurrent training) on the Health-Related Quality of Life (HRQOL) and cardiopulmonary status among HIV-infected patients, using a systematic search strategy of randomized, controlled trials (RCTs). Methods. A systematic review was performed by two independent reviewers using Cochrane Collaboration protocol. The sources used in this review were Cochrane Library, EMBASE, LILACS, MEDLINE, PEDro and Web of Science from 1950 to August 2012. The PEDro score was used to evaluate methodological quality. Result. Individual studies suggested that concurrent training contributed to improved HRQOL and cardiovascular status. Concurrent training appears to be safe and may be beneficial for medically stable adults living with HIV. The rates of nonadherence were of 16%. Conclusion. Concurrent training improves the HRQOL and cardiopulmonary status. It may be an important intervention in the care and treatment of adults living with HIV. Further research is needed to determine the minimal and optimal duration, frequency, and intensity of exercise needed to produce beneficial changes in the HIV-infected population subgroups.
Ogalha, Cecilia; Andrade, Antonio Marcos; Brites, Carlos
Abstract Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n=100) with a reference population of HIV-positive persons currently in care (n=115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [AOR]=0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR=0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR=0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR=0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR=0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR=3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations.
Pollini, Robin A.; Blanco, Estela; Crump, Carol
Mothers' disclosure of their HIV serostatus to their noninfected young children and factors associated with disclosure were investigated among 135 families. Overall, 30% of the mothers had personally disclosed their serostatus to their children. Mothers who disclosed reported higher levels of social support in their lives than mothers who did not disclose. Children whose mothers had disclosed to them displayed
Debra A. Murphy; Mary Ellen Dello Stritto; W. Neil Steers
Objective:This study aimed to explore the range of issues faced by HIV-positive and HIV-negative gay men concerning HIV serostatus self-disclosure to sexual partners. Methods: In-depth semistructured interviews of 1–2 hr each were conducted with 26 HIV-positive and 15 HIV-negative gay men who were recruited from a larger cohort of gay men followed longitudinally for several years at a major medical
Robert L. Klitzman
Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and who use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this
Ellen Benoit; Michael Pass; Doris Randolph; Deborah Murray; Martin J. Downing Jr
Objective Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. Design Prospective, cross-sectional observational design. Main Outcome Measures Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). Results The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. Conclusion These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status.
Barclay, Terry R.; Hinkin, Charles H.; Castellon, Steven A.; Mason, Karen I.; Reinhard, Matthew J.; Marion, Sarah D.; Levine, Andrew J.; Durvasula, Ramani S.
Anonymous credentials allow to selectively disclose personal properties included in the credential, while hiding the other information. For instance, a user could only disclose that he is an adult using a credential in which zip code and date of birth are included, which remain hidden for the verifier. This is a considerable improvement w.r.t. the user's anonymity. However, by disclosing
Kristof Verslype; Bart De Decker
PURPOSE: We examined whether established associations between HIV disease and HIV disease progression on worse health-related quality of life (HQOL) were applicable to women with severe trauma histories, in this case Rwandan women genocide survivors, the majority of whom were HIV-infected. Additionally, this study attempted to clarify whether post-traumatic stress symptoms were uniquely associated with HQOL or confounded with depression. METHODS: The Rwandan Women's Interassociation Study and Assessment was a longitudinal prospective study of HIV-infected and uninfected women. At study entry, 922 women (705 HIV+ and 217 HIV-) completed measures of symptoms of post-traumatic stress and HQOL as well as other demographic, clinical, and behavioral characteristics. RESULTS: Even after controlling for potential confounders and mediators, HIV+ women, in particular those with the lowest CD4 counts, scored significantly worse on HQOL and overall quality of life (QOL) than did HIV- women. Even after controlling for depression and HIV disease progression, women with more post-traumatic stress symptoms scored worse on HQOL and overall QOL than women with fewer post-traumatic stress symptoms. CONCLUSIONS: This study demonstrated that post-traumatic stress symptoms were independently associated with HQOL and overall QOL, independent of depression and other confounders or potential mediators. Future research should examine whether the long-term impact of treatment on physical and psychological symptoms of HIV and post-traumatic stress symptoms would generate improvement in HQOL. PMID:23271207
Gard, Tracy L; Hoover, Donald R; Shi, Qiuhu; Cohen, Mardge H; Mutimura, Eugene; Adedimeji, Adebola A; Anastos, Kathryn
This study compares immigrant (i.e., foreigner) with non-immigrant (i.e., local\\/native) HIV-related risk behaviors among female\\u000a sex workers (FSW) in South America. A total of 1,845 FSW were enrolled in Argentina, Bolivia, Ecuador, and Uruguay. According\\u000a to their nationality, 10.1% of participants were immigrant FSW. Immigrant FSW were more likely to be younger in Argentina;\\u000a to work in a disco\\/bar in
Christian T. Bautista; Carlos Mosquera; Margarita Serra; Alberto Gianella; Maria M. Avila; Victor Laguna-Torres; Jean K. Carr; Silvia M. Montano; José L. Sanchez
Background Previous studies indicate multiple influences on the overall health of HIV-infected persons; however, few assess and rank longitudinal changes in social and structural barriers that are disproportionately found in impoverished populations. We empirically ranked factors that longitudinally impact the overall health status of HIV-infected homeless and unstably housed men. Methods and Findings Between 2002 and 2008, a cohort of 288 HIV+ homeless and unstably housed men was recruited and followed over time. The population was 60% non-Caucasian and the median age was 41 years; 67% of study participants reported recent drug use and 20% reported recent homelessness. At baseline, the median CD4 cell count was 349 cells/µl and 18% of eligible persons (CD4<350) took antiretroviral therapy (ART). Marginal structural models were used to estimate the population-level effects of behavioral, social, and structural factors on overall physical and mental health status (measured by the SF-36), and targeted variable importance (tVIM) was used to empirically rank factors by their influence. After adjusting for confounding, and in order of their influence, the three factors with the strongest negative effects on physical health were unmet subsistence needs, Caucasian race, and no reported source of instrumental support. The three factors with the strongest negative effects on mental health were unmet subsistence needs, not having a close friend/confidant, and drug use. ART adherence >90% ranked 5th for its positive influence on mental health, and viral load ranked 4th for its negative influence on physical health. Conclusions The inability to meet food, hygiene, and housing needs was the most powerful predictor of poor physical and mental health among homeless and unstably housed HIV-infected men in an urban setting. Impoverished persons will not fully benefit from progress in HIV medicine until these barriers are overcome, a situation that is likely to continue fueling the US HIV epidemic.
Riley, Elise D.; Neilands, Torsten B.; Moore, Kelly; Cohen, Jennifer; Bangsberg, David R.; Havlir, Diane
Objectives: This study examined the relationship between psychological distress, subjective sleep disturbance and immune status among HIV-positive men and women. Methods: Fifty-seven participants (41 men, 16 women) without AIDS-related illness and currently on combination antiretroviral therapy were recruited through community advertisement and physician referral. Participants completed the Impact of Events Scale (IES) to assess symptoms of psychological distress and the
Dean G Cruess; Michael H Antoni; Jeffrey Gonzalez; Mary Ann Fletcher; Nancy Klimas; Ron Duran; Gail Ironson; Neil Schneiderman
We conducted a cross-sectional study on women who were caregivers of HIV\\/AIDS-affected spouses in Bumbu in Kinshasa, Democratic Republic of Congo. The sample consisted of 80 women randomly selected from a client visitation list of the home-based care program for AIDS patients. A semi-structured questionnaire was applied. A self-reported health status was calculated with five items from the questionnaire. The
Walter Kipp; Thomas Matukala Nkosi; Lory Laing; Gian S Jhangri
We conducted a cross-sectional study on women who were caregivers of HIV/AIDS-affected spouses in Bumbu in Kinshasa, Democratic Republic of Congo. The sample consisted of 80 women randomly selected from a client visitation list of the home-based care program for AIDS patients. A semi-structured questionnaire was applied. A self-reported health status was calculated with five items from the questionnaire. The self-reported health status score of participants indicated poor health. The study highlights the great burden on caregivers in sub-Saharan Africa. PMID:16971277
Kipp, Walter; Matukala Nkosi, Thomas; Laing, Lory; Jhangri, Gian S
BACKGROUND: The HIV epidemic in sub-Saharan Africa has had a major impact on infectious disease, and there is currently great interest in the impact of HIV on intestinal barrier function. A three year longitudinal cohort study in a shanty compound in Lusaka, Zambia, carried out before anti-retroviral therapy was widely available, was used to assess the impact of HIV on
Paul Kelly; Jim Todd; Sandie Sianongo; James Mwansa; Henry Sinsungwe; Max Katubulushi; Michael J Farthing; Roger A Feldman
We interviewed 33 HIV-infected parents from the HIV Cost and Services Utilization Study (HCSUS), 27 of their minor children, 19 adult children, and 15 caregivers about the process of children learning that their parents were HIV positive. We summarize the retrospective descriptions of parents’ disclosure of their HIV status to their children, from the perspective of multiple family members. We analyzed transcripts of these interviews with systematic qualitative methods. Both parents and children reported unplanned disclosure experiences with positive and negative outcomes. Parents sometimes reported that disclosure was not as negative as they feared. However, within-household analysis showed disagreement between parents and children from the same household regarding disclosure outcomes. These findings suggest that disclosure should be addressed within a family context to facilitate communication and children’s coping. Parents should consider negative and positive outcomes, unplanned disclosure and children’s capacity to adapt after disclosure when deciding whether to disclose.
Cowgill, Burton O.; Bogart, Laura M.; Corona, Rosalie; Ryan, Gery W.; Murphy, Debra A.; Nguyen, Theresa; Schuster, Mark A.
The personal and social costs of HIV are well documented. What remains unknown is the effect of public disclosure of HIV status on the individual who is doing the disclosing. This study describes the experience of four African American women living with HIV who participated in the development of an intergenerational education intervention for African American adolescent girls. These women suggested that they be filmed discussing the "dark side" of HIV in an effort to create an intergenerational education intervention that would alter the risk-taking behavior that they observed in young women in their community. After a rough cut of the film was completed, these women viewed the film and participated in a focus group during which they discussed what it was like to reveal and revisit their own painful experiences associated with becoming infected and then living with HIV. Findings from content analysis of transcribed dialogue included the following positive themes: (a) self-acceptance by telling one's own story and hearing the stories of the other women, (b) a sense of liberation by disclosing publicly one's image and message and letting go of others' judgments, (c) feeling supported by meeting other women who share the same experience, (d) value of using the film to impact or save young people from the pain one has experienced. A negative theme emerged related to personal pain in reliving the individual's history with HIV. PMID:16438124
Norris, Anne E; DeMarco, Rosanna
The success of combination antiretroviral therapies for the treatment of human immunodeficiency virus (HIV) has resulted in prolonged life expectancy (over 40 years from diagnosis) and an improved quality of life for people living with HIV. The risk of vertical HIV transmission during pregnancy has been reduced to less than 1%. As a result of these breakthroughs and as many of these individuals are of reproductive age, fertility issues are becoming increasingly important for this population. One population in which conception planning and reduction of horizontal HIV transmission warrants further research is HIV-discordant couples where the male partner is HIV-positive and the female partner is HIV-negative. Sperm washing is a technique carried out in a fertility clinic that separates HIV from the seminal fluid. Although sperm washing followed by intrauterine insemination significantly reduces the risk of horizontal HIV transmission, there has been limited access to the procedure in North America. Furthermore, little is known about the conception decision-making experiences of HIV-discordant couples who might benefit from sperm washing. Chart reviews and semi-structured interviews were completed with 12 HIV-discordant couples in Ontario, Canada. Couples were recruited through HIV clinics and one fertility clinic that offered sperm washing. Participants identified a number of factors that affected their decision-making around pregnancy planning. Access to sperm washing and other fertility services was an issue (cost, travel and few clinics). Participants identified a lack of information on the procedure (availability, safety). Sources of support (social networks, healthcare providers) were unevenly distributed, especially among those who did not disclose their HIV status to friends and family. Finally, the stigmatisation of HIV continues to have a negative affect on HIV-discordant couples and their intentions to conceive. Access to sperm washing and fertility service is significantly limited for this population and is accompanied with a number of challenges. PMID:21969863
Newmeyer, Trent; Tecimer, Sandy N; Jaworsky, Denise; Chihrin, Steven; Gough, Kevin; Rachlis, Anita; Martin, James; Mohammed, Saira; Loutfy, Mona R
Background Estimates of the prevalence of transmitted HIV drug resistance (TDR) in a population are derived from resistance tests performed on samples from patients thought to be naïve to antiretroviral treatment (ART). Much of the debate over reliability of estimates of the prevalence of TDR has focused on whether the sample population is representative. However estimates of the prevalence of TDR will also be distorted if some ART-experienced patients are misclassified as ART-naïve. Methods The impact of misclassification bias on the rate of TDR was examined. We developed methods to obtain adjusted estimates of the prevalence of TDR for different misclassification rates, and conducted sensitivity analyses of trends in the prevalence of TDR over time using data from the UK HIV Drug Resistance Database. Logistic regression was used to examine trends in the prevalence of TDR over time. Results The observed rate of TDR was higher than true TDR when misclassification was present and increased as the proportion of misclassification increased. As the number of naïve patients with a resistance test relative to the number of experienced patients with a test increased, the difference between true and observed TDR decreased. The observed prevalence of TDR in the UK reached a peak of 11.3% in 2002 (odds of TDR increased by 1.10 (95% CI 1.02, 1.19, p(linear trend) = 0.02) per year 1997-2002) before decreasing to 7.0% in 2007 (odds of TDR decreased by 0.90 (95% CI 0.87, 0.94, p(linear trend) < 0.001) per year 2002-2007. Trends in adjusted TDR were altered as the misclassification rate increased; the significant downward trend between 2002-2007 was lost when the misclassification increased to over 4%. Conclusion The effect of misclassification of ART on estimates of the prevalence of TDR may be appreciable, and depends on the number of naïve tests relative to the number of experienced tests. Researchers can examine the effect of ART misclassification on their estimates of the prevalence of TDR if such a bias is suspected.
Among all livestock species, cattle have a prominent status as they have contributed greatly to the economy, nutrition and culture from the beginning of farming societies until the present time. The origins and diversity of local cattle breeds have been widely assessed. However, there are still some regions for which very little of their local genetic resources is known. The present work aimed to estimate the genetic diversity and the origins of Omani cattle. Located in the south-eastern corner of the Arabian Peninsula, close to the Near East, East Africa and the Indian subcontinent, the Sultanate of Oman occupies a key position, which may enable understanding cattle dispersal around the Indian Ocean. To disclose the origin of this cattle population, we used a set of 11 polymorphic microsatellites and 113 samples representing the European, African and Indian ancestry to compare with cattle from Oman. This study found a very heterogenic population with a markedly Bos indicus ancestry and with some degree of admixture with Bos taurus of African and Near East origin. PMID:22957920
Mahgoub, Osman; Babiker, Hamza A; Kadim, I T; Al-Kindi, Mohammed; Hassan, Salwa; Al-Marzooqi, W; Eltahir, Yasmin E; Al-Abri, M A; Al-Khayat, Aisha; Al-Sinani, Kareema R; Hilal Al-Khanjari, Homoud; Costa, Vânia; Chen, Shanyuan; Beja-Pereira, Albano
This study examined correlates of disclosure of MSM behavior and seropositive HIV status to social network members among 187 African American MSM in Baltimore, MD. 49.7% of participants were HIV-positive, 64% of their social network members (excluding male sex partners) were aware of their MSM behavior, and 71.3% were aware of their HIV-positive status. Disclosure of MSM behavior to network members was more frequent among participants who were younger, had a higher level of education, and were HIV-positive. Attributes of the social network members associated with MSM disclosure included the network member being HIV-positive, providing emotional support, socializing with the participant, and not being a female sex partner. Participants who were younger were more likely to disclose their positive HIV status. Attributes of social network members associated with disclosure of positive serostatus included the network member being older, HIV-positive, providing emotional support, loaning money, and not being a male sex partner. PMID:21811844
Latkin, Carl; Yang, Cui; Tobin, Karin; Roebuck, Geoffrey; Spikes, Pilgrim; Patterson, Jocelyn
Data on the prevalence of human papillomavirus (HPV) types in cervical carcinoma in women with HIV are scarce but are essential to elucidate the influence of immunity on the carcinogenicity of different HPV types, and the potential impact of prophylactic HPV vaccines in populations with high HIV prevalence. We conducted a multicentre case-case study in Kenya and South Africa. During 2007-2009, frozen tissue biopsies from women with cervical carcinoma were tested for HPV DNA using GP5+/6+-PCR assay. One hundred and six HIV-positive (mean age 40.8 years) and 129 HIV-negative women (mean age 45.7) with squamous cell carcinoma were included. Among HIV-positive women, the mean CD4 count was 334 cells/?L and 48.1% were on combined antiretroviral therapy. HIV-positive women had many more multiple HPV infections (21.6% of HPV-positive carcinomas) compared with HIV-negative women (3.3%) (p < 0.001) and the proportion of multiple infections was inversely related to CD4 level. An excess of HPV18 of borderline statistical significance was found in HIV-positive compared with HIV-negative cases (Prevalence ratio (PR) = 1.9, 95% confidence interval (CI): 1.0-3.7, adjusted for study centre, age and multiplicity of infection). HPV16 and/or 18 prevalence combined, however, was similar in HIV-positive (66.7%) and HIV-negative cases (69.1%) (PR = 1.0, 95% CI: 0.9-1.2). No significant difference was found for other HPV types. Our data suggest that current prophylactic HPV vaccines against HPV16 and 18 may prevent similar proportions of cervical SCC in HIV-positive as in HIV-negative women provided that vaccine-related protection is sustained after HIV infection. PMID:21960453
De Vuyst, Hugo; Ndirangu, Gathari; Moodley, Manivasan; Tenet, Vanessa; Estambale, Benson; Meijer, Chris J L M; Snijders, Peter J F; Clifford, Gary; Franceschi, Silvia
Knowledge of human papillomavirus (HPV) type distribution in populations at risk for anal cancer is needed. Here, we describe the anal HPV genotype distribution in a large Spanish cohort (Cohort of the Spanish HIV Research Network HPV [CoRIS-HPV]) of HIV-positive men who have sex with men (MSM) according to geographical origin, age, and cytological status. A cross-sectional analysis of baseline data from 1,439 HIV-infected MSM (2007 to 2012) was performed. Anal HPV genotyping was performed using the Linear Array HPV genotyping test. Descriptive analyses of subject characteristics, prevalences, and 95% confidence intervals (CI) were performed. The global prevalences of HPV, high-risk HPV (HR-HPV), and low-risk HPV (LR-HPV) types were 95.8%, 83.0%, and 72.7%, respectively. Among the HR-HPV types, HPV16 was the most common, followed by HPV59, -39, -51, -18, and -52. The prevalence of multiple HR-HPV infections was 58.5%. There were no differences in the crude analyses between Spanish and Latin-American MSM for most HPV types, and a peak in prevalence for most HPV types was seen in patients in their late thirties. Globally and by specific HPV groups, men with abnormal anal cytologies had a higher prevalence of infection than those with normal cytologies. This study has the largest number of HIV-positive MSM with HPV genotype data analyzed according to cytological status as far as we know. The information gained from this study can help with the design of anal cancer prevention strategies in HIV-positive patients. PMID:23966501
Torres, Montserrat; González, Cristina; Del Romero, Jorge; Viciana, Pompeyo; Ocampo, Antonio; Rodríguez-Fortúnez, Patricia; Masiá, Mar; Blanco, José Ramón; Portilla, Joaquín; Rodríguez, Carmen; Hernández-Novoa, Beatriz; Del Amo, Julia; Ortiz, Marta
Objective We identified factors associated with improved self-reported health status in a sample of people living with HIV/AIDS (PLWHA) following enrollment in oral health care. Methods Data were collected from 1,499 enrollees in the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance Innovations in Oral Health Care Initiative. Data were gathered from 2007–2010 through in-person interviews at 14 sites; self-reported health status was measured using the SF-8™ Health Survey's physical and mental health summary scores. Utilization records of oral health-care services provided to enrollees were also obtained. Data were analyzed using general estimating equation linear regression. Results Between baseline and follow-up, we found that physical health status improved marginally while mental health status improved to a greater degree. For change in physical health status, a decrease in oral health problems and lack of health insurance were significantly associated with improved health status. Improved mental health status was associated with a decrease in oral health problems at the last available visit and no pain or distress in one's teeth or gums at the last available visit. Conclusion For low-income PLWHA, engagement in a program to increase access to oral health care was associated with improvement in overall well-being as measured by change in the SF-8 Health Survey. These results contribute to the knowledge base about using the SF-8 to assess the impact of clinical interventions. For public health practitioners working with PLWHA, findings suggest that access to oral health care can help promote well-being for this vulnerable population.
