Pub Date : 2024-07-01Epub Date: 2024-05-07DOI: 10.1080/09540121.2024.2307378
Haoyi Wang, Hanne M L Zimmermann, David van de Vijver, Kai J Jonas
Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is efficacious in preventing HIV among men-who-have-sex-with-men (MSM) and will be soon available in Europe. This study investigated the intention and preference to use LAI-PrEP among MSM in the Netherlands by employing a diffusion of innovation approach. This study had a cross-sectional design nested within a cohort study established in 2017 to understand oral PrEP use among MSM. 309 MSM completed the survey on their awareness, interest, intention, and preference for LAI-PrEP in June 2022. Among them, 83% showed high/very-high interest in, and 63% showed high/very-high intention to use LAI-PrEP. A repeated innovator effect from the early adopters to LAI-PrEP was not observed. Early adopters did not show increased intention to use LAI-PrEP compared to other MSM subgroups, but neither did PrEP-naïve nor PrEP-discontinued MSM. However, among the 218 current oral PrEP users, suboptimal adherence was associated with preference for LAI-PrEP but not with intention to use it. In conclusion, our findings indicated that an effective, available, and affordable LAI-PrEP would be welcomed in the Netherlands, but that its introduction may not significantly expand PrEP coverage. However, the introduction of LAI-PrEP in the Netherlands could prove beneficial to MSM with suboptimal adherence to oral PrEP.
{"title":"Intention and preference to use long-acting injectable PrEP among MSM in the Netherlands: a diffusion of innovation approach.","authors":"Haoyi Wang, Hanne M L Zimmermann, David van de Vijver, Kai J Jonas","doi":"10.1080/09540121.2024.2307378","DOIUrl":"10.1080/09540121.2024.2307378","url":null,"abstract":"<p><p>Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is efficacious in preventing HIV among men-who-have-sex-with-men (MSM) and will be soon available in Europe. This study investigated the intention and preference to use LAI-PrEP among MSM in the Netherlands by employing a diffusion of innovation approach. This study had a cross-sectional design nested within a cohort study established in 2017 to understand oral PrEP use among MSM. 309 MSM completed the survey on their awareness, interest, intention, and preference for LAI-PrEP in June 2022. Among them, 83% showed high/very-high interest in, and 63% showed high/very-high intention to use LAI-PrEP. A repeated innovator effect from the early adopters to LAI-PrEP was not observed. Early adopters did not show increased intention to use LAI-PrEP compared to other MSM subgroups, but neither did PrEP-naïve nor PrEP-discontinued MSM. However, among the 218 current oral PrEP users, suboptimal adherence was associated with preference for LAI-PrEP but not with intention to use it. In conclusion, our findings indicated that an effective, available, and affordable LAI-PrEP would be welcomed in the Netherlands, but that its introduction may not significantly expand PrEP coverage. However, the introduction of LAI-PrEP in the Netherlands could prove beneficial to MSM with suboptimal adherence to oral PrEP.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-01-30DOI: 10.1080/09540121.2024.2305785
Yuri A Amirkhanian, Anastasia Y Meylakhs, Anna V Kuznetsova, Jeffrey A Kelly, Katherine G Quinn
The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.