Bachman, Sara S.; Walter, Angela W.; Umez-Eronini, Amarachi
Objectives To evaluate clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Design Retrospective study. Methods 98 HIV-infected adult patients with CSF culture-proven cryptococcal meningitis admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Results Cryptococcal meningitis was the first AIDS-defining illness in 69% of whom 97% (95/98) had known prior HIV-infection. The median CD4+ T cell count was 39 cells/mcL (IQR: 17–87 cells/mcL). Prior antiretroviral therapy (ART) was reported in 50%. Failure to sterilize the CSF by 7–14 days was associated with baseline fungal burden of ?10 yeasts/mcL by quantitative CSF microscopy (OR=15.3, 95% CI: 4.1–56.7;P<.001) and positive blood cultures (OR=11.5, 95% CI:1.2–109;P=.034). At 7–14 days, ?10 yeasts/mcL CSF was associated with positive CSF cultures in 98% vs. 36% when <10 yeasts/mcL CSF (P<.001). In-hospital mortality was 30% and associated with symptoms duration for >14 days, altered mental status (P<.001), CSF WBC counts <5 cells/mcL (P=.027), intracranial hypertension (P=.011), viral loads >50,000 copies/mL (P=.036), ?10 yeasts/mcL CSF at 7–14 days (P=.038), and intracranial pressure >50 cmH20 at 7–14 days (P=.007). Conclusion Most patients were aware of their HIV-status. Fungal burden of ?10 yeasts/mcL by quantitative CSF microscopy predicted current CSF culture status and may be useful to customize the induction therapy. High uncontrolled intracranial pressure was associated with mortality.
Vidal, Jose E.; Gerhardt, Juliana; Peixoto de Miranda, Erique J.; Dauar, Rafi F.; Oliveira Filho, Gilberto S.; Penalva de Oliveira, Augusto C.; Boulware, David R.
Objective: To investigate the characteristics of South African men who have sex with men (MSM) who (1) have been tested for HIV and (2) are HIV positive. Methods: Data were collected from 1045 MSM in community surveys using questionnaires that were administered either face-to-face, by mail or on the internet. The mean age of the men was 29.9 years. The
T G M Sandfort; J Nel; E Rich; V Reddy; H Yi
Background: Anemia is a frequent complication among HIV- infected persons and is associated with faster disease progression and mortality. Objective: We examined the effect of multivitamin supplementa- tion on hemoglobin concentrations and the risk of anemia among HIV-infected pregnant women and their children. Design: HIV-1-infected pregnant women (n 1078) from Dar es Salaam,Tanzania,wereenrolledinadouble-blindtrialandprovided daily supplements of preformed vitamin A and
Wafaie W Fawzi; Gernard I Msamanga; Roland Kupka; Donna Spiegelman; Eduardo Villamor; Ferdinand Mugusi; Ruilan Wei; David Hunter
The evolution of serological tests for syphilis (STSs) after therapy in HIV+ patients is a major point of controversy, with possible seroreactivation and illicit seroreversion in these patients. The aim of our study was to evaluate the long-term outcome of STSs in a cohort of HIV+ male homosexuals with a history of treated syphilis as compared with HIV– controls. Patients
M. Janier; C. Chastang; E. Spindler; S. Strazzi; C. Rabian; A. Marcelli; P. Morel
People living with HIV (PLWH) and their families are subjected to prejudice, discrimination and hostility related to the stigmatization of AIDS. This paper examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive, qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. Forty-three focus groups were conducted with 251 participants (114 nurses, 111 PLWHs and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents of stigma. Nurse reports of coping strategies that they used as well as coping strategies they observed as used by HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. Seventeen different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one’s HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma.
Makoae, Lucia N.; Greeff, Minrie; Phetlhu, Rene D.; Uys, Leana R.; Naidoo, Joanne R.; Kohi, Thecla W.; Dlamini, Priscilla S.; Chirwa, Maureen L.; Holzemer, William L.
People living with HIV (PLWH) and their families are subjected to prejudice, discrimination, and hostility related to the stigmatization of AIDS. This report examines how PLWH cope with HIV-related stigma in the five southern African countries of Lesotho, Malawi, South Africa, Swaziland, and Tanzania. A descriptive qualitative research design was used to explore the experience of HIV-related stigma of PLWH and nurses in 2004. A total of 43 focus groups were conducted with 251 participants (114 nurses, 111 PLWH, and 26 volunteers). In describing incidents of stigma, respondents reported strategies used or observed to cope with those incidents. Nurse reports of coping strategies that they used as well as observed in HIV-infected patients were coded. Coping strategies used by PLWH in dealing with HIV-related stigma were coded. A total of 17 different self-care strategies were identified: restructuring, seeing oneself as OK, letting go, turning to God, hoping, changing behavior, keeping oneself active, using humor, joining a support or social group, disclosing one's HIV status, speaking to others with same problem, getting counseling, helping others to cope with the illness, educating others, learning from others, acquiring knowledge and understanding about the disease, and getting help from others. Coping appears to be self-taught and only modestly helpful in managing perceived stigma. PMID:18328964
Makoae, Lucia N; Greeff, Minrie; Phetlhu, René D; Uys, Leana R; Naidoo, Joanne R; Kohi, Thecla W; Dlamini, Priscilla S; Chirwa, Maureen L; Holzemer, William L
Stigma profoundly affects the lives of people with HIV/AIDS. Fear of being identified as having HIV or AIDS may discourage a person from getting tested, from accessing medical services and medications, and from disclosing their HIV status to family and friends. In the present study, we use focus groups to identify the most salient domains of stigma and the coping strategies that may be common to a group of diverse, low-income women and men living with HIV in Los Angeles, CA (n = 48). We also explore the impact of stigma on health and healthcare among HIV positive persons in our sample. Results indicate that the most salient domains of stigma include: blame and stereotypes of HIV, fear of contagion, disclosure of a stigmatized role, and renegotiating social contracts. We use the analysis to develop a framework where stigma is viewed as a social process composed of the struggle for both internal change (self-acceptance) and reintegration into the community. We discuss implications of HIV-related stigma for the mental and physical health of HIV-positive women and men and suggestions for possible interventions to address stigma in the healthcare setting. PMID:17786561
Sayles, Jennifer N; Ryan, Gery W; Silver, Junell S; Sarkisian, Catherine A; Cunningham, William E
Nondisclosure of one's HIV infection to sexual partners obviates safer sex negotiations and thus jeopardizes HIV transmission prevention. The role of alcohol use in the disclosure decision process is largely unexplored. This study assessed the association between alcohol use and recent nondisclosure of HIV serostatus to sex partners by HIV-infected risky drinkers in St. Petersburg, Russia. Approximately half (317/605; 52.4 %) reported not having disclosed their HIV serostatus to all partners since awareness of infection. Using three separate GEE logistic regression models, we found no significant association between alcohol dependence, risky alcohol use (past 30 days), or alcohol use at time of sex (past 30 days) with recent (past 3 months) nondisclosure (AOR [95 % CI] 0.81 [0.55, 1.20], 1.31 [0.79, 2.17], 0.75 [0.54, 1.05], respectively). Alcohol use at time of sex was associated with decreased odds of recent nondisclosure among seroconcordant partners and among casual partners. Factors associated with nondisclosure were relationship with a casual partner, a serodiscordant partner, multiple sex partners, awareness of HIV diagnosis less than 1 year, and a lifetime history of sexually transmitted disease. Nondisclosure of HIV status to sex partners is common among HIV-infected Russians, however alcohol does not appear to be a predictor of recent disclosure. PMID:22677972
Lunze, Karsten; Cheng, Debbie M; Quinn, Emily; Krupitsky, Evgeny; Raj, Anita; Walley, Alexander Y; Bridden, Carly; Chaisson, Christine; Lioznov, Dmitry; Blokhina, Elena; Samet, Jeffrey H
Despite recognition that traditional Mexican gender norms can contribute to the twin epidemics of violence against women and HIV, there is an absence of published literature on experiences of violence among Mexican women with HIV. We conducted a cross-sectional survey with 77 HIV-infected women from 21 of Mexico's 32 states to describe experiences of violence before and after HIV-diagnosis. We measured lifetime physical, sexual, and psychological violence; physical violence from a male partner in the previous 12 months; and physical and psychological violence related to disclosing an HIV diagnosis. Respondents reported ever experiencing physical violence (37.3%) and sexual violence (29.2%). Disclosure of HIV status resulted in physical violence for 7.2% and psychological violence for 26.5% of the respondents. This study underlines the need to identify and address past and current gender-based violence during pre- and post-HIV test counseling and as a systematic and integral part of HIV care. PMID:22512924
Kendall, Tamil; van Dijk, Marieke; Wilson, Katherine S; Picasso, Nizarindandi; Lara, Diana; Garcia, Sandra
Trust in health care providers and the health care system are essential. This study examined factors associated with trust in providers and distrust in the health care system among minority HIV-positive and -negative women.Interviews were conducted and laboratory tests performed with 102 women from the Women's Interagency HIV Study Bronx site. Interviews collected information about trust in providers, distrust in
C. O. Cunningham; N. L. Sohler; L. Korin; W. Gao; K. Anastos
The HIV\\/AIDS epidemic is a major public health threat with evidence showing that information campaigns are effective policy tools to control its evolution. Specifically, many of these campaigns are designed to increase children's knowledge on HIV before they become sexually active or start to experiment with intravenous drugs. However, the effectiveness of such campaigns is subject to the message reaching
This study describes HIV-related behaviors recorded through a questionnaire applied to 570 individuals in Porto Alegre, Rio Grande do Sul, Brazil, who were not regular drug users. Mean age was 30.3 years, 51.1 % were male, and most were low-income (59.1%). The HIV seropositive rate was 9.9% (13.1% for males, 6.9% for females), and there was a positive association with male gender, age over 30 years, and low income. Women reported more unprotected sex (86.4%) than men (74.4%) and more sex involving drugs (11.6% vs. 2.1%); men reported more unprotected homosexual sex (18.7% vs. 1.4%) and more sex with sex workers (19.0% vs. 0.4%). There was no association between sporadic drug use and seropositive status. The association between age and seropositive status confirms previous findings, indicating more lifetime risk exposure. The study confirms the so-called pauperization of the epidemic, with poor individuals showing a higher seropositive rate. Males and females showed different behaviors associated with seropositive status, confirming the need for specific and differentiated preventive strategies for each group. PMID:15692660
Pechansky, Flávio; von Diemen, Lisia; Kessler, Félix; De Boni, Raquel; Surrat, Hilary; Inciardi, James
The sexual behaviors of non-gay identified men who have sex with men and women (MSMW) who do not disclose their same-sex behavior\\u000a to their female partners (referred to by some as men “on the down low”) were examined, including the potential for these men\\u000a to serve as a “bisexual bridge” for HIV and STD acquisition and transmission. Self-reported sexual behavior
Karolynn Siegel; Eric W. Schrimshaw; Helen-Maria Lekas; Jeffrey T. Parsons
Abstract A divide exists between categories of men who have sex with men (MSM) in India based on their sex position, which has consequences for the design of novel HIV prevention interventions. We examine the interaction between sex position and other attributes on existing HIV risk including previous HIV testing, unprotected anal intercourse (UAI), and HIV serostatus among MSM recruited from drop-in centers and public cruising areas in the twin cities of Hyderabad and Secunderabad, India. A survey was administered by trained research assistants and minimally invasive HIV testing was performed by finger-stick or oral testing. HIV seropositive MSM underwent CD4+ lymphocyte count measurement. In our sample (n=676), 32.6% of men were married to women, 22.2% of receptive only participants were married, and 21.9% of men were HIV seropositive. In bivariate analysis, sex position was associated with previous HIV testing, UAI, HIV serostatus, and CD4+ lymphocyte count at diagnosis. In multivariate analysis with interaction terms, dual unmarried men were more likely to have undergone an HIV test than insertive unmarried men (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.2–6.5), a relationship that did not hold among married men. Conversely, dual married men were less likely than insertive married men to engage in UAI (OR 0.3; 95% CI 0.1–0.6), a relationship that did not hold among unmarried men. Further implementation research is warranted in order to best direct novel biologic and behavioral prevention interventions towards specific risk behaviors in this and other similar contexts.
Hemmige, Vagish; Snyder, Hannah; Liao, Chuanhong; Mayer, Kenneth; Lakshmi, Vemu; Gandham, Sabitha R.; Orunganti, Ganesh
A divide exists between categories of men who have sex with men (MSM) in India based on their sex position, which has consequences for the design of novel HIV prevention interventions. We examine the interaction between sex position and other attributes on existing HIV risk including previous HIV testing, unprotected anal intercourse (UAI), and HIV serostatus among MSM recruited from drop-in centers and public cruising areas in the twin cities of Hyderabad and Secunderabad, India. A survey was administered by trained research assistants and minimally invasive HIV testing was performed by finger-stick or oral testing. HIV seropositive MSM underwent CD4+ lymphocyte count measurement. In our sample (n = 676), 32.6% of men were married to women, 22.2% of receptive only participants were married, and 21.9% of men were HIV seropositive. In bivariate analysis, sex position was associated with previous HIV testing, UAI, HIV serostatus, and CD4+ lymphocyte count at diagnosis. In multivariate analysis with interaction terms, dual unmarried men were more likely to have undergone an HIV test than insertive unmarried men (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.2-6.5), a relationship that did not hold among married men. Conversely, dual married men were less likely than insertive married men to engage in UAI (OR 0.3; 95% CI 0.1-0.6), a relationship that did not hold among unmarried men. Further implementation research is warranted in order to best direct novel biologic and behavioral prevention interventions towards specific risk behaviors in this and other similar contexts. PMID:21682588
Hemmige, Vagish; Snyder, Hannah; Liao, Chuanhong; Mayer, Kenneth; Lakshmi, Vemu; Gandham, Sabitha R; Orunganti, Ganesh; Schneider, John
Background The relationship between HIV serostatus disclosure and sexual risk behavior is inconsistent across studies. As men who have sex with men (MSM) are emerging as the key affected population in Bangkok, Thailand with reported HIV prevalence of 30%, we assessed whether HIV disclosure is associated with protected sex in this population. Methods A risk behavior questionnaire was administered using Audio Computer-Assisted Self-Interviewing (ACASI) to determine whether HIV serostatus disclosure was associated with protected sex in 200 HIV-positive MSM in Bangkok. HIV serostatus disclosure to the most recent sexual partner prior to or at the time of the sexual encounter was assessed. Protected sex was defined as insertive or receptive anal intercourse with a condom at the most recent sexual encounter. Results The mean age was 30.2 years, CD4 was 353 cells/mm3, and one-third was on antiretroviral therapy. At the most recent sexual encounter, HIV serostatus disclosure rate was low (26%); 60.5% of subjects had not discussed their serostatus at all, while 5.5% had not revealed their true serostatus. Seventeen percent reported unprotected anal intercourse and about half had sex with their primary partners. The serostatus of the most recent sexual partner was HIV-positive in 19.2%, HIV-negative in 26.4%, and unknown in 54.4% of subjects. There was no association between disclosure and protected sex, with 41 of 48 (85.4%) disclosers and 104 of 126 (82.5%) of non-disclosers reported protected sex (p?=?.65). Subjects with HIV-positive partners were less likely to report protected sex overall (20 of 33, 60.6%) compared to those with HIV negative (82 of 96, 85.4%) or unknown (41 of 45, 91.1%) partners (p?=?.001). Age (27-32 years vs. ?26 years, p?=?.008), primary partner status (p < .001), and HIV-positive serostatus of sexual partner (p?.001) were significantly associated with disclosure in the multivariate analyses. Conclusion Rates of HIV disclosure to sexual partners by HIV-positive MSM in Bangkok are low. Despite low rates of HIV serostatus disclosure, most HIV-positive MSM reported protected sex with their partners at risk for infection. Future studies should focus on understanding barriers to disclosure and factors driving risk behavior amongst MSM in Thailand.
Little research has focused specifically on disclosure among HIV+ Black Africans living in the UK; however, the available evidence suggests that this population may be reluctant to disclose to significant others. Forty-five HIV+ Black African men and women were recruited from a London HIV clinic. Semi-structured interviews gathered information on: disclosure, social support, mental and physical health, medication adherence, acculturation
T. Calin; J. Green; J. Hetherton; G. Brook
Efforts to expand access to HIV care and treatment often stress the importance of disclosure of HIV status to aid adherence, social support, and continued resource mobilization. We argue that an examination of disclosure processes early in the process of seeking testing and treatment can illuminate individual decisions and motivations, offering insight into potentially improving engagement in care and adherence. We report on baseline data of early HIV disclosure and nondisclosure, including reasons for and responses to disclosure from a cohort of men and women (n=949) currently accessing antiretroviral treatment in two regions of Uganda. We found early disclosures at the time of suspicion or testing positive for HIV by men and women to be largely for the purposes of emotional support and friendship. Responses to these selected disclosures were overwhelmingly positive and supportive, including assistance in accessing treatment. Nonetheless, some negative responses of worry, fear, or social ostracism did occur. Individuals deliberately chose to not disclose their status to partners, relatives, and others in their network, for reasons of privacy or not wanting to cause worry from the other person. These data demonstrate the strategic choices that individuals make early in the course of suspicion, testing, and treatment for HIV to mobilize resources and gain emotional or material support, and similarly their decisions and ability to maintain privacy regarding their status. PMID:23356654
Winchester, M S; McGrath, J W; Kaawa-Mafigiri, D; Namutiibwa, F; Ssendegye, G; Nalwoga, A; Kyarikunda, E; Birungi, J; Kisakye, S; Ayebazibwe, N; Walakira, E; Rwabukwali, C B
Background Although severe oral opportunistic infections decreased with the implementation of highly active antiretroviral therapy, periodontitis is still a commonly described problem in patients infected with human immunodeficiency virus (HIV). The objective of the present investigation was to determine possible differences in periodontal parameters between antiretroviral treated and untreated patients. Methods The study population comprised 80 patients infected with HIV divided into two groups. The first group was receiving antiretroviral therapy while the second group was therapy naive. The following parameters were examined: probing pocket depth, gingival recession, clinical attachment level, papilla bleeding score, periodontal screening index and the index for decayed, missed and filled teeth. A questionnaire concerning oral hygiene, dental care and smoking habits was filled out by the patients. Results There were no significant differences regarding the periodontal parameters between the groups except in the clinical marker for inflammation, the papilla bleeding score, which was twice as high (P < 0.0001) in the antiretroviral untreated group (0.58 ± 0.40 versus 1.02 ± 0.59). The participants of this investigation generally showed a prevalence of periodontitis comparable to that in healthy subjects. The results of the questionnaire were comparable between the two groups. Conclusion There is no indication for advanced periodontal damage in HIV-infected versus non-infected patients in comparable age groups. Due to their immunodeficiency, HIV-infected patients should be monitored closely to prevent irreversible periodontal damage. Periodontal monitoring and early therapy is recommended independent of an indication for highly active antiretroviral therapy.
This investigation was conducted to examine the relation between loneliness and self-disclosing behavior. Specifically, the effects of loneliness on the level of intimacy of self-disclosure in response to nonintimate and intimate self-disclosure of an initiator of a conversation were examined. In addition, this study investigated the relation between loneliness and appropriateness of self-disclosing behavior. Appropriateness was defined as reciprocity of
MARY ELIZABETH SIEGEL
We assessed attitudes to medicines, HIV treatments and antiretroviral-based prevention in a national, online survey of 1,041 Australian gay men (88.3% HIV-negative and 11.7% HIV-positive). Multivariate analysis of variance was used to identify the effect of HIV status on attitudes. HIV-negative men disagreed with the idea that HIV drugs should be restricted to HIV-positive people. HIV-positive men agreed and HIV-negative men disagreed that taking HIV treatments was straightforward and HIV-negative men were more sceptical about whether HIV treatment or an undetectable viral load prevented HIV transmission. HIV-negative and HIV-positive men had similar attitudes to pre-exposure prophylaxis but divergent views about 'treatment as prevention'. PMID:23001412
Holt, Martin; Murphy, Dean; Callander, Denton; Ellard, Jeanne; Rosengarten, Marsha; Kippax, Susan; de Wit, John
Religious beliefs play an important role in the lives of Tanzanians, but little is known about the influence of religion for people living with HIV/AIDS (PLWHA). This study shares perspectives of PLWHA and identifies opportunities for religious organizations to support the psychological well-being of this group. Data were collected in 2006 and 2007 through semistructured interviews with 36 clients (8 Muslims and 28 Christians) receiving free antiretrovirals (ARVs) in Arusha, Tanzania. Swahili-speaking interviewers asked about participation in religion, change in religious engagement since HIV diagnosis, and what role faith plays in living with HIV and taking ARVs. Interviews were audiotaped, transcribed, translated, and analyzed using Atlas t.i. The findings revealed that patients' personal faith positively influenced their experiences living with HIV, but that religious organizations had neutral or negative influences. On the positive side, prayer gave hope to live with HIV, and religious faith increased after diagnosis. Some respondents said that prayer supported their adherence to medications. On the other hand, few disclosed their HIV status in their religious communities, expressing fear of stigma. Most had heard that prayer can cure HIV, and two expected to be cured. While it was common to hear messages about HIV prevention from churches or mosques, few had heard messages about living with HIV. The findings point to missed opportunities by religious organizations to support PLWHA, particularly the need to ensure that messages about HIV are not stigmatizing; share information about HIV treatment; introduce role models of PLWHA; and emphasize that prayers and medical care go hand-in-hand. PMID:19335171
Watt, Melissa H; Maman, Suzanne; Jacobson, Mark; Laiser, John; John, Muze
With Alzheimer’s disease increasing in prevalence and public awareness, more people are becoming interested in learning their chances of developing this condition. Disclosing Alzheimer’s disease risk has been discouraged because of the limited predictive value of available tests, lack of prevention and treatment options, and concerns regarding potential psychological and social harms. However, challenges to this status quo include the availability of direct-to-consumer health risk information (e.g., genetic susceptibility tests), as well as a growing literature suggesting that people seeking risk information for Alzheimer’s disease through formal education and counseling protocols generally find it useful and do not experience adverse effects. This paper reviews current and potential methods of risk assessment for Alzheimer’s disease, discusses the process and impact of disclosing risk to interested patients and consumers, and considers the practical and ethical challenges in this emerging area. Anticipated future directions are addressed.