艾滋病疫情在俄罗斯持续蔓延,但接受治疗的情况却不尽如人意。这项定性研究旨在了解俄罗斯未坚持治疗的男男性行为者(MSM)艾滋病病毒感染者的社会资本资源、生活污名化经历、应对方法和披露情况。在网上招募的 25 名 HIV 阳性男男性行为者通过 Zoom 完成了深度访谈,并使用 MAXQDA 软件对数据进行了分析。在与医疗服务提供者和亲属(尤其是男性)等社会关系较弱的人交往时,更有可能遭遇污名化。亲密的朋友--通常是其他艾滋病毒呈阳性的男男性行为者和女性亲属--最能给予支持,也最不容易造成污名化。在披露艾滋病毒血清状况时,最常考虑的是类似的人。减少污名化影响的应对策略包括忽视污名化经历、寻求社交圈成员的支持、尽量减少与污名化者的接触、寻求与艾滋病毒呈阳性者建立新的关系、通过参与宣传活动主动减少污名化,以及纠正神话和教育他人了解艾滋病毒感染。这些发现突出表明,有必要采取干预措施,帮助艾滋病毒呈阳性的男男性行为者建立可接受的社会资本资源,以减少污名化的影响,并在其社会网络中建立支持,通常是与其他艾滋病毒呈阳性的男男性行为者建立支持。
{"title":"Stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis.","authors":"Yuri A Amirkhanian, Anastasia Y Meylakhs, Anna V Kuznetsova, Jeffrey A Kelly, Katherine G Quinn","doi":"10.1080/09540121.2024.2305785","DOIUrl":"10.1080/09540121.2024.2305785","url":null,"abstract":"<p><p>The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-03-27DOI: 10.1080/09540121.2024.2332462
Rebecca Jopling, Wilson Mutsvuke, Madison Fertig, Conall O'Cleirigh, Walter Mangezi, Melanie Abas
Emerging adults aged 18-29 have high rates of viral non-suppression, and poorer adherence to ART when compared to older adults. Semi-structured interviews were conducted with 24 emerging adults in Zimbabwe who had a recent history of viral non-suppression, to explore barriers and facilitators of adherence to ART. Interviews were coded using inductive thematic analysis. The mean age of participants was 23, 65% were male, and 79% reported acquiring HIV at birth. Twelve barriers to adherence were identified. Hiding HIV status due to the possible negative consequences of disclosure had a significant impact on adherence to ART. This was particularly important for emerging adults navigating starting intimate relationships. Being away from home, poverty, poor mental health, isolation, significant life events, alcohol, health systems barriers, and stigma were reported as barriers to adherence. Support from peers and family after disclosure of HIV status, phone-based reminders, problem-solving strategies to adhere, knowing others living with HIV, acted as facilitators to adherence to ART. Beliefs about medicines and relationships with health care providers acted as both barriers and facilitators to adherence. Interventions to reduce stigma, foster peer support, and therapy for common mental disorders could facilitate emerging adults aged 18-29 to adhere to ART.
{"title":"\"What if I got rejected by the girl? I would rather stop the pills\": barriers and facilitators of adherence to antiretroviral therapy for emerging adults aged 18-29 living with HIV in Zimbabwe.","authors":"Rebecca Jopling, Wilson Mutsvuke, Madison Fertig, Conall O'Cleirigh, Walter Mangezi, Melanie Abas","doi":"10.1080/09540121.2024.2332462","DOIUrl":"10.1080/09540121.2024.2332462","url":null,"abstract":"<p><p>Emerging adults aged 18-29 have high rates of viral non-suppression, and poorer adherence to ART when compared to older adults. Semi-structured interviews were conducted with 24 emerging adults in Zimbabwe who had a recent history of viral non-suppression, to explore barriers and facilitators of adherence to ART. Interviews were coded using inductive thematic analysis. The mean age of participants was 23, 65% were male, and 79% reported acquiring HIV at birth. Twelve barriers to adherence were identified. Hiding HIV status due to the possible negative consequences of disclosure had a significant impact on adherence to ART. This was particularly important for emerging adults navigating starting intimate relationships. Being away from home, poverty, poor mental health, isolation, significant life events, alcohol, health systems barriers, and stigma were reported as barriers to adherence. Support from peers and family after disclosure of HIV status, phone-based reminders, problem-solving strategies to adhere, knowing others living with HIV, acted as facilitators to adherence to ART. Beliefs about medicines and relationships with health care providers acted as both barriers and facilitators to adherence. Interventions to reduce stigma, foster peer support, and therapy for common mental disorders could facilitate emerging adults aged 18-29 to adhere to ART.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children and adolescents living with HIV in Africa experience poor outcomes across the HIV cascade of care. Paediatric and adolescent-friendly services are crucial to their well-being, and recent years have seen a call for urgent service improvements. While frontline health workers are responsible for these services, less attention has been given to their contextual realities, and what constitutes an enabling service delivery environment. We engaged participatory priority-setting and group discussions across twenty-four sites in twelve high HIV-burden African countries in November 2022 with 801 frontline paediatric-adolescent providers. Data were analysed using thematic analysis and priority mapping. We constructed a socio-ecological model for supportive and empowering service delivery environments for frontline paediatric-adolescent HIV services. Individual-level themes related to well-being, self-care and mental health. Interpersonal themes included supportive supervision/mentorship, teamwork and acknowledgement. At the organisational level, resources, physical infrastructure and confidential spaces were included. The community level included feeling appreciated and positive stakeholder relationships. The structural level included funding, discriminatory SRHR policies and guidelines. Results provide insight into priorities, challenges and needs of frontline providers in the paediatric-adolescent HIV response. Improving the well-being of HIV-affected children and adolescents requires greater investment and attention to creating more caring, supportive environments for their frontline providers.