Roberts, J Scott; Tersegno, Sarah M
BACKGROUND: The Federal Ministry of Health of Ethiopia is implementing an ambitious and rapid scale-up of health care services for the prevention, care and treatment of HIV\\/AIDS in public facilities. With support from the United States President's Emergency Plan for AIDS Relief, 38 830 service providers were trained, from early 2005 until December 2007, in HIV-related topics. Anecdotal evidence suggested
Marion E McNabb; Cynthia A Hiner; Anne Pfitzer; Yassir Abduljewad; Mesrak Nadew; Petros Faltamo; Jean Anderson
This retrospective study aimed to evaluate the clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Ninety-eight HIV-infected adult patients with CSF culture-proven cryptococcal meningitis were admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Cryptococcal meningitis was the first AIDS-defining illness in 69%, of whom 97% (95/98) had known prior HIV infection. The median CD4+ T-cell count was 39 cells/?L (interquartile range 17-87 cells/?L). Prior antiretroviral therapy was reported in 50%. Failure to sterilize the CSF by 7-14 days was associated with baseline fungal burden of ? 10 yeasts/?L by quantitative CSF microscopy (odds ratio [OR] = 15.3, 95% confidence interval [CI] 4.1-56.7; P < 0.001) and positive blood cultures (OR = 11.5, 95% CI 1.2-109; P = 0.034). At 7-14 days, ? 10 yeasts/?L CSF was associated with positive CSF cultures in 98% versus 36% with <10 yeasts/?L CSF (P < 0.001). In-hospital mortality was 30% and was associated with symptoms duration for >14 days, altered mental status (P < 0.001), CSF white blood cell counts <5 cells/?L (P = 0.027), intracranial hypertension (P = 0.011), viral loads >50,000 copies/mL (P = 0.036), ? 10 yeasts/?L CSF at 7-14 days (P = 0.038), and intracranial pressure >50 cmH(2)0 at 7-14 days (P = 0.007). In conclusion, most patients were aware of their HIV status. Fungal burden of ? 10 yeasts/?L by quantitative CSF microscopy predicted current CSF culture status and may be useful to customize the induction therapy. High uncontrolled intracranial pressure was associated with mortality. PMID:22578940
Vidal, José E; Gerhardt, Juliana; Peixoto de Miranda, Erique J; Dauar, Rafi F; Oliveira Filho, Gilberto S; Penalva de Oliveira, Augusto C; Boulware, David R
The HIV-1 regulatory protein Tat and the accessory protein Vpr are thought to stimulate viral replication and contribute to viral pathogenesis as extracellular proteins. Humoral immune responses to these early viral proteins may therefore be beneficial. We examined serum anti-Tat and anti-Vpr IgG by ELISA in the GRIV cohort of HIV-1 seropositive slow/non-progressors (NP) and fast-progressors (FP), and in seronegative controls. Based on information obtained during a brief follow-up period (median = 20 months), NPs were sub-grouped as those maintaining non-progression status and therefore stable (NP-S), and those showing signs of disease progression (NP-P). As the primary comparison, initial serum anti-Tat and anti-Vpr IgG (prior to follow-up) were analyzed in the NP sub-groups and in FPs. Anti-Tat IgG was significantly higher in stable NP-S compared to unstable NP-P (P = 0.047) and FPs (P < 0.0005); the predictive value of higher anti-Tat IgG for maintenance of non-progression status was 92% (P = 0.029). In contrast, no-difference was observed in anti-Vpr IgG between NP-S and NP-P, although both were significantly higher than FPs (P = 0.001). Serum anti-Tat IgG mapped to linear epitopes within the amino-terminus, the basic domain and the carboxy-terminal region of Tat in stable NP-S. Similar epitopes were identified in patients immunized with the Tat-toxoid in a Phase I study in Milan. High titer serum anti-Tat IgG from both GRIV and Milan cohorts cross-reacted in ELISA with Tat from diverse viral isolates, including HIV-1 subtype-E (CMU08) and SIVmac251 Tat; a correlation was observed between anti-Tat IgG titers and cross-reactivity. These results demonstrate that higher levels of serum anti-Tat IgG, but not anti-Vpr IgG, are associated with maintenance of non-progression status in HIV-1 infection. Evidence that vaccination with the Tat toxoid induces humoral immune responses to Tat similar to those observed in stable non-progressors is encouraging for vaccine strategies targeting Tat. PMID:12642031
Richardson, Max W; Mirchandani, Jyotika; Duong, Joseph; Grimaldo, Sammy; Kocieda, Virginia; Hendel, Houria; Khalili, Kamel; Zagury, Jean François; Rappaport, Jay
Disclosing HIV status to friends, family, and sex partners is often stressful. However, HIV disclosure has been associated with improved physical health, psychological well-being, and improved health behaviors. The aim of this study was to address some of the gaps in the literature regarding the disclosure process by conducting a mixed-methods study of disclosure in people newly diagnosed with HIV and the relationship of disclosure to stigma and social support. The CHAI (Coping, HIV, and Affect Interview) Study was a longitudinal cohort study that followed individuals who were newly diagnosed with HIV. The study took place from October 2004 to June 2008 in the San Francisco Bay Area. This sample includes data from 50 participants who were interviewed 1, 3, and 9 months following diagnosis with HIV. We identified four main approaches to HIV disclosure that revealed distinct differences in how participants appraised disclosure, whether disclosure was experienced as stressful, and whether disclosure or nondisclosure functioned as a way of coping with an HIV diagnosis. Implications of these findings for disclosure counseling are discussed. PMID:22256856
Hult, Jen R; Wrubel, Judith; Bränström, Richard; Acree, Michael; Moskowitz, Judith Tedlie
Background Retrieving pertinent information from biological scientific literature requires cutting-edge text mining methods which may be able to recognize the meaning of the very ambiguous names of biological entities. Aliases of a gene share a common vocabulary in their respective collections of PubMed abstracts. This may be true even when these aliases are not associated with the same subset of documents. This gene-specific vocabulary defines a unique fingerprint that can be used to disclose ambiguous aliases. The present work describes an original method for automatically assessing the ambiguity levels of gene aliases in large gene terminologies based exclusively in the content of their associated literature. The method can deal with the two major problems restricting the usage of current text mining tools: 1) different names associated with the same gene; and 2) one name associated with multiple genes, or even with non-gene entities. Important, this method does not require training examples. Results Aliases were considered “ambiguous” when their Jaccard distance to the respective official gene symbol was equal or greater than the smallest distance between the official gene symbol and one of the three internal controls (randomly picked unrelated official gene symbols). Otherwise, they were assigned the status of “synonyms”. We evaluated the coherence of the results by comparing the frequencies of the official gene symbols in the text corpora retrieved with their respective “synonyms” or “ambiguous” aliases. Official gene symbols were mentioned in the abstract collections of 42 % (70/165) of their respective synonyms. No official gene symbol occurred in the abstract collections of any of their respective ambiguous aliases. In overall, querying PubMed with official gene symbols and “synonym” aliases allowed a 3.6-fold increase in the number of unique documents retrieved. Conclusions These results confirm that this method is able to distinguish between synonyms and ambiguous gene aliases based exclusively on their vocabulary fingerprint. The approach we describe could be used to enhance the retrieval of relevant literature related to a gene.
Psychometric properties of external HIV-related stigma and discrimination scales and their predictors were investigated. A cross-sectional community-based study was carried out among 520 participants using an ongoing health and demographic surveillance system in León, Nicaragua. Participants completed an 18-item HIV stigma scale and 19 HIV and AIDS discrimination-related statements. A factor analysis found that 15 of the 18 items in the stigma scale and 18 of the 19 items in the discrimination scale loaded clearly into five- and four-factor structures, respectively. Overall Cronbach's alpha of .81 for the HIV stigma scale and .91 for the HIV discrimination scale provided evidence of internal consistency. Hierarchical multiple linear regression analysis identified that females, rural residents, people with insufficient HIV-related transmission knowledge, those not tested for HIV, those reporting an elevated self-perception of HIV risk, and those unwilling to disclose their HIV status were associated with higher stigmatizing attitudes and higher discriminatory actions towards HIV-positive people. This is the first community-based study in Nicaragua that demonstrates that overall HIV stigma and discrimination scales were reliable and valid in a community-based sample comprised of men and women of reproductive age. Stigma and discrimination were reported high in the general population, especially among sub-groups. The findings in the current study suggest community-based strategies, including the monitoring of stigma and discrimination, and designing and implementing stigma reduction interventions, are greatly needed to reduce inequities and increase acceptance of persons with HIV. PMID:23514083
Ugarte, William J; Högberg, Ulf; Valladares, Eliette C; Essén, Birgitta
Many young people growing up with HIV are choosing not to disclose their status to others, yet are likely to face difficult decisions and conversations such as explaining school absence, taking medication, coping with physical changes and for many, parental bereavement. This study aims to describe and explore the attitudes and opinions of adolescents with perinatally acquired HIV towards disclosure. Semi-structured interviews were conducted with nine young people aged 13-19 and analysed using Interpretative Phenomenological Analysis. Four themes emerged to illuminate the young people's attitudes towards disclosure. These were 1) myths and assumptions, 2) the disclosure dilemma, 3) fear and 4) keeping HIV in its place. This study confirms that many young people with HIV are choosing not to disclose. However, it appears that it is a complex decision-making process that changes over time and is influenced by developmental factors and societal attitudes towards HIV. Recommendations are suggested for services to better support adolescents growing up with HIV. PMID:22287554
Hogwood, Jemma; Campbell, Tomás; Butler, Stephen
Aims Combined anti-retroviral therapy (cART) has led to a reduction in the incidence of HIV-associated dementia (HAD), a severe motor/cognitive disorder afflicting HIV(+) patients. However, the prevalence of subtler forms of neurocognitive dysfunction, which together with HAD are termed HIV-associated neurocognitive disorders (HAND), continues to escalate in the post-cART era. The microgliosis, astrogliosis, dendritic damage, and synaptic and neuronal loss observed in autopsy cases suggest an underlying neuroinflammatory process, due to the neurotoxic factors released by HIV-infected/activated macrophages/ microglia in the brain, might underlie the pathogenesis of HAND in the post-cART era. These factors are known to induce the integrated stress response (ISR) in several neurodegenerative diseases; we have previously shown that BiP, an indicator of general ISR activation, is upregulated in cortical autopsy tissue from HIV-infected patients. The ISR is composed of three pathways, each with its own initiator protein: PERK, IRE1? and ATF6. Methods To further elucidate the specific ISR pathways activated in the central nervous system of HAND patients, we examined the protein levels of several ISR proteins, including ATF6, peIF2? and ATF4, in cortical tissue from HIV-infected patients. Results The ISR does not respond in an all-or-none fashion in HAND, but rather demonstrates a nuanced activation pattern. Specifically, our studies implicate the ATF6 pathway of the ISR as a more likely candidate than the PERK pathway for increases in BiP levels in astrocytes. Conclusion These findings begin to characterize the nature of the ISR response in HAND and provide potential targets for therapeutic intervention in this disease.
Akay, C.; Lindl, K. A.; Shyam, N.; Nabet, B.; Goenaga-Vazquez, Y.; Ruzbarsky, J.; Wang, Y.; Kolson, D. L.; Jordan-Sciutto, K. L.
Larry Conway, an HIV-positive bartender, will receive $25,000 in damages from his former employer, The Pub, in Evansville, IL. The Federal Court ruled that Conway was terminated because he disclosed his HIV status to an emergency room nurse following a workplace-based accident. Upon hearing the news, restaurant owner Larry Pollock relieved Conway of his position. Conway's attorneys claimed that The Pub violated the Americans with Disabilities Act (ADA), which prohibits disability-based employment discrimination. The suit was filed on behalf of the Equal Employment Opportunity Commission (EEOC), which also charged that Conway's privacy had been violated. During pretrial discovery proceedings, the key issue was whether Conway's case could be heard because of the small size of The Pub's operation. Before the issue could be resolved, The Pub offered to settle out of court. Under the terms of the settlement, The Pub will institute a confidentiality policy for all employees' medical information. Conway has filed suit against St. Mary's Hospital for disclosing his HIV status to his employer. That case is in the discovery phase. PMID:11362947
Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this vulnerable population, but research is challenged by the men’s need for secrecy. In this paper we report on successful efforts to recruit 33 non-disclosing, NGI Black MSMW for in-depth interviews concerning substance use, HIV risk and attitudes toward disclosing their risk behaviour. We employed targeted and referral sampling, with initial contacts and/or key informants drawn from several types of settings in New York City including known gay venues, community organisations, neighbourhood networks and the Internet. Key informant gatekeepers and the ability to establish rapport proved central to success. Perceived stigma is a source of social isolation, but men are willing to discuss their risk behaviour when they trust interviewers to protect their privacy and engage with them in a non-judgemental manner. Findings imply that the most effective prevention approaches for this population may be those that target risk behaviours without focusing on disclosure of sexual identities.
Benoit, Ellen; Pass, Michael; Randolph, Doris; Murray, Deborah; Downing, Martin J.
Non-gay identified (NGI) Black men who have sex with both men and women (MSMW) and who use substances are at risk of acquiring and transmitting HIV to their partners. Homophobic community norms can discourage such men from disclosing their risk behaviour to female partners and others, including service providers. It is important to understand the dynamics of risk in this vulnerable population, but research is challenged by the men's need for secrecy. In this paper we report on successful efforts to recruit 33 non-disclosing, NGI Black MSMW for in-depth interviews concerning substance use, HIV risk and attitudes toward disclosing their risk behaviour. We employed targeted and referral sampling, with initial contacts and/or key informants drawn from several types of settings in New York City, including known gay venues, community organisations, neighbourhood networks and the Internet. Key informant gatekeepers and the ability to establish rapport proved central to success. Perceived stigma is a source of social isolation, but men are willing to discuss their risk behaviour when they trust interviewers to protect their privacy and engage with them in a non-judgemental manner. Findings imply that the most effective prevention approaches for this population may be those that target risk behaviours without focusing on disclosure of sexual identities. PMID:22937767
Benoit, Ellen; Pass, Michael; Randolph, Doris; Murray, Deborah; Downing, Martin J
Background: Healthcare-related errors cause patient morbidity and mortality. Despite fear of reprimand, laboratory personnel have a professional obligation to rapidly report major medical errors when they are identified. Well-defined protocols regarding how and when to disclose a suspected error by a colleague do not exist. Patient: We describe a woman with a well documented allergy to sulfamethoxazole who was treated
Kimberley G. Crone; Michele B. Muraski; Joy D. Skeel; Latisha Love-Gregory; Jack H. Ladenson; Ann M. Gronowski
A gap exists between recommendations to disclose errors to patients and current practice. This gap may reflect important, yet unanswered questions about implementing disclosure principles. We explore some of these unanswered questions by presenting three real cases that pose challenging disclosure dilemmas. The first case involves a pancreas transplant that failed due to the pancreas graft being discarded, an error that was not disclosed partly because the family did not ask clarifying questions. Relying on patient or family questions to determine the content of disclosure is problematic. We propose a standard of materiality that can help clinicians to decide what information to disclose. The second case involves a fatal diagnostic error that the patient's widower was unaware had happened. The error was not disclosed out of concern that disclosure would cause the widower more harm than good. This case highlights how institutions can overlook patients' and families' needs following errors and emphasizes that benevolent deception has little role in disclosure. Institutions should consider whether involving neutral third parties could make disclosures more patient centered. The third case presents an intraoperative cardiac arrest due to a large air embolism where uncertainty around the clinical event was high and complicated the disclosure. Uncertainty is common to many medical errors but should not deter open conversations with patients and families about what is and is not known about the event. Continued discussion within the medical profession about applying disclosure principles to real-world cases can help to better meet patients' and families' needs following medical errors. PMID:19736193
Gallagher, Thomas H; Bell, Sigall K; Smith, Kelly M; Mello, Michelle M; McDonald, Timothy B
Purpose – In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance. Design\\/methodology\\/approach – The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it
Mark Exworthy; Glenn Smith; Jonathan Gabe; Ian Rees Jones
...RECORDS Production or Disclosure of Records Under the Freedom of Information Act, 5 U.S.C. 552 Charges for Search and Reproduction Â§ 2502.16 Information to be disclosed. (a) In general, all records of the Office of Administration are...
|Nearly 400 colleges across the United States are about to be asked to disclose intimate financial details of their operations to the Internal Revenue Service. This article reports on a highly detailed financial questionnaire designed by the IRS for the first phase of its Colleges and Universities Compliance Project, which is part of a continuing…
To date, there are no studies from El Salvador among people with HIV to inform prevention programs. We conducted a study in El Salvador in 2008 among people with HIV using audio computer-assisted interviews on risk behaviors and access to health care. Blood was tested for syphilis and herpes simplex type 2 (HSV-2). Active syphilis was defined as RPR titer ?1:8. Genital specimens were tested for other sexually transmitted infections (STI) by PCR. We evaluated factors associated with unprotected sex with last stable partner of HIV-negative or unknown status among those reporting a stable partner. A total of 811 HIV-positive individuals participated: 413 men and 398 women. Prevalence of Chlamydia and gonorrhea was low (?1%), while prevalence of other STI was high: Mycoplasma genitalium (14%), syphilis (15% seropositivity, active syphilis 3%) and HSV-2 (85%). In multivariate analysis, disclosing HIV status to partner (OR 0.2, 95% CI: 0.1-0.3, p<0.001), participation in HIV support groups (OR 0.3, 95% CI: 0.1-0.8, p=0.01), easy access to condoms (OR 0.4, 95% CI: 0.2-0.9, p=0.04) were protective factors for unprotected sex. Reporting a casual partner in the last 12 months (OR 3.6, 95% CI: 1.5-8.5, p=0.004). and having an STI (OR 2.6, 95% CI:1.3-5.5, p=0.02) were associated with an increased odds of unprotected sex. Prevention interventions among HIV-positives in El Salvador should focus on increasing condom access, promoting HIV disclosure and couples testing and reducing the number of partners. The positive role of support groups should be used to enhance behavioral change. PMID:23049671
Paz-Bailey, G; Shah, N; Creswell, J; Guardado, M E; Nieto, A I; Estrada, M C; Cedillos, R; Pascale, J M; Monterroso, E
|Objective: The study focused on children's nonverbal behavior in investigative interviews exploring suspicions of child abuse. The key aims were to determine whether non-verbal behavior in the pre-substantive phases of the interview predicted whether or not children would disclose the alleged abuse later in the interview and to identify…
Katz, Carmit; Hershkowitz, Irit; Malloy, Lindsay C.; Lamb, Michael E.; Atabaki, Armita; Spindler, Sabine
The purpose of the present study was to determine whether mental health professionals would breach the confidentiality of HIV-infected patients with uninformed sex partners, and how any such disclosure would occur. Subjects read one of eight vignettes that depicted a patient who refused to disclose his viral status. Results revealed a split of opinion about breaching confidentiality and about the preferred mode for doing so. Neither diagnosis nor mode of viral transmission significantly influenced breaching decisions. Subjects demonstrated a high level of AIDS risk knowledge but only a moderate level of legal/ethical knowledge. Implications of these findings are discussed. PMID:11443701
Simone, S J; Fulero, S M
The Russian HIV epidemic is primarily fuelled by injection drug use, but heterosexual spread may be playing an increasing role in transmission. Government-funded AIDS clinics provide most HIV treatment in Russia, and represent an important contact point between the medical community and infected population. Little is known about the population actively seeking HIV treatment. To describe demographics, perceived mode of acquisition and serostatus disclosure practices of HIV-infected individuals seeking treatment in St Petersburg, Russia, we conducted a cross-sectional study of 204 HIV-infected patients presenting to the St Petersburg City AIDS Center between May and June 2007. Mean age of respondents was 28 years old, 51% were women and two-thirds (67%) reported a history of injection drug use. Men were more likely to report injection (62% versus 45%) while women were more likely to identify sexual transmission (45% versus 32%) as their perceived infection route. Predictors of serostatus disclosure were female gender, married status and higher education. Women represent half of all patients seeking HIV treatment in St Petersburg, and are more likely than men to have disclosed their HIV-positive serostatus to sexual partners. While this population may not represent the burden of HIV disease in Russia, it is an important target group for secondary prevention. PMID:23104740
Davidson, A S; Zaller, N; Dukhovlinova, E; Toussova, O; Feller, E; Heimer, R; Kozlov, A
Stigma complicates the treatment of HIV worldwide. We examined whether a multi-component framework, initially consisting of enacted, felt normative, and internalized forms of individual stigma experiences, could be used to understand HIV-related stigma in Southern India. In Study 1, qualitative interviews with a convenience sample of 16 people living with HIV revealed instances of all three types of stigma. Experiences of discrimination (enacted stigma) were reported relatively infrequently. Rather, perceptions of high levels of stigma (felt normative stigma) motivated people to avoid disclosing their HIV status. These perceptions often were shaped by stories of discrimination against others HIV-infected individuals, which we adapted as an additional component of our framework (vicarious stigma). Participants also varied in their acceptance of HIV stigma as legitimate (internalized stigma). In Study 2, newly-developed measures of the stigma components were administered in a survey to 229 people living with HIV. Findings suggested that enacted and vicarious stigma influenced felt normative stigma; that enacted, felt normative, and internalized stigma were associated with higher levels of depression; and that the associations of depression with felt normative and internalized forms of stigma were mediated by the use of coping strategies designed to avoid disclosure of one's HIV serostatus.
Herek, Gregory M; Ramakrishna, Jayashree; Bharat, Shalini; Chandy, Sara; Wrubel, Judith; Ekstrand, Maria L
... t S tigma: The stigma associated with HIV and homosexuality may help to spread HIV in African American communities. Fear of disclosing risk behavior or sexual orientation prevents many from seeking testing, treatment and support from friends and family. As a ...
There is growing behavioral and epidemiological evidence to suggest that young men who have sex with men (YMSM) are at high\\u000a risk for becoming HIV-infected. Unfortunately, relatively little research has been conducted to examine the range of individual,\\u000a social, and community-level factors that put these young men at increased risk. To address existing gaps in the literature,\\u000a the Healthy Young
Michele D. Kipke; George Weiss; Carolyn F. Wong
CUMHURYET ÜNVERSTESD?? HEKML??? FAKÜLTESNE BAVURAN HASTALARDA HEPATT B, C VE HIV SEROPREVELANSI VE HEPATT B AILANMA DURUMU SEROPREVALENCE OF HIV, HEPATITIS B AND HEPATITIS C OF PATIENTS REFERRED TO CUMHURYET UNIVERSITY FACULTY OF DENTISTRY AND THEIR STATUS OF HEPATITIS B VACCINE
SUMMARY Purpose: The purpose of this study was to detect seroprevalence of HIV, Hepatitis B and Hepatitis C of patients referred to Cumhuriyet University Faculty of Dentistry and their status of to be vaccinated of Hepatitis B. Material and Methods: The study was cross sectional and descriptive depended on time. A number of 522 patients were included to the study
Defne YALÇIN YELER; Feridun HÜRMÜZLÜ; Özden ÖZEL; Ziynet ÇINAR
The TIM (T cell/transmembrane, immunoglobulin and mucin) proteins are crucial regulators of Th1/Th2 immune responses and have been implicated in several diseases including HIV-1/AIDS. The TIM1 exon 4 that codes for mucin domain is highly diverse, with sequence variants associated with varying phenotypes. In this study, TIM1 exon 4 was sequenced among 227 HIV-1 seroprevalent and 288 healthy non infected individuals from North Indian population and haplotypes established. A novel but rare haplotype D1(?) was identified among the healthy and differed from D1 by a synonymous substitution G>T at Thr208Thr. The TIM1 haplotype diversity showed no association with susceptibility to HIV-1 infection. The seroprevalent individuals carrying D3A had relatively higher median CD4+T cell counts (368/?l) than those without (313/?l; p=0.02). A comparison of CD4+T counts between D3-A individuals on ART or ART naïve did not show any significant difference plausibly due to confounding nature of ART and other factors. PMID:23220501
Sharma, Gaurav; Ohtani, Hitoshi; Kaur, Gurvinder; Naruse, Taeko K; Sharma, S K; Vajpayee, Madhu; Kimura, Akinori; Mehra, Narinder
...disclosed or established cost accounting practices. 30.604 Section...CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION CAS Administration...disclosed or established cost accounting practices. (a)...
An anonymous audio computer-assisted self-interview (A-CASI) designed to increase awareness of abuse was completed by 305 women with diverse disabilities. Data were also collected about lifetime and past year abuse; perpetrator risk characteristics; facilitators and barriers to disclosing abuse; abuse disclosure to a health provider, case manager, or police officer; and whether a health provider had ever discussed abuse or personal safety. A total of 276 (90%) women reported abuse, 208 (68%) reported abuse within the past year. Women who reported the most abuse experiences in the past year and the most dangerous perpetrators endorsed fewer facilitators and more barriers, but were also more likely to have ever disclosed abuse. Only 15% reported that a health provider had ever discussed abuse and personal safety. PMID:21882667
Curry, Mary Ann; Renker, Paula; Robinson-Whelen, Susan; Hughes, Rosemary B; Swank, Paul; Oschwald, Mary; Powers, Laurie E
\\u000a How do teenagers react when marketeers request personal data online? This is the central question of a survey conducted among\\u000a 1,318 Belgian 12–18 year-olds. The present study reveals that despite a sceptical attitude towards online data collecting\\u000a practices, teenagers are still prepared to disclose much personal information. The study discerns two categories of personal\\u000a information: contact data and profile data.
Michel Walrave; Wannes Heirman
Comparative chromosome painting, termed ZOO-FISH, using DNA libraries from flow sorted human chromosomes 1,16,17 and X, and mouse chromosome 11 discloses the presence of syntenic groups in distantly related mammalian Orders ranging from primates (Homo sapiens), rodents (Mus musculus), even-toed ungulates (Muntiacus muntjak vaginalis and Muntiacus reevesi) and whales (Balaenoptera physalus). These mammalian Orders have evolved separately for 55-80 million
Harry Scherthan; Thomas Cremer; Ulfur Arnason; Heinz-Ulrich Weier; Antonio Lima-de-Faria; Lutz Frönicke
Serotype specific antibody concentration and opsonophagocytic activity (OPA) were evaluated following three doses of pneumococcal conjugate vaccine. Groups included HIV+ infants with CD4+ ?25% initiated on immediate antiretroviral treatment (HIV+/ART+) or ART was deferred until clinically or immunologically indicated (HIV+/ART?). Immune responses were also evaluated in HIV non-infected infants born to HIV-seronegative (M?/I?) or HIV+ mothers (M+/I?). Antibody concentrations were similar between HIV+/ART+ and HIV+/ART? infants. Antibody concentrations were, however, lower in M?/I? compared to M+/I? infants. M?/I? infants, nevertheless, had superior OPA responses compared to HIV+/ART+, who in turn had better OPA responses compared to HIV+/ART? infants.
Madhi, Shabir A.; Adrian, Peter; Cotton, Mark F.; McIntyre, James A.; Jean-Philippe, Patrick; Meadows, Shawn; Nachman, Sharon; Kayhty, Helena; Klugman, Keith P.; Violari, Avye
HIV-disclosure among childbearing women remains poorly understood, particularly in sub-Saharan Africa. This paper chronicles disclosure experiences of 31 women attending prevention of mother-to-child HIV transmission services in Johannesburg. Data collection entailed repeat in-depth interviews over a nine-month period. Virtually all women (93.5%) had told at least one person (usually a partner), most voluntarily and within a week of the test result. Secondary disclosure was most likely with female family members, through indirect means and involuntary. Confidentiality breach by primary targets likely contributed to the observed high rates of involuntary secondary disclosure and negative secondary disclosure experiences. For most mothers, voluntary disclosure was driven by the desire to ensure adequate infant care and avoid vertical HIV transmission. The impact of disclosure was not always clear-cut. While most primary disclosure experiences were ultimately constructive, secondary disclosure more likely led to rejection, stigmatization and the withholding of financial support. Our data illustrate the influence of social contextual factors on disclosure patterns and impact. For these mothers, socio-cultural norms, the current media and political environment surrounding HIV/AIDS, household composition and social networks and childbearing status shaped disclosure experiences; sometimes constraining disclosure circumstances and sometimes creating a safe space to disclose. Programmatic implications are also discussed. PMID:17012085
Varga, C A; Sherman, G G; Jones, S A
Background The Step Study found that men who had sex with men (MSM) who received an adenovirus type 5 (Ad5) vector-based vaccine and were uncircumcised or had prior Ad5 immunity had a higher HIV incidence than MSM who received placebo. We investigated whether differences in HIV exposure, measured by reported sexual risk behaviors, may explain the increased risk. Methods Among 1,764 MSM in the trial, 724 were uncircumcised, 994 had prior Ad5 immunity and 560 were both uncircumcised and had prior Ad5 immunity. Analyses compared sexual risk behaviors and perceived treatment assignment among vaccine and placebo recipients, determined risk factors for HIV acquisition and examined the role of insertive anal intercourse in HIV risk among uncircumcised men. Findings Few sexual risk behaviors were significantly higher in vaccine vs. placebo recipients at baseline or during follow-up. Among uncircumcised men, vaccine recipients at baseline were more likely to report unprotected insertive anal intercourse with HIV negative partners (25.0% vs. 18.1%; p=0.03). Among uncircumcised men who had prior Ad5 immunity, vaccine recipients were more likely to report unprotected insertive anal intercourse with partners of unknown HIV status (46.0% vs. 37.5%; p=0.05). Vaccine recipients remained at higher risk of HIV infection compared to placebo recipients (HR =2.8; 95% CI:1.7, 6.8) controlling for potential confounders. Interpretation These analyses do not support a behavioral explanation for the increased HIV infection rates observed among uncircumcised men in the Step Study. Identifying biologic mechanisms to explain the increased risk is a priority. This study is registered with ClinicalTrials.gov, number NCT00095576.
Koblin, Beryl A.; Mayer, Kenneth H.; Noonan, Elizabeth; Wang, Ching-Yun; Marmor, Michael; Sanchez, Jorge; Brown, Stephen J.; Robertson, Michael N.; Buchbinder, Susan P.
A longitudinal study was conducted to investigate the association between human immunodeficiency virus (HIV) infection, history of major depressive disorder (MDD), and persistent or recurrent MDD among intravenous drug users. Psychiatric disorders were assessed in a sample of HIV-positive (HIV+) and HIV-negative (HIV?) intravenous drug users every 6 months for 3 years. Results indicated that HIV status and baseline MDD
Jeffrey G Johnson; Judith G Rabkin; Joshua D Lipsitz; Janet B. W Williams; Robert H Remien
Introduction Translation of the evidence regarding the protective role of highly active antiretroviral therapy (HAART) on HIV sexual transmission rates into sexual behaviour patterns of HIV-infected subjects remains largely unexplored. This study aims to describe frequency of self-reported condom use among women living with HIV in Italy and to investigate the variables associated with inconsistent condom use (ICU). Methods DIDI (Donne con Infezione Da HIV) is an Italian multicentre study based on a questionnaire survey performed during November 2010 and February 2011. Women-reported frequency of condom use was dichotomized in “always” versus “at times”/“never” (ICU). Results Among 343 women, prevalence of ICU was 44.3%. Women declared a stable partnership with an HIV-negative (38%) and with an HIV-positive person (43%), or an occasional sexual partner (19%). Among the 194 women engaged in a stable HIV-negative or an occasional partnership, 51% reported fear of infecting the partner. Nonetheless, 43% did not disclose HIV-positive status. Less than 5% of women used contraceptive methods other than condoms. At multivariable analysis, variables associated with ICU in the subgroup of women with a stable HIV-negative or an occasional HIV-unknown partner were: having an occasional partner (AOR 3.51, 95% confidence interval [CI] 1.44–8.54, p=0.005), and reporting fear of infecting the sexual partner (AOR 3.20, 95% CI 1.43–7.16, p=0.004). Current use of HAART together with virological control in plasma level did not predict ICU after adjusting for demographic, behavioural and HIV-related factors. With regard to socio-demographic factors, lower education was the only variable significantly associated with ICU in the multivariate analysis (AOR 2.27, 95% CI 1.07–4.82, p=0.03). No association was found between high adherence to HAART and ICU after adjusting for potential confounders (AOR 0.89, 95% CI 0.39–2.01, p=0.78). Conclusions Currently in Italy, the use of HAART with undetectable HIV RNA in plasma as well as antiretroviral adherence is not associated with a specific condom use pattern in women living with HIV and engaged with a sero-discordant or an HIV-unknown partner. This might suggest that the awareness of the protective role of antiretroviral treatment on HIV sexual transmission is still limited among HIV-infected persons, at least in this country.
Cicconi, Paola; Monforte, Antonella d'Arminio; Castagna, Antonella; Quirino, Tiziana; Alessandrini, Anna; Gargiulo, Miriam; Francisci, Daniela; Anzalone, Enza; Liuzzi, Giuseppina; Pierro, Paola; Ammassari, Adriana
Introduction: Translation of the evidence regarding the protective role of highly active antiretroviral therapy (HAART) on HIV sexual transmission rates into sexual behaviour patterns of HIV-infected subjects remains largely unexplored. This study aims to describe frequency of self-reported condom use among women living with HIV in Italy and to investigate the variables associated with inconsistent condom use (ICU). Methods: DIDI (Donne con Infezione Da HIV) is an Italian multicentre study based on a questionnaire survey performed during November 2010 and February 2011. Women-reported frequency of condom use was dichotomized in "always" versus "at times"/"never" (ICU). Results: Among 343 women, prevalence of ICU was 44.3%. Women declared a stable partnership with an HIV-negative (38%) and with an HIV-positive person (43%), or an occasional sexual partner (19%). Among the 194 women engaged in a stable HIV-negative or an occasional partnership, 51% reported fear of infecting the partner. Nonetheless, 43% did not disclose HIV-positive status. Less than 5% of women used contraceptive methods other than condoms. At multivariable analysis, variables associated with ICU in the subgroup of women with a stable HIV-negative or an occasional HIV-unknown partner were: having an occasional partner (AOR 3.51, 95% confidence interval [CI] 1.44-8.54, p=0.005), and reporting fear of infecting the sexual partner (AOR 3.20, 95% CI 1.43-7.16, p=0.004). Current use of HAART together with virological control in plasma level did not predict ICU after adjusting for demographic, behavioural and HIV-related factors. With regard to socio-demographic factors, lower education was the only variable significantly associated with ICU in the multivariate analysis (AOR 2.27, 95% CI 1.07-4.82, p=0.03). No association was found between high adherence to HAART and ICU after adjusting for potential confounders (AOR 0.89, 95% CI 0.39-2.01, p=0.78). Conclusions: Currently in Italy, the use of HAART with undetectable HIV RNA in plasma as well as antiretroviral adherence is not associated with a specific condom use pattern in women living with HIV and engaged with a sero-discordant or an HIV-unknown partner. This might suggest that the awareness of the protective role of antiretroviral treatment on HIV sexual transmission is still limited among HIV-infected persons, at least in this country. PMID:24135086
Cicconi, Paola; Monforte, Antonella d'Arminio; Castagna, Antonella; Quirino, Tiziana; Alessandrini, Anna; Gargiulo, Miriam; Francisci, Daniela; Anzalone, Enza; Liuzzi, Giuseppina; Pierro, Paola; Ammassari, Adriana
Background The health-related quality of life (HRQL) of people living with HIV infection is an important consideration in HIV management. The PROQOL-HIV psychometric instrument was recently developed internationally as a contemporary, discriminating HIV-HRQL measure incorporating influential emotional dimensions such as stigma. Here we present the first within-country results of PROQOL-HIV using qualitative and quantitative data collected from a West Australian cohort who participated in the development and validation of PROQOL-HIV, and provide a comprehensive picture of HRQL in our setting. Methods We carried out a secondary analysis of data from Australian patients who participated in the international study: 15 in-depth interviews were conducted and 102 HRQL surveys using the PROQOL-HIV instrument and a symptom questionnaire were administered. We employed qualitative methods to extract description from the interview data and linear regression for exploration of the composite and sub-scale scores derived from the survey. Results Interviews revealed the long-standing difficulties of living with HIV, particularly in the domains of intimate relationships, perceived stigma, and chronic ill health. The novel PROQOL-HIV instrument discriminated impact of treatment via symptomatology, pill burden and treatment duration. Patients demonstrated lower HRQL if they were: newly diagnosed (p=0.001); naive to anti-retroviral treatment (p=0.009); reporting depression, unemployment or a high frequency of adverse symptoms, (all p<0.001). Total HRQL was notably reduced by perceived stigma with a third of surveyed patients reporting persistent fears of both disclosing their HIV status and infecting others. Conclusions The analysis showed that psychological distress was a major influence on HRQL in our cohort. This was compounded in people with poor physical health which in turn was associated with unemployment and depression. People with HIV infection are living longer and residual side effects of the earlier regimens complicate current clinical management and affect their quality of life. However, even for the newly diagnosed exposed to less toxic regimens, HIV-related stigma exerts negative social and psychological effects. It is evident that context-specific interventions are required to address persistent distress related to stigma, reframe personal and public perceptions of HIV infection and ameliorate its disabling social and psychological effects.
Intestinal infection causing diarrheal disease is a dominant contributor to high morbidity and mortality in developing countries. This intervention study aimed to assess the response of specific anti-microbial and anti-retroviral therapy (ART) on enteropathogens identified in HIV/AIDS adult subjects from northern India. Seventy five ART naive (group 1) and seventy five ART adherent (group 2) HIV/AIDS adult subjects with diarrhea were enrolled. Stool samples from all subjects were examined for enteropathogens by wet mount, staining methods, culture and ELISA. Subjects with enteropathogens were started on specific therapy as per National AIDS Control Organisation, Government of India's guidelines. Follow-up stool samples were examined after 2-4 weeks of completion of therapy for persistence/clearing of enteropathogens. CD4+ T lymphocyte count was done for all subjects. At enrollment, group 1 had 26.13% bacterial, 57.66% parasitic & 16.22% fungal pathogens while group 2 had 11.9%, 69.05% & 19.05% pathogens, respectively. Parasitic diarrhea was more common than bacterial diarrhea. The coccidian parasites (Cryptosporidium spp. & Isospora belli) were the common parasites identified. Clearance of enteric pathogens was significant after specific anti-microbial therapy (p = 0.0001). Persistence of enteropathogens was seen primarily for coccidian parasites. Clearance of enteropathogens after specific therapy and the diagnostic yield of stool specimens were influenced by the CD4+ counts. Immune competence coupled with specific anti-microbial therapy displays the best response against enteric pathogens. PMID:23968293
Jha, Arun Kumar; Uppal, Beena; Chadha, Sanjim; Aggarwal, Prabhav; Ghosh, Roumi; Dewan, Richa
We present preliminary results of a 200-orbit HST/WFC3 survey of compact Galactic planetary nebulae, aimed at filling the blanks in the morphological studies, and in particular to study the early onset of morphology. Planetary nebulae smaller than 4" are usually younger than ˜5000 yr, thus the early stages of their evolution is conveniently studied therein. Both broad- and narrow-band imagery has been employed to disclose both nebular and central star characteristics. We found that early morphology is represented by the known main types, including bipolar and quadrupolar PNe. Statistics, images, and correlations with dust properties of the nebulae analyzed via Spitzer spectra are presented in this paper.
Stanghellini, L.; Shaw, R. A.; Villaver, E.