{"title":"Empowering and supporting frontline providers in the paediatric-adolescent HIV response: results from participatory priority-setting and group discussions in twenty-four sites in twelve high HIV-burden African countries.","authors":"Lesley Gittings, Nokuzola Ncube, Agnes Ronan, Isobella Chimatira, Luann Hatane","doi":"10.1080/09540121.2024.2308023","DOIUrl":"10.1080/09540121.2024.2308023","url":null,"abstract":"<p><p>Children and adolescents living with HIV in Africa experience poor outcomes across the HIV cascade of care. Paediatric and adolescent-friendly services are crucial to their well-being, and recent years have seen a call for urgent service improvements. While frontline health workers are responsible for these services, less attention has been given to their contextual realities, and what constitutes an enabling service delivery environment. We engaged participatory priority-setting and group discussions across twenty-four sites in twelve high HIV-burden African countries in November 2022 with 801 frontline paediatric-adolescent providers. Data were analysed using thematic analysis and priority mapping. We constructed a socio-ecological model for supportive and empowering service delivery environments for frontline paediatric-adolescent HIV services. Individual-level themes related to well-being, self-care and mental health. Interpersonal themes included supportive supervision/mentorship, teamwork and acknowledgement. At the organisational level, resources, physical infrastructure and confidential spaces were included. The community level included feeling appreciated and positive stakeholder relationships. The structural level included funding, discriminatory SRHR policies and guidelines. Results provide insight into priorities, challenges and needs of frontline providers in the paediatric-adolescent HIV response. Improving the well-being of HIV-affected children and adolescents requires greater investment and attention to creating more caring, supportive environments for their frontline providers.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-05-06DOI: 10.1080/09540121.2024.2333435
Tatenda Mawoyo, Kathryn J Steventon Roberts, Christina Laurenzi, Sarah Skeen, Stefani Du Toit, Ramsha Hisham, Lucie Cluver, Lorraine Sherr, Mark Tomlinson
The COVID-19 pandemic resulted in high death rates globally, and over 10.5 million children lost a parent or primary caregiver. Because HIV-related orphanhood has been associated with elevated HIV risk, we sought to examine HIV risk in children affected by COVID-19 orphanhood. Four hundred and twenty-one children and adolescents were interviewed, measuring seven HIV risk behaviours: condom use, age-disparate sex, transactional sex, multiple partners, sex associated with drugs/alcohol, mental health and social risks. Approximately 50% (211/421) experienced orphanhood due to COVID-19, 4.8% (20/421) reported living in an HIV-affected household, and 48.2% (203/421) did not know the HIV status of their household. The mean age of the sample was 12.7 years (SD:2.30), of whom 1.2% (5/421) were living with HIV. Eighty percent (337/421) reported at least one HIV risk behaviour. HIV sexual risk behaviours were more common among children living in HIV-affected households compared to those not living in HIV-affected households and those with unknown household status (35.0% vs. 13.6% vs.10.8%, X2 = 9.25, p = 0.01). Children living in HIV-affected households had poorer mental health and elevated substance use (70.0% vs. 48.5%, X2 = 6.21, p = 0.05; 35.0% vs. 19.9%, X2 = 4.02, p = 0.1306, respectively). HIV-affected households may require specific interventions to support the health and well-being of children and adolescents.