Medical error is an inevitable occurrence that stresses the relationship between healthcare professionals and their patients. The number of errors is shocking; so too, is the revelation that few medical errors are routinely disclosed. When healthcare providers fail to inform patients of harm-causing medical error, then trust in the patient/provider relationship is broken and many ethical challenges surface. To successfully restore trust and perhaps lower liability costs, healthcare providers must avoid pointing fingers and adopt a policy of honesty and full disclosure. PMID:12166433
Introduction Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), and in-depth interviews (IDI)) to better understand adherence barriers for Rwandan adolescents. Forty-two HIV positive adolescents (ages 12–21) and a selection of their primary caregivers were interviewed. All were perinatally-infected and received (cART) for ?12 months. Topics discussed during FGDs and IDIs included learning HIV status, disclosure and stigma, care and treatment issues, cART adherence barriers. Results Median age was 17 years, 45% female, 45% orphaned, and 48% in boarding schools. We identified three overarching but inter-related themes that appeared to influence adherence. Stigma, perceived and experienced, and inadvertent disclosure of HIV status hampered adolescents from obtaining and taking their drugs, attending clinic visits, carrying their cARTs with them in public. The second major theme was the need for better support, in particular for adolescents with different living situations, (orphanages, foster-care, and boarding schools). Lack of privacy to keep and take medication came out as major barrier for adolescents living in congested households, as well the institutionalization of boarding schools where privacy is almost non-existent. The third important theme was the desire to be ‘normal’ and not be recognized as an HIV-infected individual, and to have a normal life not perturbed by taking a regimen of medications or being forced to disclose where others would treat them differently. Conclusions We propose better management of HIV-infected adolescents integrated into boarding school, orphanages, and foster care; training of school-faculty on how to support students and allow them privacy for taking their medications. To provide better care and support, HIV programs should stimulate caregivers of HIV-infected adolescents to join them for their clinic visits.
Mutwa, Philippe R.; Van Nuil, Jennifer Ilo; Asiimwe-Kateera, Brenda; Kestelyn, Evelyne; Vyankandondera, Joseph; Pool, Robert; Ruhirimbura, John; Kanakuze, Chantal; Reiss, Peter; Geelen, Sibyl; van de Wijgert, Janneke; Boer, Kimberly R.
Since 1970, OSHA has used its authority to regulate various health and safety hazards in private workplaces. Two types of OSHA regulations establish rights to know and duties to disclose: rules dealing with specific substances, and generic access to information rules. OSHA rules for specific hazards such as coke oven emissions, asbestos, arsenic, acrylonitrile, cotton dust, noise, and lead each contain separate requirements for record compilation, reporting, and worker access. Generic rights of access and duties to disclose are afforded by three OSHA rules: the rule on inspections under the general duty clause of the enabling statute, the access to medical and exposure records rule, and the new hazard communication rule. Under the general duty clause and OSHA regulation, workers have the right to request OSHA inspection, and to be notified of any imminent dangers of death or serious physical harm discovered by the inspector. The effectiveness of this rule is dependent on worker initiative, OSHA inspection, and the extent to which proprietary claims limit disclosures. It is usually invoked after some exposure has occurred, and thus has a somewhat limited role in risk prevention. Legal and historical aspects of these regulations are discussed in detail in this review. 38 references
Introduction: There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians’ own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. Methods: This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. Results: The steps are 1) physician preparation, such as talking about the physician’s emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. Conclusion: This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.
Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R
As technical knowledge and public information in medical genetics continue to expand, the geneticist may expect to be held responsible for informing patients and clients about new developments in research and diagnosis. The long legal evolution of the physician's duty to disclose, and more recent findings of a physician's duty to recall former patients to inform them about newly discovered risks of treatment, indicate that medical geneticists may have a duty to disclose both current and future information about conditions that are or could be inherited. Recent case law supports findings of professional liability for both present and future disclosure, even in the absence of an active physician-patient relationship. The requirement of candid and complete disclosure will affect the counseling approach in testing for deleterious genes and in providing medical treatment for minors with hereditary diseases. Finding a duty to recall may impose further professional burdens on the geneticist to reach beyond the immediate counseling arena and to recontact patients, perhaps years after their initial visit to genetics clinic. PMID:1867289
Pelias, M Z
Studies concerning persons living with HIV (PLWH) report that stressful life events (SLEs) contribute to an exacerbation of symptoms and reduced antiretroviral (ARV) adherence and quality of life (QOL). Little is known about whether these findings are site-specific. Our study's aims were to characterize the type and frequency of SLEs for PLWH in Puerto Rico, South Africa, and the United States, and to assess the impact of SLEs by national site, symptoms, and ARV adherence concerns on QOL. The sample consisted of 704 participants. The total number of SLEs correlated significantly with the total number of symptoms, adherence concerns, and QOL (p ? .001). Overall, 27.2% of the variance in QOL was explained by the aforementioned variables. Although SLEs were of concern to PLWH, worries about ARV adherence were of even greater concern. Routine assessment of ARV concerns and SLEs can promote ongoing ARV adherence and improved QOL. PMID:23473660
Corless, Inge B; Voss, Joachim; Guarino, A J; Wantland, Dean; Holzemer, William; Jane Hamilton, Mary; Sefcik, Elizabeth; Willard, Suzanne; Kirksey, Kenn; Portillo, Carmen; Mendez, Marta Rivero; Rosa, Maria E; Nicholas, Patrice K; Human, Sarie; Maryland, Mary; Moezzi, Shahnaz; Robinson, Linda; Cuca, Yvette
Low CD4 lymphocyte count was a marker for neurological disease in human immunodeficiency virus type 1 (HIV-1); but is now\\u000a less common among patients with access to highly active antiretroviral therapy. In this study, the authors determine the reliability\\u000a of self-reported CD4 nadir and its predictive value for neurological status. The authors identify a high degree of reliability\\u000a (r =
Victor Valcour; Priscilla Yee; Andrew E. Williams; Bruce Shiramizu; Michael Watters; Ola Selnes; Robert Paul; Cecilia Shikuma; Ned Sacktor
HIV-related stigma has been recognized as a significant public health issue, yet gaps remain in development and evaluation of mass media interventions to reduce stigma. The Malawi 'Radio Diaries' (RD) program features people with HIV telling stories about their everyday lives. This study evaluates the program's effects on stigma and the additional effects of group discussion. Thirty villages with 10 participants each were randomized to listen to RD only, to the program followed by group discussion or to a control program. Post-intervention surveys assessed four stigma outcomes: fear of casual contact, shame, blame and judgment and willingness to disclose HIV status. Regression analyses indicated that fear of casual contact was reduced by the intervention. Shame was reduced by the radio program, but only for those reporting prior exposure to the radio program and for those who did not have a close friend or relative with HIV. Shame was not reduced when the radio program was followed by discussion. The intervention reduced blame for men and not women and for younger participants but not older participants. Including people with HIV/AIDS in mass media interventions has potential to reduce stigma. PMID:21393376
Creel, A H; Rimal, R N; Mkandawire, G; Böse, K; Brown, J W
BACKGROUND: China has witnessed a remarkable increase in sexually transmitted infections (STIs) and HIV. The study is to assess the prevalence of HIV, HBV, HCV and syphilis and related risk factors among drug users in mandatory detoxification center Qingyuan, Guangdong, China. METHOD: A cross-sectional study on drug use behaviors, sex behaviors, and presence of antibodies to HIV, HCV, Treponema pallidum,
Jie Wu; Jinying Huang; Duorong Xu; Ciyong Lu; Xueqing Deng; Xiaolan Zhou
Despite a growing literature assessing pregnancy desires among HIV-infected women enrolled in clinical care, little attention has been paid to HIV-infected youth for whom pregnancy is a very relevant issue. In urban areas with high rates of teen pregnancy and HIV infection, further understanding of childbearing motivations and relationship dynamics influencing pregnancy desires among female youth is needed. This study
Sarah Finocchario-Kessler; Michael D. Sweat; Jacinda K. Dariotis; Jean R. Anderson; Jacky M. Jennings; Jean M. Keller; Amita A. Vyas; Maria E. Trent
Despite a growing literature assessing pregnancy desires among HIV-infected women enrolled in clinical care, little attention has been paid to HIV-infected youth for whom pregnancy is a very relevant issue. In urban areas with high rates of teen pregnancy and HIV infection, further understanding of childbearing motivations and relationship dynamics influencing pregnancy desires among female youth is needed. This study
Sarah Finocchario-Kessler; Michael D. Sweat; Jacinda K. Dariotis; Jean R. Anderson; Jacky M. Jennings; Jean M. Keller; Amita A. Vyas; Maria E. Trent
A total of two hundred ninety-nine 4- to 9-year-old maltreated and nonmaltreated children of comparable socioeconomic status and ethnicity judged whether children should or would disclose unspecified transgressions of adults (instigators) to other adults (recipients) in scenarios varying the identity of the instigator (stranger or parent), the identity of the recipient (parent, police, or teacher), and the severity of the transgression (“something really bad” or “something just a little bad”). Children endorsed more disclosure against stranger than parent instigators and less disclosure to teacher than parent and police recipients. The youngest maltreated children endorsed less disclosure than nonmaltreated children, but the opposite was true among the oldest children. Older maltreated children distinguished less than nonmaltreated children between parents and other types of instigators and recipients.
Lyon, Thomas D.; Ahern, Elizabeth C.; Malloy, Lindsay C.; Quas, Jodi A.
A total of two hundred ninety-nine 4- to 9-year-old maltreated and nonmaltreated children of comparable socioeconomic status and ethnicity judged whether children should or would disclose unspecified transgressions of adults (instigators) to other adults (recipients) in scenarios varying the identity of the instigator (stranger or parent), the identity of the recipient (parent, police, or teacher), and the severity of the transgression ("something really bad" or "something just a little bad"). Children endorsed more disclosure against stranger than parent instigators and less disclosure to teacher than parent and police recipients. The youngest maltreated children endorsed less disclosure than nonmaltreated children, but the opposite was true among the oldest children. Older maltreated children distinguished less than nonmaltreated children between parents and other types of instigators and recipients. PMID:21077859
Lyon, Thomas D; Ahern, Elizabeth C; Malloy, Lindsay C; Quas, Jodi A
Humans devote 30–40% of speech output solely to informing others of their own subjective experiences. What drives this propensity for disclosure? Here, we test recent theories that individuals place high subjective value on opportunities to communicate their thoughts and feelings to others and that doing so engages neural and cognitive mechanisms associated with reward. Five studies provided support for this hypothesis. Self-disclosure was strongly associated with increased activation in brain regions that form the mesolimbic dopamine system, including the nucleus accumbens and ventral tegmental area. Moreover, individuals were willing to forgo money to disclose about the self. Two additional studies demonstrated that these effects stemmed from the independent value that individuals placed on self-referential thought and on simply sharing information with others. Together, these findings suggest that the human tendency to convey information about personal experience may arise from the intrinsic value associated with self-disclosure.
Tamir, Diana I.; Mitchell, Jason P.
SUMMARY SETTING: Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients. DESIGN: A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia. RESULTS: Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54). CONCLUSION: Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance. CONTEXTE: Chezles patients tuberculeux russes, l’utilisation d’alcool, la résistance aux médicaments antituberculeux et un comportement à risque pour le virus de l’immunodéficience humaine (VIH) sont des sujets croissants d’inquiétude. SCHÉMA: Une étude: de prévalence de l’utilisation d’alcool et du comportement à risque pour le VIH a été menée sur un échantillon de 200 hommes et femmes adultes, admis dans des hôpitaux pour la tuberculose (TB) de Saint-Pétersbourg et d’Ivanovo en Russie. RÉSULTATS: Il y avait 72% d’hommes dans l’échantillon. L’âge moyen est de 41 ans. On a diagnostiqué la TB active par l’emploi d’une combinaison du cliché thoracique, de la bacilloscopie et des cultures d’expectoration. Chez 62% des patients, les critères DSM-IV pour utilisation courante d’alcool ou pour dépendance étaient présents. L’utilisation de drogues est inhabituelle: deux patients seulement ont signalé une utilisation récente de l’héroïne par voie intraveineuse. Il n’y avait qu’un seul cas d’infection VIH. Le score total moyen de la batterie d’évaluation des risques a été de 3,4. Il y avait de la dépression chez 60% de 1’échantillon, dont 17% étaient en dépression sévère. L’utilisation ou la dépendance à l’égard de l’alcool étaient associées avec une multiplication par huit de la résistance aux médicaments (OR 8,58 ; IC95% 2,09-35,32). Les patients atteints de rechute de TB ou de TB chronique sont plus susceptibles de répondre aux critérés d’abus ou de dépendance de l’alcool (OR 2,56; IC95% 1,0-6,54). CONCLUSION: Les maladies liées à l’utilisation d’alcool sont fréquentes chez les patients traités pour TB active et sont associées à une morbidité significative. Des enquêtes complémentaires sont nécessaires pour examiner les relations entre les maladies liées à l’utilisation d’alcool et la résistance à l’égard des médicaments antituberculeux. MARCO DE REFERENCIA: El consumo de alcohol, la tuberculosis (TB) farmacorresistente y los comportamientos de riesgo para la infección por el virus de la inmunodeficiencia humana (VIH) constituyen una preocupación creciente en los pacientes con TB en la Fedéración de Rusia. MÉTODOS: Se llevó a cabo un estudio de prevalen
Fleming, M. F.; Krupitsky, E.; Tsoy, M.; Zvartau, E.; Brazhenko, N.; Jakubowiak, W.; E. McCaul, M.
Tuberculosis (TB) is the frequent major opportunistic infection in HIV-infected patients, and is the leading cause of mortality among HIV-infected patients. Genetic susceptibility to TB in HIV negative subjects is well documented. Since coinfections can influence the way in which immune system respond to different pathogens, genetic susceptibility to TB in HIV patients might also change. Studies from India and other parts of the world have shown that genetic susceptibility to TB is influenced by HIV infection. In the present review, we emphasize the role of genetic factors in determining susceptibility to HIV infection, disease progression and development of TB in HIV-infected patients. Polymorphisms in human leukocyte antigen (HLA), MBL2, CD209, vitamin D receptor, cytokine, chemokine and chemokine receptor genes have been shown to be associated with development of TB in HIV patients. However, the results are inconclusive and larger well-defined studies with precise clinical data are required to validate these associations. Apart from candidate gene approach, genome-wide association studies are also needed to unravel the unknown or to establish the previously reported genetic associations with HIV associated TB. Despite the preliminary status of the reported associations, it is becoming clear that susceptibility to development of TB in HIV patients is influenced by both environmental and genetic components. Understanding the genetic and immunologic factors that influence susceptibility to TB in HIV patients could lead to novel insights for vaccine development as well as diagnostic advances to target treatment to those who are at risk for developing active disease. PMID:21943869
Raghavan, S; Alagarasu, K; Selvaraj, P
Background Little is known concerning the impact of HIV status disclosure on quality of life, leaving clinicians and families to rely on research of children with other terminal illnesses. Objectives The purpose of this work was to examine the impact of HIV disclosure on pediatric quality of life and to describe the distribution of age at disclosure in a perinatally infected pediatric population. Methods A longitudinal analysis was conducted of perinatally HIV-infected youth ?5 years of age enrolled in a prospective cohort study, Pediatric AIDS Clinical Trials Group 219C, with ?1 study visit before and after HIV disclosure. Age-specific quality-of-life instruments were completed by primary caregivers at routine study visits. The distribution of age at disclosure was summarized. Six quality-of-life domains were assessed, including general health perception, symptom distress, psychological status, health care utilization, physical functioning, and social/role functioning. For each domain, mixed-effects models were fit to estimate the effect of disclosure on quality of life. Results A total of 395 children with 2423 study visits were analyzed (1317 predisclosure visits and 1106 postdisclosure visits). The median age at disclosure was estimated to be 11 years. Older age at disclosure was associated with earlier year of birth. Mean domain scores were not significantly different at the last undisclosed visit compared with the first disclosed visit, with the exception of general health perception. When all of the visits were considered, 5 of 6 mean domain scores were lower after disclosure, although the differences were not significant. In mixed-effects models, disclosure did not significantly impact quality of life for any domain. Conclusions Age at disclosure decreased significantly over time. There were no statistically significant differences between predisclosure and postdisclosure quality of life; therefore, disclosure should be encouraged at an appropriate time.
Butler, Anne M.; Williams, Paige L.; Howland, Lois C.; Storm, Deborah; Hutton, Nancy; Seage, George R.
...1545-BJ54 Requirements of a Statement Disclosing Uncertain Tax Positions; Correction AGENCY: Internal Revenue Service (IRS), Treasury...require corporations to file a schedule disclosing uncertain tax positions related to the tax return as required by the IRS. FOR...
...Disclose Personal Beneficiary/Claimant Information to a Third Party) Activity Under OMB Review AGENCY: Veterans Benefits...Disclose Personal Beneficiary/Claimant Information to a Third Party, VA Form 21-0845. OMB Control Number:...
OBJECTIVES To determine the rate, patterns and predictors of HIV disclosure in a predominantly heterosexual population in the Caribbean region. METHODS A cross-sectional survey was carried out among a 15% random sample (n= 398) of the hospital caseload in all 9 hospitals providing HIV care in French Antilles and French Guiana. Information was obtained from a face-to-face questionnaire and from medical records. Determinants of disclosure to 1) steady partner and 2) other members of the social network were analysed using logistic regression. RESULTS From the time of diagnosis, 84.6% of those in a couple (n=173) disclosed their HIV+ status to their steady partner/spouse, 55.6% disclosed to other close relatives and friends and 30.3% did not tell their status to anyone. Disclosure within steady partnership was less likely among non-French individuals (Haitians: aOR 0.11 [95%CI 0.02–0.72], other nationalities: aOR 0.13 [0.02–0.68]), and among patients diagnosed since 1997 (aOR 0.21 [0.05–0.86]). Determinants of disclosure to the family, friend or religious network were found to be gender (women: aOR 2.04 [1.24–3.36]), age at diagnosis (>=50 years vs <30 years: aOR 0.42 [0.19–0.90]), nationality (Haitians vs French: aOR 0.39 [0.19–0.77]), transmission route (non-sexual vs sexual: aOR 3.38 [1.12–10.23]) and hospital inpatients (hospitalised vs non-hospitalised patients: aOR 1.98 [1.17–3.37]). A marginally significant association was found between eduction and disclosure: less educated people disclosed less often both to steady partner and to their social network. After disclosing, most persons living with HIV/AIDS received social and emotional support from their confidants. Discriminatory attitudes were infrequent. CONCLUSIONS In this study, almost one third of persons living with HIV/AIDS had not told anyone that they were HIV positive. Interventions targeting the general population and social institutions, and support of PLWHA by healthcare staff are needed to improve the situation.
Bouillon, Kim; Lert, France; Sitta, Remi; Schmaus, Annie; Spire, Bruno; Dray-Spira, Rosemary
OBJECTIVES: The aim of this prospective study was to compare changes in lipid metabolism and nutritional status after either 6 and 12 months of follow-up in subjects with lipodystrophy syndrome after traditional lifestyle therapy with or without fibric acid analogue intervention (bezafibrate and clofibrate). METHODS: Food intake, alterations in body composition and metabolic abnormalities were assessed in subjects with lipodystrophy syndrome at the beginning of the study. The nutritional status and metabolic alterations of the subjects were monitored, and the subjects received nutritional counseling each time they were seen. The subjects were monitored either two times over a period no longer than six months (Group A; n ?=? 18) or three times over a period of at least 12 months (Group B; n ?=? 35). All of the subjects underwent nutrition counseling that was based on behavior modification. The fibric acid analogue was only given to patients with serum triglyceride levels above 400 mg/dL. RESULTS: After six months of follow-up, Group A showed no alterations in the experimental parameters. After twelve months, there was a decrease in serum triglyceride levels (410.4 ± 235.5 vs. 307.7 ± 150.5 mg/dL, p< 0.05) and an increase in both HDLc levels (37.9 ± 36.6 vs. 44.9 ± 27.9 mg/dL, p<0.05) and lean mass (79.9 ± 7.8 vs. 80.3 ± 9.9 %, p< 0.05) in Group B. CONCLUSION: After one year of follow-up (three sessions of nutritional and medical counseling), the metabolic parameters of the subjects with lipodystrophy improved after traditional lifestyle therapy with or without fibric acid analogue intervention.
dos Anjos, Eloisa Marchi; Pfrimer, Karina; Machado, Alcyone Artioli; de Carvalho Cunha, Selma Freire; Salomao, Roberta Garcia; Monteiro, Jacqueline Pontes
Background: Wasting is a strong independent predictor of mortal- ity in HIV-infected persons. Vitamin supplements delay the disease progression, but their effect on wasting is not known. Data are lacking on the risk factors for wasting in African HIV-infected per- sons. Objectives: The objectives were to examine the effect of vitamin supplements on wasting in HIV-infected women and to assess
Eduardo Villamor; Elmar Saathoff; Karim Manji; Gernard Msamanga; David J Hunter; Wafaie W Fawzi
Real jurors in actual felony trials completed a set of personality questionnaires including measures of Disclosiveness, Willingness to Communicate, and Communication Apprehension subscales for Friend and Meeting. Empaneled and excused jurors were examined for individual differences. As predicted, empaneled jurors had significantly higher disclosiveness scores, particularly with respect to positive disclosiveness, than excused jurors. Understanding communication traits significantly improves one's
Charles J. Wigley III
While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned. PMID:21777091
Kim, Young Mi; Kalibala, Samuel; Neema, Stella; Lukwago, John; Weiss, Deborah C
HIV\\/AIDS has been a growing problem since the 1980s. The purpose of this study is to understand the relationship between social networks of women and their HIV\\/AIDS status in Debre Zeit, Ethiopia. In-depth interviews were conducted to collect data from 24 women, 14 of whom were HIV positive. A content analysis technique was applied and UCINET software was used to
The 2 largest maternity hospitals in Bangkok implemented comprehensive programs to prevent mother-to-child HIV transmission in 1998. We conducted a cross-sectional survey of post-partum HIV-infected women in 1999 through 2001 to evaluate these programs. Women were given structured interviews at 0 to 3 days, 1 month, and 2 months postpartum. Medical records of women and their newborns were reviewed. Of 488 enrolled women, 443 (91%) had antenatal care: 391 (88%) at study hospitals and 52 (12%) elsewhere. The HIV diagnosis was first known before pregnancy for 61 (13%) women, during pregnancy for 357 (73%) women, during labor for 22 (5%) women, and shortly after delivery for 48 (10%) women. Antenatal zidovudine (ZDV) was used by 347 (71%) women, and intrapartum ZDV was used by 372 (76%) women. Twelve (55%) of the 22 women who first learned of their HIV infection during labor took intrapartum ZDV. All 495 newborn infants started prophylactic ZDV; the first dose was given within 12 hours for 491 (99%) children. Ten (2%) children were breast-fed at least once by their mother, and 10 (2%) were breast-fed at least once by someone else. Although uptake of services was high, inconsistent antenatal care, fear of stigmatization, and difficulty in disclosing HIV status prevented some women from using services. PMID:15671807
Teeraratkul, Achara; Simonds, R J; Asavapiriyanont, Suvanna; Chalermchokcharoenkit, Amphan; Vanprapa, Nirun; Chotpitayasunondh, Tawee; Mock, Philip A; Skunodum, Natapakwa; Neeyapun, Kanchana; Jetsawang, Bongkoch; Culnane, Mary; Tappero, Jordan
To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIV-infected women 17 to 49 years of age (mean = 30.1 years). Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical or sexual abuse. Women reporting greater violence were more likely to disclose their HIV-seropositive status to their sex partner. Using logistic regression, greater intent to get pregnant (odds ratio [OR] = 0.933), decreased present life satisfaction (OR = 1.048), having three or more children (OR = 0.474), and history of drug use (OR = 0.794) significantly distinguished between women who reported physical and/or sexual violence and those who did not. PMID:11936064
Sowell, Richard L; Phillips, Kenneth D; Seals, Brenda; Murdaugh, Carolyn; Rush, Charles
The Centers for Disease Control and Prevention (CDC) have been releasing data on US AIDS and HIV cases since 1982. This semi-annual report provides tables and graphics for by state, metropolitan area, mode of exposure to HIV, gender, race/ ethnicity, age group, vital status, and more.
Summary HIV has a propensity to invade subcortical regions of the brain, which may lead to a subcortical dementia termed HIV-cognitive motor complex. Therefore, we aimed to assess whether dopamine (DA) D2 receptors and transpor- ters (DAT) are affected in the basal ganglia of subjects with HIV, and how these changes relate to dementia status. Fif- teen HIV subjects (age
Gene-Jack Wang; Linda Chang; Nora D. Volkow; Frank Telang; Jean Logan; Thomas Ernst; Joanna S. Fowler
The resumption of sexual activity after delivery is a key moment in the management of the risk of sexual HIV transmission within the couple for women who had been prenatally tested for HIV. In this study, we have investigated consistent condom use during the resumption of sexual activity and its evolution over time among women tested for HIV infection during pregnancy. We tested for HIV during pregnancy 546 HIV-infected and 393 HIV-negative women within the DITRAME Plus ANRS project in Abidjan; these women were followed-up for two years after delivery. Most HIV-negative women (96.7%) disclosed their HIV-test result to their partners, whereas only 45.6% of HIV-infected women did it (p<0.001). Partners of HIV-infected women were more likely to be tested for HIV before resuming sexual activity than partners of HIV-negative women (11.7% versus 7.4% p=0.054). Less than one third of both HIV-infected and HIV-negative women reported having systematically used condoms during the resumption of sexual activity. The proportions of HIV-infected and HIV-negative women having consistently used condom were respectively 26.2% and 19.8% (p=0.193) at 3 months post-partum, 12.1% and 15.9% (p=0.139) at 12 months post-partum, 8.4% and 10.6%, (p=0.302) at 18 months post-partum. In our study, although women had been prenatally tested for HIV and properly counselled on the sexual risk of HIV transmission, male partners were not tested for HIV before the resumption of sexual activity after delivery, very few couples were using condoms systematically and condom use was decreasing over time.
Brou, Hermann; Djohan, Gerard; Becquet, Renaud; Allou, Gerard; Ekouevi, Didier K.; Zanou, B.; Leroy, Valeriane; Desgrees-Du-Lou, Annabel
HIV-related risk perceptions and risk practices among gay men have changed over time. We revisited perceived HIV risk and engagement in anal intercourse with casual partners among HIV-negative gay men who participated in one of the Sydney Gay Community Periodic Surveys (GCPS). Perceived HIV risk was assessed by a range of anal intercourse practices combined with pre-specified casual partners' HIV status and viral load levels. Perceived HIV risk forms a potential hierarchy, broadly reflecting differences in the probability of HIV transmission through various anal intercourse practices. To a lesser extent, it also varies by casual partners' HIV status and viral load. Men who had unprotected anal intercourse with casual partners (UAIC) perceived lower HIV risk than those who used condoms consistently in the 6 months prior to survey. Recognising the complex associations between risk perceptions and risk practices helps to better address challenges arising from the 'Treatment as Prevention' (TasP). PMID:23314802
Mao, Limin; Adam, Philippe; Kippax, Susan; Holt, Martin; Prestage, Garrett; Calmette, Yves; Zablotska, Iryna; de Wit, John
A cross-sectional study to estimate the prevalence of latent tuberculosis (TB) in a group of Zambians at high risk of human immunodeficiency virus type 1 (HIV-1) infection and to examine the effect of HIV-1 infection on the tuberculin response was conducted in the University Teaching Hospital in Lusaka, Zambia during July to September 1990. Patients were selected from those presenting
Laurie E. Duncan; Alison M. Elliott; Richard J. Hayes; Subhash K. Hira; George Tembo; Grace T. Mumba; Shahul H. Ebrahim; Maria Quigley; Joseph O. M. Pobee; Keith P. W. J. McAdam
The quick HIV testing method called "MiraWell Rapid HIV Test" uses a specialized testing kit to determine whether an individual's blood is contaminated with the HIV virus or not. When a drop of blood is placed on the center of the testing kit, a simple pattern will appear in the middle of the kit to indicate the test status, i.e., positive or negative. This HIV test should be done in a small clinic or in a lab and the test must be conducted by a trained technician. A smart HIV testing system was developed through this research to eliminate the human error that is associated with the use of the quick HIV testing kits. Also, the smart HIV system will improve the testing productivity in comparison to those achieved by the trained technicians. In this research, we have developed a cost-effective system that analyzes the image produced by the HIV kits. We have used a System-On-Chip (SOC) design approach based on the Field Programmable Gate Array (FPGA) technology and the Xilinx Virtex SOC chip in building the system's prototype. The system used a CMOS digital camera to capture the image and an FPGA chip to process the captured image and send the testing results to the display unit. The system can be used in small clinics and pharmacies and eliminates the need for trained technicians. The system has been tested successfully and 98% of the tests were correct. PMID:16078623
El Kateeb, Ali; Law, Peter; Chan, King
Rapid automated determination of lipid hydroperoxide concentrations and total antioxidant status of serum samples from patients infected with HIV: elevated lipid hydroperoxide concentrations and depleted total antioxidant capacity of serum samples.
Excessive production of oxygen free radicals causes the oxidation of circulating or membrane lipids, proteins, and DNA. Patients infected with HIV usually have severe malnutrition in the AIDS stage of disease. Therefore, they may be at higher risk of oxidative stress. We measured lipid hydroperoxide concentration, antioxidant status, cholesterol, triglyceride, iron, ceruloplasmin, and transferrin concentrations in the serum samples of 14 patients infected with HIV and compared our results with the results from 14 volunteers who served as controls. Lipid hydroperoxide concentrations in serum samples were measured by a colorimetric assay in which hemoglobin catalyzes the reaction of lipid hydroperoxide with a methylene blue derivative, yielding methylene blue. The total antioxidant capacity of serum was measured by the ability of serum to inhibit the formation of ferrylmyoglobin by metmyoglobin and hydrogen peroxide. Both assays were automated on the Syva-30R analyzer (Behring, San Francisco, Calif). We measured serum cholesterol and triglyceride concentrations by using the Vitro 950 analyzer (Johnson & Johnson, Rochester, NY). The lipid hydroperoxide concentrations were significantly elevated (mean, 1.44; SD, 0.95 micromol/L) in patients with HIV compared with control subjects (mean, 0.25; SD, 0.24 micromol/L). In contrast, the total antioxidant capacity was significantly lower in patients with HIV (mean, 1.04; SD, 0.13 mmol/L of trolox equivalent) compared with control subjects (mean, 1.66; SD, 0.09 mmol/L). We observed a fair correlation between serum lipid hydroperoxide concentrations and serum triglyceride concentrations in patients with AIDS. The correlation between serum hydroperoxide concentration and antioxidant status of serum was relatively poor. The lipid hydroperoxide assay was linear, from 0.1 micromol/L to 50 micromol/L. The within-run and between-run coefficients of variation were 3.5% and 4.5%, respectively, at a lipid hydroperoxide concentration of 2.5 micromol/L. The total antioxidant capacity assay was linear, from 0.1 to 2.5 mmol/L of trolox equivalent. The within-run and between-run coefficients of variation were 1.4% and 4.2% for the standard, with a target total antioxidant capacity of 1.5 mmol/L of trolox equivalent. We conclude that our automated assays for determination of total antioxidant status of serum and lipid hydroperoxide products may be helpful screening tests followed by measuring individual antioxidants, such as tocopherol, ascorbic acid, and other antioxidants for patients with severe deficiency of antioxidant status. PMID:9495197
McLemore, J L; Beeley, P; Thorton, K; Morrisroe, K; Blackwell, W; Dasgupta, A
Pharmacokinetics and Pharmacodynamics in HIV Prevention; Current Status and Future Directions: A Summary of the DAIDS and BMGF Sponsored Think Tank on Pharmacokinetics (PK)/Pharmacodynamics (PD) in HIV Prevention.
Abstract Thirty years after its beginning, the HIV/AIDS epidemic is still raging around the world. According to UNAIDS, in 2011 alone 1.7M deaths were attributable to AIDS, and 2.5M people were newly infected by the virus. Despite the success in treating HIV-infected people with potent antiretroviral drugs, preventing HIV infection is the key to ending the epidemic. Recently, the efficacy of topical and systemic antiviral chemoprophylaxis (i.e., preexposure prophylaxis or "PrEP"), using the same drugs used for HIV treatment, has been demonstrated in a number of clinical trials. However, results from other trials have been inconsistent, especially those evaluating PrEP in women. These inconsistencies may result from our incomplete understanding of pharmacokinetics (PK)/pharmacodynamics (PD) at the mucosal sites of sexual transmission: the male and female gastrointestinal and reproductive tracts. The drug concentrations used in these trials were derived from those used for treatment; however, we still do not know the relationship between the therapeutic and the preventive dose. This article presents the first comprehensive review of the available data in the HIV pharmacology field from animal models to human studies, and outlines gaps, challenges, and future directions. Addressing these pharmacological gaps and challenges will be critical in selecting and advancing future PrEP candidates and strategies with the greatest impact on the HIV epidemic. PMID:23614610
Romano, Joseph; Kashuba, Angela; Becker, Stephen; Cummins, James; Turpin, Jim; Veronese On Behalf Of The Antiretroviral Pharmacology In Hiv Prevention Think Tank Participants, Fulvia
Various studies have reported rates of human immunodeficiency virus (HIV) transmission from mother to child of 13-40%. Vertical transmission occurs in utero, during delivery, or, in a small number of cases, through breast milk. Whether mothers at various stages of HIV infection experience different rates of transmission remains unknown. Maternal antibodies cross the placenta and are present from birth up to 18 months of age. The offspring of HIV-positive mothers tend to be low birthweight, under 37 weeks' gestation, and at high risk of perinatal mortality. It is likely, however, that this profile is indicative of the low socioeconomic status of most women with HIV rather than a result of infection. Also emerging is a psychosocial profile of the HIV child. These children are isolated, neglected, battered, frequently abandoned, and exhibit various degrees of mental retardation. Also common are delayed psychomotor development, loss of developmental milestones, limited attention span, poor language development, and abnormal reflexes. These features result from the interaction of low socioeconomic status, a lack of psychosocial stimulation, nutritional deficiencies, and central nervous system infections. Since HIV-infected children tend to be the offspring of drug addicts, bisexuals, and prostitutes, they are not awarded the same compassion as children afflicted with other terminal illnesses. Moreover, these children are generally neglected by groups formed to provide support to AIDS patients. Thus, it is up to the general public, the mass media, and the health care system to advocate for the needs of these neglected children. PMID:1932194
Canosa, C A
A cross-sectional study to estimate the prevalence of latent tuberculosis (TB) in a group of Zambians at high risk of human immunodeficiency virus type 1 (HIV-l) infection and to examine the effect of HIV-l infection on the tuberculin response was conducted in the University Teaching Hospital in Lusaka, Zambia during July to September 1990. Patients were selected from those presenting
Laurie E. Duncanl; Alison M. Elliott; Richard J. Hayes; Subhash K. Hira; George Ten; Grace T. Mumba
Background HIV surveillance systems aim to monitor trends of HIV infection, the geographical distribution and its magnitude, and the impact of HIV. The quality of HIV surveillance is a key element in determining the uncertainty ranges around HIV estimates. This paper aims to assess the quality of HIV surveillance systems in low- and middle-income countries in 2009 compared with 2007. Methods Four dimensions related to the quality of surveillance systems are assessed: frequency and timeliness of data; appropriateness of populations; consistency of locations and groups; and representativeness of the groups. An algorithm for scoring the quality of surveillance systems was used separately for low and concentrated epidemics and for generalised epidemics. Results The number of countries categorised as fully functioning in 2009 was 35, down from 40 in 2007. 47 countries were identified as partially functioning, while 56 were categorised as poorly functioning. When compared with 2007, the quality of HIV surveillance remains similar. The number of ANC sites in sub-Saharan Africa has increased over time. The number of countries with low and concentrated epidemics that do not have functioning HIV surveillance systems has increased from 53 to 56 between 2007 and 2009. Conclusion Overall, the quality of surveillance in low- and middle-income countries has remained stable. Still too many countries have poorly functioning surveillance systems. Several countries with generalised epidemics have conducted more than one population-based survey which can be used to confirm trends. In countries with concentrated or low-level epidemics, the lack of data on high-risk populations remains a challenge.
Jacobson, J; Garg, R; Thuy, N; Stengaard, A; Alonso, M; Ziady, H O; Mukenge, L; Ntabangana, S; Chamla, D; Alisalad, A; Gouws, E; Sabin, K; Souteyrand, Y
Hypertension, a major risk factor for cardiovascular disease worldwide, is increasing significantly in urbanised South Africans. Impaired glomerular filtration is a potential contributor to hypertension. Although HIV infection is widespread, little is known regarding its contribution to diminished estimated glomerular filtration rate (eGFR) and, in turn, hypertension in Africans. We compared eGFRs and cardiovascular profiles of newly identified HIV infected African men (N=53) not yet undergoing anti-retroviral therapy, and uninfected African men of similar age and anthropometry. The aim of the study was to determine whether eGFR is diminished in treatment naive HIV infected individuals and whether eGFR is associated with a potential modulator of hypertension, namely serum L-arginine. Cardiovascular risk factor profiles of HIV infected and uninfected men were similar. In men with healthy eGFRs >90?ml?min(-1) per 1.73?m(2), eGFR was significantly lower with HIV infection (114 (90; 147)) compared with that in uninfected men: (120 (91; 168)), P=0.043. Despite the absence of clinically-diagnosed renal dysfunction, eGFR associated significantly with serum L-arginine only in HIV infected men (R(2)=0.277, ?=-0.299, P=0.034), whereas L-arginine did not stay in the model for uninfected men. This difference suggests that the fate of L-arginine as a substrate for nitric oxide generation may be altered in HIV infected individuals. Subsequently this is likely to escalate endothelial dysfunction, contributing to later hypertension and cardiovascular disease. Our findings show that while glomerular filtration rate is not associated with L-arginine in uninfected men, it is diminished and significantly negatively associated with serum L-arginine in HIV infected men. PMID:23448845
Glyn, M C; Van Rooyen, J M; Schutte, R; Huisman, H W; Böger, R H; Schwedhelm, E; Lüneburg, N; Mels, C M C; Schutte, A E
There are roughly 30 to 40 million HIV infected individuals in the world as of December 2007, and drug abuse directly contributes to one-third of all HIV-infections in the United States. Antiretroviral therapy has increased the lifespan of HIV-seropositives, but CNS function often remains diminished, effectively decreasing quality of life. A modest proportion may develop HIV-associated dementia, the severity and progression of which is increased with drug abuse. HIV and drugs of abuse in the CNS target subcortical brain structures and DA systems in particular. This toxicity is mediated by a number of neurotoxic mechanisms, including but not limited to, aberrant immune response and oxidative stress. Therefore, novel therapeutic strategies must be developed that can address a wide variety of disparate neurotoxic mechanisms and apoptotic cascades. This paper reviews the research pertaining to the where, what, and how of HIV and cocaine/methamphetamine toxicity in the CNS. Specifically, where these toxins most affect the brain, what aspects of the virus are neurotoxic, and how these toxins mediate neurotoxicity.
Ferris, Mark J.; Mactutus, Charles F.; Booze, Rosemarie M.
The processing of sensitive information in the health field is subject to rigorous standards that guarantee the protection of information confidentiality. Recently, the Italian Data Protection Authority (Garante per la Protezione dei Dati Personali) stated their formal opinion on a standard procedure in dental offices involving the submission of a questionnaire that includes the patient's health status. HIV infection status is included on the form. The Authority has stated that all health data collection must be in accordance with the current Italian normative framework for personal data protection and respect the patient's freedom. This freedom allows the patient to decide, in a conscious and responsible way, whether to share health information with health personnel without experiencing any prejudice in the provision of healthcare requested. Moreover, data collection must be relevant and cannot exceed the principles of treatment goals with reference to the specific care of the concerned person. However, the need for recording information regarding HIV infection at the first appointment, regardless of the clinical intervention or therapeutic plan that needs to be conducted, should not alter the standard protection measures of the healthcare staff. In fact, these measures are adopted for every patient. PMID:22313663
Conti, Adelaide; Delbon, Paola; Laffranchi, Laura; Paganelli, Corrado; De Ferrari, Francesco
The development and validation of the HIV-Quality Audit Marker (HIV-QAM), an instrument designed to measure changes in the status of hospitalized AIDS patients due to nusing care, is reported. The HIV-QAM is designed to capture the nurse data-collector's judgment of the status of the patient based upon observations, interviews, record reviews, and listening to inter-shift report. The final version of
W. L. Holzemer; S. Bakken Henry; A. Stewart; S. Janson-Bjerklie
The objective was to examine the extent to which people living with HIV in London reported being discriminated against because\\u000a of their infection. In 2004–2005, people living with HIV attending NHS outpatient HIV clinics in north east London were asked:\\u000a “Have you ever been treated unfairly or differently because of your HIV status—in other words discriminated against?”. Of\\u000a the 1,687
Jonathan Elford; Fowzia Ibrahim; Cecilia Bukutu; Jane Anderson
In Africa, HIV infections occur mostly in stable relationships, yet little is known about the determinants of condom use in\\u000a this context. We examined condom use among 272 coupled HIV clients in Uganda who had just screened for ART eligibility; 128\\u000a had an HIV-positive partner, 47 HIV-negative, and 97 a partner with unknown HIV status. Sixty-six percent reported unprotected\\u000a sex
Glenn J. Wagner; Ian Holloway; Bonnie Ghosh-Dastidar; Gery Ryan; Cissy Kityo; Peter Mugyenyi
...2010-10-01 2010-10-01 false SSI disclosed by TSA or the Coast Guard. ...SENSITIVE SECURITY INFORMATION Â§ 1520.15 SSI disclosed by TSA or the Coast Guard. ...552a), and other laws, records containing SSI are not available for public...
...2009-10-01 2009-10-01 false SSI disclosed by TSA or the Coast Guard. ...SENSITIVE SECURITY INFORMATION Â§ 1520.15 SSI disclosed by TSA or the Coast Guard. ...552a), and other laws, records containing SSI are not available for public...
...Duty to disclose information material to patentability...Section 1.56 Patents, Trademarks, and...Duty to disclose information material to patentability. (a) A patent by its very nature...reports of a foreign patent office in a counterpart...2) The closest information over which...
|Latent Class Analysis (LCA) was used to examine the patterning of adolescents' strategy choice when discussing issues with parents in a sample of 1678 Chilean 11-19 year olds (mean age = 14.9). Adolescents reported whether they fully disclosed, partially disclosed, avoided the issue, or lied for six core areas that bridged personal autonomy and…
Cumsille, Patricio; Darling, Nancy; Martinez, M. Loreto
Examines individual differences among empaneled and excused jurors' responses to a set of personality questionnaires. Finds that empaneled jurors had significantly higher disclosiveness scores, particularly with respect to positive disclosiveness, than excused jurors. Suggests that jury selection is partially a function of personality, rather than…
Wigley, Charles J., III
Latent Class Analysis (LCA) was used to examine the patterning of adolescents' strategy choice when discussing issues with parents in a sample of 1678 Chilean 11-19 year olds (mean age = 14.9). Adolescents reported whether they fully disclosed, partially disclosed, avoided the issue, or lied for six core areas that bridged personal autonomy and…
Cumsille, Patricio; Darling, Nancy; Martinez, M. Loreto
|Objective: The aims of this study are to identify factors that influence the disclosures made by female survivors of unwanted sexual experiences (USE) in childhood and adolescence. The predictors of both the timing of disclosure (short delay, long delay, non-disclosure) and the recipient of the disclosure (disclosing ever to an adult, disclosing…
Kogan, Steven M.
In Nyanza Province, Kenya, HIV incidence is highest (26.2%) in the beach communities along Lake Victoria. Prior research documented high mobility and HIV risks among fishermen; mobility patterns and HIV risks faced by women in fishing communities are less well researched. This study aimed to characterize forms of mobility among women in the fish trade in Nyanza; describe the spatial and social features of beaches; and assess characteristics of the “sex-for-fish” economy and its implications for HIV prevention. We used qualitative methods, including participant observation in 6 beach villages and other key destinations in the Kisumu area of Nyanza that attract female migrants, and we recruited individuals for in-depth semi-structured interviews at those destinations. We interviewed 40 women, of whom 18 were fish traders, and 15 men, of whom 7 were fishermen. Data were analyzed using Atlas.ti software. We found that female fish traders are often migrants to beaches; they are also highly mobile. They are at high risk of HIV acquisition and transmission via their exchange of sex for fish with jaboya fishermen.
Camlin, Carol S.; Kwena, Zachary A.; Dworkin, Shari L.
Few Positive Prevention interventions have been implemented in Africa; however, greater attention is now being paid to interventions that include messages of personal responsibility or altruism that may motivate HIV-infected individuals towards HIV prevention behaviors in Africa. We conducted 47 in-depth interviews in 2004 with HIV-infected men and women purposefully sampled to represent a range of sexual activities among clients of an AIDS support organization in Uganda. Qualitative interviews were selected from a cross-sectional survey of 1092 HIV-infected men and women. Clients were interviewed about their concerns around sexual HIV transmission, feelings of responsibility and reasons for these feelings, as well as about the challenges and consequences of actions to prevent HIV transmission. The reasons they provided for their sense of prevention responsibility revolved around ethical and practical themes. Responsibility toward sexual partners was linked to the belief that conscious transmission of HIV equals murder, would cause physical and emotional harm, and would leave children orphaned. The primary reason specific to preventing HIV transmission to unborn children was the perception that they are 'innocent'. Most participants felt that HIV-infected individuals held a greater responsibility for preventing HIV transmission than did HIV-uninfected individuals. Respondents reported that their sense of responsibility lead them to reduce HIV transmission risk, encourage partner testing, disclose HIV test results, and assume an HIV/AIDS educator role. Challenges to HIV preventive behavior and altruistic intentions included: sexual desire; inconsistent condom use, especially in long term relationships; myths around condom use; fear of disclosure; gender-power dynamics; and social and financial pressure. Our finding that altruism played an important role in motivating preventive behaviors among HIV-infected persons in Uganda supports the inclusion of altruistic prevention and counseling messages within Positive Prevention interventions. PMID:19101063
King, Rachel; Lifshay, Julie; Nakayiwa, Sylvia; Katuntu, David; Lindkvist, Pille; Bunnell, Rebecca
Background China has witnessed a remarkable increase in sexually transmitted infections (STIs) and HIV. The study is to assess the prevalence of HIV, HBV, HCV and syphilis and related risk factors among drug users in mandatory detoxification center Qingyuan, Guangdong, China. Method A cross-sectional study on drug use behaviors, sex behaviors, and presence of antibodies to HIV, HCV, Treponema pallidum, and surface antigen of HBV (HBsAg) was conducted among drug users recruited from 3 detoxification centers in Qingyuan, Guangdong, China. Risk factors for each of four infections were analyzed with logistic regression model. Results A total of 740 subjects were recruited, the median age was 31 years old (range 24-38). The seroprevalence rates of HIV, HBsAg, HCV and syphilis were 4.6%, 19.3%, 71.6% and 12.6%, respectively. Risk factors for HIV were intravenous drug use and co-infection with syphilis. Having a regular sexual partner who was a drug user was considered to be a risk factor for HBV. Intravenous drug use was a risk factor for HCV. However, the consistent use of condoms with commercial sex partners was protective for HCV infection. Compared to drug users living in urban area, those living in rural areas were more likely to be infected with syphilis, and there was an association between commercial sex and syphilis. Conclusion The prevalence of HIV, HBV, HCV and syphilis were high among drug users in detoxification centers in Qingyuan, thus, risk reduction programs for the drug user population is urgently required.
Besides its role in bone metabolism, vitamin D shows properties on autoimmune, oncological, cardiovascular, metabolic, or infectious diseases. In this article, we talk about interpellant relationships between vitamin D and HIV. This hormone plays an important role in HIV infection, as much at a skeletal level than in the course of the disease itself. First, we notice that a low vitamin D status is currently associated with HIV infection. Moreover, it is now known that low rate of 1,25-dihydroxyvitamin D in HIV patients is associated with advanced clinical HIV infection and increased mortality. Thus, vitamin D deficiency has to be considered as an important factor in HIV progression. Indeed, vitamin D increases macrophage activity, in some way through autophagy, and this process can inhibit HIV-1 infection. Then we consider the implications of antiretroviral therapies on vitamin D metabolism. We finally evaluate the benefits of a vitamin D supplementation in HIV + patients. PMID:23444825
Pirotte, B F; Rassenfosse, M; Collin, R; Devoeght, A; Moutschen, M; Cavalier, E
We examined relationships between client-perpetrated emotional, physical, and sexual abuse, injection drug use, and HIV-serostatus\\u000a among 924 female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico-US border cities. We hypothesized that\\u000a FSWs’ injection drug use would mediate the relationship between client-perpetrated abuse and HIV-seropositivity. The prevalence\\u000a of client-perpetrated emotional, physical, and sexual abuse in the past 6 months
Monica D. Ulibarri; Steffanie A. Strathdee; Emilio C. Ulloa; Remedios Lozada; Miguel A. Fraga; Carlos Magis-Rodríguez; Adela De La Torre; Hortensia Amaro; Patricia O’Campo; Thomas L. Patterson
Background Loss of subcutaneous (SAT) with sparing of visceral (VAT) adipose tissue (AT) has been documented in HIV + men and women. Intermuscular AT (IMAT) rivals VAT in independent associations with cardiovascular risk. Objective To determine whether the size and distribution of IMAT differs in HIV+ vs. HIV- men and/or women. Design We used whole-body MRI to measure VAT, IMAT and four SAT compartments and compared them by HIV status using whole-body skeletal muscle (SM) or total AT (TAT) as co-variates in multi-ethnic groups of healthy HIV- (n=86) and stable HIV+ (n=76) men and women. Results The sizes of AT depots (adjusting for SM) did not differ by HIV status, except for smaller gluteal SAT (lower trunk, between L4-L5 to greater trochanter) in both sexes (P<0.05). The AT distribution (adjusting for TAT) was significantly different, with larger VAT (P<0.05) and smaller gluteal and limb SAT (P<0.05) in both HIV+ sexes; IMAT increased more with TAT in HIV+ vs. HIV- men (P<0.05 for slope interaction) but there were no significant differences in women. There were significant race by HIV interactions in AT distribution with more pronounced VAT differences in non-Hispanic white men and larger trunk SAT in African Americans HIV+ vs. HIV-. Conclusion The AT distribution differed markedly in HIV+ vs. HIV- with limb and lower body SAT representing a smaller proportion of TAT in HIV+ in both sexes and IMAT representing a larger proportion of TAT in HIV+ vs. HIV- men.
Dodell, G.B.; Kotler, D.P.; Engelson, E.S.; Ionescu, G.; Gimelshteyn, Y.; Pollack, A.; Gallagher, D.; Berglund, L.; Albu, J.B.
BACKGROUND: Loss of subcutaneous (SAT) with sparing of visceral (VAT) adipose tissue (AT) has been documented in HIV + men and women. Intermuscular AT (IMAT) rivals VAT in independent associations with cardiovascular risk. OBJECTIVE: To determine whether the size and distribution of IMAT differs in HIV+ vs. HIV- men and/or women. DESIGN: We used whole-body MRI to measure VAT, IMAT and four SAT compartments and compared them by HIV status using whole-body skeletal muscle (SM) or total AT (TAT) as co-variates in multi-ethnic groups of healthy HIV- (n=86) and stable HIV+ (n=76) men and women. RESULTS: The sizes of AT depots (adjusting for SM) did not differ by HIV status, except for smaller gluteal SAT (lower trunk, between L(4)-L(5) to greater trochanter) in both sexes (P<0.05). The AT distribution (adjusting for TAT) was significantly different, with larger VAT (P<0.05) and smaller gluteal and limb SAT (P<0.05) in both HIV+ sexes; IMAT increased more with TAT in HIV+ vs. HIV- men (P<0.05 for slope interaction) but there were no significant differences in women. There were significant race by HIV interactions in AT distribution with more pronounced VAT differences in non-Hispanic white men and larger trunk SAT in African Americans HIV+ vs. HIV-. CONCLUSION: The AT distribution differed markedly in HIV+ vs. HIV- with limb and lower body SAT representing a smaller proportion of TAT in HIV+ in both sexes and IMAT representing a larger proportion of TAT in HIV+ vs. HIV- men. PMID:21643551
Dodell, G B; Kotler, D P; Engelson, E S; Ionescu, G; Gimelshteyn, Y; Pollack, A; Gallagher, D; Berglund, L; Albu, J B
The impact of integrating food supplementation, nutritional education and HAART (Highly Active Antiretroviral Therapy) on the nutritional status of patients living with HIV/AIDS in Mozambique: results from the DREAM Programme.
DREAM (Drug Resources Enhancement against AIDS and Malnutrition) is a multiregional health program active in Mozambique since 2002 and provides free of charge an integrating package of care consisting of peer to peer nutritional and health education, food supplementation, voluntary counseling and testing, immunological, virological, clinical assessment and HAART (Highly Active AntiRetroviral Treatment). The main goals of this paper are to describe the state of health and nutrition and the adequacy of the diet of a sample of HIV/AIDS patients in Mozambique on HAART and not. A single-arm retrospective cohort study was conducted. 106 HIV/AIDS adult patients (84 in HAART), all receiving food supplementation and peer-to-peer nutritional education, were randomly recruited in Mozambique in two public health centres where DREAM is running. The programme is characterized by: provision of HAART, clinical and laboratory monitoring, peer to peer health and nutritional education and food supplementation. We measured BMI, haemoglobin, viral load, CD4 count at baseline (T0) and after at least 1 year (T1). Dietary intake was estimated using 24h food recall and dietary diversity was assessed by using the Dietary Diversity Score (DDS) at T1. Overall, the patients'diet appeared to be quite balanced in nutrients. In the cohort not in HAART the mean BMI values showed an increases but not significant (initial value: 21.9 ± 2.9; final value: 22.5 ± 3.3 ) and the mean haemoglobin values (g/dl) showed a significant increases (initial value: 10.5+ 2.1; final value: 11.5 ± 1.7 p< 0.024) . In the cohort in HAART, both the mean of BMI value (initial value: 20.7 ± 3.9; final value: 21.9 ± 3.3 p< 0.001) and of haemoglobin (initial value: 9.9 ± 2.2; final value: 10.8 ± 1.7 p< 0.001) showed a higher significant increase. The increase in BMI was statistically associated with the DDS in HAART patients. In conclusion nutritional status improvement was observed in both cohorts. The improvement in BMI was significant and substantially higher in HAART patients because of the impact of HAART on nutritional status of AIDS patients. Subjects on HAART and with a DDS > 5, showed a substantial BMI gain. This association showed an additional expression of the synergic effect of integrating food supplementation, nutritional education and HAART on the nutritional status of African AIDS patients and also highlights the complementary role of an adequate and diversified diet in persons living with HIV/AIDS in resources limited settings. PMID:21468153
Scarcella, P; Buonomo, E; Zimba, I; Doro Altan, A M; Germano, P; Palombi, L; Marazzi, M C
Some adolescent girls perinatally infected with HIV (PIH) engage in sexual behavior that poses risks to their own well-being and that of sexual partners. Interventions to promote condom use among girls PIH may be most effective if provided prior to first sexual intercourse. With in-depth interviews, we explored gender- and HIV-specific informational and motivational factors that might be important for sexual risk reduction interventions designed to reach US girls PIH before they first engage in sexual intercourse. Open-ended interview questions and vignettes were employed. The information-motivation-behavioral skills (IMB) model guided descriptive qualitative analyses. Participants (20 girls PIH ages 12-16 years) had experienced kissing (n=12), genital touching (n=6), and oral (n=3), vaginal (n=2), and anal sex (n=1). Most knew sex poses transmission risks but not all knew anal sex is risky. Motivations for and against condom use included concerns about: sexual transmission, psychological barriers, and partners' awareness of the girl's HIV+ status. Girls were highly motivated to prevent transmission, but challenged by lack of condom negotiation skills as well as negative potential consequences of unsafe sex refusal and HIV status disclosure. Perhaps most critical for intervention development is the finding that some girls believe disclosing one's HIV status to a male partner shifts the responsibility of preventing transmission to that partner. These results suggest a modified IMB model that highlights the role of disclosure in affecting condom use among girls PIH and their partners. Implications for cognitive-behavioral interventions are discussed. PMID:21390891
Marhefka, Stephanie L; Valentin, Cidna R; Pinto, Rogério M; Demetriou, Nicole; Wiznia, Andrew; Mellins, Claude Ann
Background: We evaluated the impact of HIV coinfection on the chest radiographic pattern and extent of disease and its relation to the load of Mycobacterium tuberculosis in Ethiopian out-patients with pulmonary tuberculosis. Patients and Methods: A total of 168 patients with cultureverified pulmonary tuberculosis had their chest X-rays (CXR) reviewed for the site, pattern, and extent of disease and the
G. Aderaye; J. Bruchfeld; G. Assefa; D. Feleke; G. Källenius; M. Baat; L. Lindquist
Background. Antiretroviral therapy (ART) has reached millions of HIV-infected patients worldwide, however very little is known about their perceptions about HIV disease and its treatment. The AIDS Treatment for Life International Survey (ATLIS) is the largest sampling of patient perceptions about HIV disease and its treatment, as well as their behaviors, including HIV status disclosure and ART adherence. Methods. The
Mark Mascolini; José M. Zuniga
Many professional organizations and governmental bodies recommend disclosing financial conflicts of interest to potential research participants. Three possible goals of such disclosures are to inform the decision making of potential research participants, to protect against liability, and to deter conflicts of interest. We reviewed US academic medical centers' policies regarding the disclosure of conflicts of interest in research. Forty-eight percent mentioned disclosing conflicts to potential research participants. Of those, 58% included verbatim language that could be used in informed consent documents. Considerable variability exists concerning the specific information that should be disclosed. Most of the institutions' policies are consistent with the goal of protection from legal liability.
Weinfurt, Kevin P.; Dinan, Michaela A.; Allsbrook, Jennifer S.; Friedman, Joelle Y.; Hall, Mark A.; Schulman, Kevin A.; Sugarman, Jeremy
Background Social constructions of masculinity have been shown to serve as an obstacle to men's access and adherence to antiretroviral therapies (ART). In the light of women's relative lack of power in many aspects of interpersonal relationships with men in many African settings, our objective is to explore how male denial of HIV/AIDS impacts on their female partners' ability to access and adhere to ART. Methods We conducted a qualitative case study involving thematic analysis of 37 individual interviews and five focus groups with a total of 53 male and female antiretroviral drug users and 25 healthcare providers in rural eastern Zimbabwe. Results Rooted in hegemonic notions of masculinity, men saw HIV/AIDS as a threat to their manhood and dignity and exhibited a profound fear of the disease. In the process of denying and avoiding their association with AIDS, many men undermine their wives' efforts to access and adhere to ART. Many women felt unable to disclose their HIV status to their husbands, forcing them to take their medication in secret, and act without a supportive treatment partner, which is widely accepted to be vitally important for adherence success. Some husbands, when discovering that their wives are on ART, deny them permission to take the drugs, or indeed steal the drugs for their own treatment. Men's avoidance of HIV also leave many HIV-positive women feeling vulnerable to re-infection as their husbands, in an attempt to demonstrate their manhood, are believed to continue engaging in HIV-risky behaviours. Conclusions Hegemonic notions of masculinity can interfere with women's adherence to ART. It is important that those concerned with promoting effective treatment services recognise the gender and household dynamics that may prevent some women from successfully adhering to ART, and explore ways to work with both women and men to identify couples-based strategies to increase adherence to ART
Background High early mortality rate among HIV infected patients following initiation of antiretroviral therapy (ART) in resource limited settings may indicate high pre-treatment mortality among ART-eligible patients. There is dearth of data on pre-treatment mortality in ART programmes in sub-Sahara Africa. This study aims to determine pre-treatment mortality rate and predictors of pre-treatment mortality among ART-eligible adult patients in a West Africa clinic-based cohort. Methods All HIV-infected patients aged 15 years or older eligible for ART between June 2004 and September 2009 were included in the analysis. Assessment for eligibility was based on the Gambia ART guideline. Survival following ART-eligibility was determined by Kaplan-Meier estimates and predictors of pre-treatment mortality determined by Cox proportional hazard models. Result Overall, 790 patients were assessed as eligible for ART based on their clinical and/or immunological status among whom 510 (64.6%) started treatment, 26 (3.3%) requested transfer to another health facility, 136 (17.2%) and 118 (14.9%) were lost to follow-up and died respectively without starting ART. ART-eligible patients who died or were lost to follow-up were more likely to be male or to have a CD4 T-cell count < 100 cells/?L, while patients in WHO clinical stage 3 or 4 were more likely to die without starting treatment. The overall pre-treatment mortality rate was 21.9 deaths per 100 person-years (95% CI 18.3 - 26.2) and the rate for the composite end point of death or loss to follow-up was 47.1 per 100 person-years (95% CI 41.6 - 53.2). Independent predictors of pre-treatment mortality were CD4 T-cell count <100 cells/?L (adjusted Hazard ratio [AHR] 3.71; 95%CI 2.54 - 5.41) and WHO stage 3 or 4 disease (AHR 1.91; 95% CI 1.12 - 3.23). Forty percent of ART-eligible patients lost to follow-up seen alive at field visit cited difficulty with the requirement of disclosing their HIV status as reason for not starting ART. Conclusion Approximately one third of ART-eligible patients did not start ART and pre-treatment mortality rate was found high among HIV infected patients in our cohort. CD4 T-cell count <100 cells/?L is the strongest independent predictor of pre-treatment mortality. The requirement to disclose HIV status as part of ART preparation counselling constitutes a huge barrier for eligible patients to access treatment.
Background Prevention of mother to child HIV transmission (PMTCT) programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed. This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme. Methods A prospective cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa, Ethiopia. Descriptive statistics, bivariate and mulitivariate logistic regression analyses were done. Results Of 282 mothers enrolled in the cohort, 232 (82%, 95% CI 77-86%) initiated medication during pregnancy, 154 (64%) initiated combined zidovudine (ZDV) prophylaxis regimen while 78 (33%) were initiated lifelong antiretroviral treatment (ART). In total, 171 (60%, 95% CI 55-66%) mothers ingested medication during labour. Of the 221 live born infants (including two sets of twins), 191 (87%, 95% CI 81-90%) ingested ZDV and single-dose nevirapine (sdNVP) at birth. Of the 219 live births (twin births were counted once), 148 (68%, 95% CI 61-73%) mother-infant pairs ingested their medication at birth. Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery. Mother-infant pairs attended in health facilities at birth were more likely (OR 6.7 95% CI 2.90-21.65) to ingest their medication than those who were attended at home. Overall, 189 (86%, 95% CI 80-90%) infants were brought for first pentavalent vaccine and 115 (52%, 95% CI 45-58%) for early infant diagnosis at six-weeks postpartum. Among the infants brought for early diagnosis, 71 (32%, 95% CI 26-39%) had documented HIV test results and six (8.4%) were HIV positive. Conclusions We found a progressive decline in medication adherence across the perinatal period. There is a big gap between mediation initiated during pregnancy and actually ingested by the mother-infant pairs at birth. Follow up for HIV-exposed infants seem not to be organized and is inconsistent. In order to maximize effectiveness of the PMTCT programme, the rate of institutional delivery should be increased, the quality of obstetric services should be improved and missed opportunities to exposed infant follow up should be minimized.
In most sub-Saharan African countries, women and girls are more vulnerable to HIV and AIDS because of economic and social\\u000a inequalities that diminish women’s abilities to make choices that promote their overall health status. The HIV epidemic threatens\\u000a African women’s full enjoyment of their basic human rights and fundamental freedoms. It threatens all the progress made toward\\u000a the advancement of
Sheila D. Tlou
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HIV/AIDS remains a chronic and incurable disease, in spite of the notable successes of combination antiretroviral therapy. Gene therapy offers the prospect of creating genetic resistance to HIV that supplants the need for antiviral drugs. In sight of this goal, a variety of anti-HIV genes have reached clinical testing, including gene-editing enzymes, protein-based inhibitors, and RNA-based therapeutics. Combinations of therapeutic genes against viral and host targets are designed to improve the overall antiviral potency and reduce the likelihood of viral resistance. In cell-based therapies, therapeutic genes are expressed in gene modified T lymphocytes or in hematopoietic stem cells that generate an HIV-resistant immune system. Such strategies must promote the selective proliferation of the transplanted cells and the prolonged expression of therapeutic genes. This review focuses on the current advances and limitations in genetic therapies against HIV, including the status of several recent and ongoing clinical studies. PMID:22985479
Burnett, John C; Zaia, John A; Rossi, John J
The purpose of this project was to study women at high risk for contracting AIDS from intravenous drug use or from sexual contact with addicts. Characteristics of the population, differences between HIV + and HIV - women, substance abuse in primary caretakiers of this high risk population, and changesin drug use when learning of HIV status were investigated. Subjects were
Mark E. Wallace; Marc Galanter; Harold Lifshutz; Keith Krasinski
The objectives of the project were 1) to determine the extent to which HIV-positive persons living in Michigan were aware of and understood Michigan's criminal HIV exposure law, 2) to examine whether awareness of the law was associated with seropositive status disclosure to prospective sex partners, and, 3) to examine whether awareness of the law was associated with potential negative effects of the law on persons living with HIV (PLWH) including heightened HIV-related stigma, perceived societal hostility toward PLWH, and perceived need to conceal one's HIV infection. The study design was cross-sectional. A statewide sample of 384 PLWH in Michigan completed anonymous pen and paper surveys in 1 of 25 data collection sessions. A majority of participants were aware of Michigan's HIV exposure law. Awareness of the law was not associated with increased seropositive status disclosure to all prospective sex partners, decreased HIV transmission risk behavior, or increased perceived responsibility for HIV transmission prevention. However, awareness of the law was significantly associated with disclosure to a greater proportion of sex partners prior to respondents’ first sexual interaction with that partner. Awareness of the law was not associated with increased HIV-related stigma, perceived societal hostility toward PLWH, or decreased comfort with seropositive status disclosure. Evidence of an effect of Michigan's HIV exposure law on seropositive status disclosure was mixed. Further research is needed to examine the various forms of HIV exposure laws among diverse groups of persons living with or at increased risk of acquiring HIV.
Galletly, Carol L.; Pinkerton, Steven D.; DiFranceisco, Wayne
|Many women of low socioeconomic status who have contracted HIV qualify for individual, dual, and multiple psychiatric diagnoses that predate their knowledge of their HIV infection. Earlier intervention addressing these problems might have prevented the onset of psychiatric disorders as well as high-risk behaviors that lead to HIV infection. (FC)|
Taylor, Elizabeth R.; And Others
Over a 10 month period 184 children, aged 5 years or less, who died at home had their nutritional status and HIV serostatus established; necropsies were also carried out. The HIV antibody test was positive in 122\\/184 (66%). Of the HIV seropositive childrenPneumocystis carinii pneumonia was present in 19 (16%), cytomegalovirus pneumonia in nine (7%), and lymphoid interstitial pneumonitis in
Michael O Ikeogu; Bart Wolf; Stanford Mathe
We characterized patients at publicly funded HIV\\/AIDS patient treatment sites who moved (“migrated”) post-diagnosis of HIV\\u000a to five urban Florida counties, by geographic, demographic, socioeconomic and risk variables. Each patient who came for services\\u000a at the sites in a 2–3 week sampling period was asked to complete a brief, self-administered questionnaire. We compared migrant\\u000a with non-migrant patients to disclose characteristics
Spencer Lieb; Mary Jo Trepka; Thomas M. Liberti; Lisa Cohen; Javier Romero
People living with human immunodeficiency virus and acquired immune deficiency syndrome (PLWHA) face numerous social challenges. The objectives of this study were to assess the level of self-disclosure of status by PLWHA, to describe the level and patterns of stigma and discrimination, if any, experienced by the PLWHA and to assess the effect of sero-positivity on the attitude of friends, family members, health workers, colleagues and community. This was a cross-sectional descriptive study carried out among PLWHA attending the University of Uyo Teaching Hospital, Uyo, Southern Nigeria. Information was obtained using an interviewer-administered semi-structured questionnaire, which was analysed using the Epi 6 software. A total of 331 respondents were interviewed. A majority, 256 (77.3%), of the respondents were within the age range of 25-44 years. A total of 121 (36.6%) PLWHA were single and 151 (46.6%) were married, while the rest were widowed, divorced or separated. A majority, 129 (85.4%), of the married respondents disclosed their status to their spouses and 65 (50.4%) were supportive. Apart from spouses, disclosure to mothers (39.9%) was highest. Most clients (57.7%) did not disclose their status to people outside their immediate families for fear of stigmatization. Up to 111 (80.4%) of the respondents working for others did not disclose their status to their employers. Among those whose status was known, discrimination was reported to be highest among friends (23.2%) and at the workplace (20.2%). Attitudes such as hostility (14.5%), withdrawal (11.7%) and neglect (6.8%) were reported from the private hospitals. Apart from disclosure to spouses, the level of disclosure to others was very low. Those whose status was known mainly received acceptance from their families but faced discriminatory attitudes such as hostility, neglect and withdrawal from friends, colleagues and hospital workers. There is a need for more enlightenment campaigns on HIV/AIDS by stakeholders to reduce stigma and discrimination and ensure adequate integration of PLWHA into the society. PMID:23237039
Johnson, Ofonime E
Introduction HIV infection is increasingly characterized as a chronic condition that can be managed through adherence to a healthy lifestyle,\\u000a complex drug regimens, and regular treatment and monitoring. The location, quality, and\\/or affordability of a person’s housing\\u000a can be a significant determinant of his or her ability to meet these requirements. The objective of this systematic review\\u000a is to inform program
Chad A. Leaver; Gordon Bargh; James R. Dunn; Stephen W. Hwang
Background South Africa accounts for more than a sixth of the global population of people infected with HIV and TB, ranking her highest in HIV/TB co-infection worldwide. Remote areas often bear the greatest burden of morbidity and mortality, yet there are spatial differences within rural settings. Objectives The primary aim was to investigate HIV/TB mortality determinants and their spatial distribution in the rural Agincourt sub-district for children aged 1–5 years in 2004. Our secondary aim was to model how the associated factors were interrelated as either underlying or proximate factors of child mortality using pathway analysis based on a Mosley-Chen conceptual framework. Methods We conducted a secondary data analysis based on cross-sectional data collected in 2004 from the Agincourt sub-district in rural northeast South Africa. Child HIV/TB death was the outcome measure derived from physician assessed verbal autopsy. Modelling used multiple logit regression models with and without spatial household random effects. Structural equation models were used in modelling the complex relationships between multiple exposures and the outcome (child HIV/TB mortality) as relayed on a conceptual framework. Results Fifty-four of 6,692 children aged 1–5 years died of HIV/TB, from a total of 5,084 households. Maternal death had the greatest effect on child HIV/TB mortality (adjusted odds ratio=4.00; 95% confidence interval=1.01–15.80). A protective effect was found in households with better socio-economic status and when the child was older. Spatial models disclosed that the areas which experienced the greatest child HIV/TB mortality were those without any health facility. Conclusion Low socio-economic status and maternal deaths impacted indirectly and directly on child mortality, respectively. These factors are major concerns locally and should be used in formulating interventions to reduce child mortality. Spatial prediction maps can guide policy makers to target interventions where they are most needed.
Musenge, Eustasius; Vounatsou, Penelope; Collinson, Mark; Tollman, Stephen; Kahn, Kathleen
Differences in innate immune responses may be associated with different capabilities of controlling HIV infection, not necessarily reflected by CD4(+) T-cell counts alone. We investigated by cytofluorometry the expression of NK cell receptors and ligands in 19 treated HIV-infected patients with CD4(+)<220 ml(-1) at presentation (11 AIDS, 8 non-AIDS) and 10 healthy donors. Expression of NKp46 and NKp30 was significantly higher in non-AIDS vs. AIDS patients. Overall, the level of NKp46 expression directly correlated with the degree of NK cell cytotoxicity. As compared to healthy donors, in both groups, there was a similar increase of CD69 and HLA-DR expression in NK cells that directly correlated with the presence of activation markers (HLA-DR) on CD4(+) and CD8(+) T cells. As compared to AIDS, in non-AIDS patients in vitro activated CD4(+) showed higher expression of MIC-A (NKG2D ligand), with significantly higher Nectin-2/DNAM-1 and MIC-A/NKG2D ratios. Thus, NK cell responses in AIDS and non-AIDS patients with similar CD4(+) counts significantly differ despite similar treatment. This suggests an involvement of innate mechanisms, in preventing AIDS-defining opportunistic infections in HIV infection and further suggests, that CD4(+) absolute counts alone, may be inadequate to explain differences in the clinical outcome. PMID:23538009
Bisio, Francesca; Bozzano, Federica; Marras, Francesco; Di Biagio, Antonio; Moretta, Lorenzo; De Maria, Andrea
Nutritional status of 50 newborns born to HIV infected mothers in a tertiary care hospital was compared with that of babies born to HIV seronegative mothers, as assessed by birthweight, mid arm circumference to head circumference ratio (MAC/HC), ponderal index (PI), and clinical assessment of nutritional status (CAN) score. The incidence of malnutrition in babies born to HIV infected mothers was 36%, 82%, 20%, and 44% using birth weight, MAC/HC, PI, and CAN scores, respectively, compared to 10%, 56%, 8%, and 22% incidence in babies born to HIV seronegative mothers, respectively. Rate of fetal malnutrition was significantly more in babies born to HIV infected mothers. PMID:19213988
In this Introduction, the author discusses how the collection of essays provide insightful analysis of biological, legal, and public health issues surrounding mandatory testing of pregnant women and infants for HIV. As background, beginning February 1, 1997, New York ordered that every newborn in the state be tested for HIV-antibodies. In addition, the results are disclosed to the delivering mother,
Elizabeth B. Cooper
|Despite advances in HIV prevention and care, African Americans and Latino Americans remain at much higher risk of acquiring HIV, are more likely to be unaware of their HIV-positive status, are less likely to be linked to and retained in care, and are less likely to have suppressed viral load than are Whites. The first National HIV/AIDS Strategy…
Grossman, Cynthia I.; Purcell, David W.; Rotheram-Borus, Mary Jane; Veniegas, Rosemary
|This study presents survey data collected from a sample of HIV-positive men (N = 182) who had high transmission-risk sex, defined as unprotected anal intercourse with a man whose HIV-status was negative or unknown, in the previous 6 months. Despite the tremendous changes in HIV treatment and their impact on people living with HIV, little recent…
Skinta, Matthew D.; Murphy, Jessie L.; Paul, Jay P.; Schwarcz, Sandra K.; Dilley, James W.
Lifestyle factors in drug users may render them particularly vulnerable to HIV infection. This study examined a group of 74 registered drug users at a Drug Dependency Clinic and compared lifestyle factors in those who were HIV-positive and those HIV-negative. Despite HIV status, sharing was extensive (over 90%). Sharing with partners only is not failsafe as partners in turn shared.
G. Mulleady; L. Sherr
|Mother-daughter communication plays an influential role in adolescent development. The impact of maternal HIV infection on family communication is not clear. This study explores how living with HIV impacts sexual risk communication between mothers and daughters and whether maternal HIV status influences adolescent choices about engagement in HIV…
Cederbaum, Julie A.
\\u000a Women now constitute the majority of those living with HIV\\/AIDS globally, even if only by a small margin (UNAIDS, 2007). While\\u000a the lower status of women has been recognized as increasing their HIV risk, issues of migration and conflict combined with\\u000a this lower status are believed to propel women’s risk for infection further, particularly in high infection areas such as
Anita Raj; Jhumka Gupta; Jay G. Silverman
Background Privacy concerns by providers have been a barrier to disclosing patient information for public health purposes. This is the case even for mandated notifiable disease reporting. In the context of a pandemic it has been argued that the public good should supersede an individual's right to privacy. The precise nature of these provider privacy concerns, and whether they are diluted in the context of a pandemic are not known. Our objective was to understand the privacy barriers which could potentially influence family physicians' reporting of patient-level surveillance data to public health agencies during the Fall 2009 pandemic H1N1 influenza outbreak. Methods Thirty seven family doctors participated in a series of five focus groups between October 29-31 2009. They also completed a survey about the data they were willing to disclose to public health units. Descriptive statistics were used to summarize the amount of patient detail the participants were willing to disclose, factors that would facilitate data disclosure, and the consensus on those factors. The analysis of the qualitative data was based on grounded theory. Results The family doctors were reluctant to disclose patient data to public health units. This was due to concerns about the extent to which public health agencies are dependable to protect health information (trusting beliefs), and the possibility of loss due to disclosing health information (risk beliefs). We identified six specific actions that public health units can take which would affect these beliefs, and potentially increase the willingness to disclose patient information for public health purposes. Conclusions The uncertainty surrounding a pandemic of a new strain of influenza has not changed the privacy concerns of physicians about disclosing patient data. It is important to address these concerns to ensure reliable reporting during future outbreaks.
Background As immune compromised HIV sero-positive people regain health after initiating antiretroviral treatment (ART), they may seek a return to an active 'normal' life, including sexual activity. The aim of the paper is to explore the changing sexual desires and behaviour of people on ART in Uganda over a 30 month period. Methods This study employed longitudinal qualitative interviews with forty people starting ART. The participants received their ART, adherence education and counselling support from The AIDS Support Organisation (TASO). The participants were selected sequentially as they started ART, stratified by sex, ART delivery mode (clinic or home-based) and HIV progression stage (early or advanced) and interviewed at enrolment, 3, 6, 18 and 30 months of their ART use. Results Sexual desire changed over time with many reporting diminished desire at 3 and 6 months on ART compared to 18 and 30 months of use. The reasons for remaining abstinent included fear of superinfection or infecting others, fear that engaging in sex would awaken the virus and weaken them and a desire to adhere to the counsellors' health advice to remain abstinent. The motivations for resumption of sexual activity were: for companionship, to obtain material support, social norms around marriage, desire to bear children as well as to satisfy sexual desires. The challenges for most of the participants were using condoms consistently and finding a suitable sexual partner (preferably someone with a similar HIV serostatus) who could agree to have a sexual relationship with them and provide for their material needs. Conclusions These findings point to the importance of tailoring counselling messages to the changing realities of the ART users' cultural expectations around child bearing, marriage and sexual desire. People taking ART require support so they feel comfortable to disclose their HIV status to sexual partners.
The use of chemotherapy to suppress replication of the human immunodeficiency virus (HIV) has transformed the face of AIDS in the developed world. Pronounced reductions in illness and death have been achieved and healthcare utilization has diminished. HIV therapy has also provided many new insights into the pathogenesis and the viral and cellular dynamics of HIV infection. But challenges remain.
Douglas D. Richman
...authority to disclose information to United States, States, and foreign government agencies and foreign futures authorities...authority to disclose information to United States, States, and foreign government agencies and foreign futures...
Smoking occurs at high rates among people with HIV/AIDS, but little attention has been paid to understanding the nature of tobacco use among HIV+ smokers, especially the role that HIV symptoms may play in cognitive smoking processes. Accordingly, the present investigation examined the relation between HIV symptom distress (i.e., the degree to which HIV symptoms are bothersome) and smoking outcome expectancies. Fifty-seven HIV+ adult smokers (82.50% male; M(age)=47.18; 45.6% White, 28.1% Black, 17.5% Hispanic) were recruited from AIDS service organizations and hospital-based clinics. On average, participants reported knowing their HIV+ status for 16 years and the majority of participants reported that they acquired HIV through unprotected sex (66.6%). Participants completed measures pertaining to HIV symptoms, smoking behavior, and smoking outcome expectancies. HIV symptom distress was positively related to negative reinforcement, negative consequences, and positive reinforcement smoking outcome expectancies after accounting for relevant covariates. The present research suggests that HIV symptom distress may play an important role in understanding smoking outcome expectancies for smokers with HIV/AIDS. Clinical implications for HIV+ smokers are discussed, including the importance of developing effective smoking cessation treatments that meet the unique needs of this group of smokers. PMID:23305258
Grover, Kristin W; Gonzalez, Adam; Zvolensky, Michael J
Children living in HIV\\/AIDS affected households bear the heaviest burden of the epidemic. Besides direct vertical transmission, HIV\\/ AIDS potentially worsens the children’s welfare indirectly through its socio-economic impact. This paper uses household survey data including information about individual HIV infection status to analyze the direct and indirect effects of HIV-infected household members on child mortality, undernutrition and educational attainment
In this article, I examine the ethical and legal issues related to disclosure of conflicts of interest to research subjects, and discuss some empirical studies related to the topic. I argue that researchers have an ethical obligation to disclose conflicts of interest to research subjects, provided that they take steps to help subjects understand information about conflicts of interest and how to interpret it. Researchers also may have a legal duty to disclose conflicts of interests to subjects, depending on the facts of the case and the court's interpretation of the law. To reinforce and clarify the legal obligation to disclose conflicts of interest, the federal regulations should be amended to include disclosure of conflicts of interest as one of the informed consent requirements. Institutional review boards play a key role in helping researchers to disclose conflicts of interest to subjects in an appropriate manner. Institutional review boards should approve the disclosure language in informed consent documents, and they should require researchers to disclose financial interests to research subjects, if they have any, as a condition of approval. PMID:15675055
Resnik, David B
Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), we compared the rate of sexual onset during adolescence across four youth-caregiver combinations: PHIV+ youth with HIV+ caregivers (12%); PHIV+ youth with HIV? caregivers (27%); HIV? youth with HIV+ caregivers (34%); and HIV? youth with HIV-caregivers (27%). Youth with HIV? caregivers were more likely than other youth-caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. We discuss our findings by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence.
Bauermeister, Jose A.; Elkington, Katherine S.; Robbins, Reuben N.; Kang, Ezer; Mellins, Claude A.
Little research has focused specifically on disclosure among HIV+ Black Africans living in the UK; however, the available evidence suggests that this population may be reluctant to disclose to significant others. Forty-five HIV+ Black African men and women were recruited from a London HIV clinic. Semi-structured interviews gathered information on: disclosure, social support, mental and physical health, medication adherence, acculturation and the perceived prevalence of stigma. Both qualitative and quantitative analyses were conducted. The majority of the participants had disclosed to one significant other and there was an inverse association between perceived stigma and disclosure. Disclosure could not be predicted by any of the respondent characteristics identified in the study; rather, disclosure decisions were reasoned, interpersonal in nature and many of the motivations were specific to the individual. There was little evidence to suggest that those who disclosed to more than one other gained additional benefits in physical or mental well-being. Clinicians seeking to assist members of this population to disclose need to assess the specific reasons for and barriers against disclosure for that individual. PMID:17453574
Calin, T; Green, J; Hetherton, J; Brook, G
Social class perception (identification) was studied as a function of ‘objective’ status (socioeco-nomic level) and class (occupational class) using a sample of Swedish high school students. Confirming the two minor hypotheses, the results disclosed that class perception was affected by both the ‘objective’ class and status of the subject: the manual occupational class, and those with low socioeconomic status, had
Bo Ekehammar; Jim Sidanius; Ingrid Nilsson
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
T. C. Mast; G. Kigozi; F. Wabwire-mangen; R. Black; N. Sewankambo; D. Serwadda; R. Gray; M. Wawer; A. W. Wu