摘要 COVID-19 大流行导致全球高死亡率,超过 1050 万儿童失去了父母或主要照顾者。由于与艾滋病相关的孤儿与艾滋病风险升高有关,我们试图研究受 COVID-19 孤儿影响的儿童的艾滋病风险。我们对 421 名儿童和青少年进行了访谈,测量了七种 HIV 风险行为:安全套的使用、不同年龄段的性行为、性交易、多个性伴侣、与毒品/酒精相关的性行为、心理健康和社会风险。约 50%(211/421)的受访者因 COVID-19 而成为孤儿,4.8%(20/421)的受访者称生活在受 HIV 影响的家庭中,48.2%(203/421)的受访者不知道其家庭的 HIV 感染状况。样本的平均年龄为 12.7 岁(标准差:2.30),其中 1.2%(5/421)为 HIV 感染者。80%的样本(337/421)报告了至少一种 HIV 风险行为。与未受艾滋病毒影响的家庭和家庭状况未知的儿童相比,受艾滋病毒影响家庭的儿童更常见艾滋病毒性危险行为(35.0% vs. 13.6% vs. 10.8%,X2 = 9.25,p = 0.01)。生活在受艾滋病毒影响家庭的儿童心理健康状况较差,药物使用率较高(分别为 70.0% vs. 48.5%,X2 = 6.21,p = 0.05;35.0% vs. 19.9%,X2 = 4.02,p = 0.1306)。受艾滋病毒影响的家庭可能需要特定的干预措施来支持儿童和青少年的健康和福祉。
{"title":"How do new crises impact HIV risk behaviour - exploring HIV risk behaviour according to COVID-19-related orphanhood status in South Africa?","authors":"Tatenda Mawoyo, Kathryn J Steventon Roberts, Christina Laurenzi, Sarah Skeen, Stefani Du Toit, Ramsha Hisham, Lucie Cluver, Lorraine Sherr, Mark Tomlinson","doi":"10.1080/09540121.2024.2333435","DOIUrl":"10.1080/09540121.2024.2333435","url":null,"abstract":"<p><p>The COVID-19 pandemic resulted in high death rates globally, and over 10.5 million children lost a parent or primary caregiver. Because HIV-related orphanhood has been associated with elevated HIV risk, we sought to examine HIV risk in children affected by COVID-19 orphanhood. Four hundred and twenty-one children and adolescents were interviewed, measuring seven HIV risk behaviours: condom use, age-disparate sex, transactional sex, multiple partners, sex associated with drugs/alcohol, mental health and social risks. Approximately 50% (211/421) experienced orphanhood due to COVID-19, 4.8% (20/421) reported living in an HIV-affected household, and 48.2% (203/421) did not know the HIV status of their household. The mean age of the sample was 12.7 years (SD:2.30), of whom 1.2% (5/421) were living with HIV. Eighty percent (337/421) reported at least one HIV risk behaviour. HIV sexual risk behaviours were more common among children living in HIV-affected households compared to those not living in HIV-affected households and those with unknown household status (35.0% vs. 13.6% vs.10.8%, X2 = 9.25, <i>p</i> = 0.01). Children living in HIV-affected households had poorer mental health and elevated substance use (70.0% vs. 48.5%, X2 = 6.21, <i>p</i> = 0.05; 35.0% vs. 19.9%, X2 = 4.02, <i>p</i> = 0.1306, respectively). HIV-affected households may require specific interventions to support the health and well-being of children and adolescents.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-09-04DOI: 10.1080/09540121.2023.2253507
Elochukwu Ernest Uzim, Po-Han Lee
Medication withdrawal remains a problem in Nigeria's HIV care. The Enugu state of southeast Nigeria has 3,736 people living with HIV/AIDS (PLHIV), with a 1.9% HIV-positive prevalence rate among the age band of 15-49 years, higher than 1.3%, the national average for the same cohort. Despite the disease burden, many cases are "lost to follow-up" in this region. Through four focus groups of patients (20 participants in total) and in-depth interviews with four clinicians from four public hospitals, this study aimed to understand the barriers to attending healthcare appointments faced by young adults. The participants were recruited through flyers, posters, and snowballs at clinics; both data sets were first analysed separately yet used to triangulate each other. We found that clinical interruptions are mainly attributable to factors such as stigma, suicidal ideation, loss of means of livelihood due to PLHIV's "new identities", and thus poverty and malnutrition. These barriers, complicated by the COVID-19 pandemic and armed conflicts in the region, have made medication adherence further challenging. Therefore, we recommend the Nigerian government integrate non-biomedical support for PLHIV into people-centred HIV care.
{"title":"Lost to follow up: the (non)psychosocial barriers to HIV/AIDS care in southeast Nigeria.","authors":"Elochukwu Ernest Uzim, Po-Han Lee","doi":"10.1080/09540121.2023.2253507","DOIUrl":"10.1080/09540121.2023.2253507","url":null,"abstract":"<p><p>Medication withdrawal remains a problem in Nigeria's HIV care. The Enugu state of southeast Nigeria has 3,736 people living with HIV/AIDS (PLHIV), with a 1.9% HIV-positive prevalence rate among the age band of 15-49 years, higher than 1.3%, the national average for the same cohort. Despite the disease burden, many cases are \"lost to follow-up\" in this region. Through four focus groups of patients (20 participants in total) and in-depth interviews with four clinicians from four public hospitals, this study aimed to understand the barriers to attending healthcare appointments faced by young adults. The participants were recruited through flyers, posters, and snowballs at clinics; both data sets were first analysed separately yet used to triangulate each other. We found that clinical interruptions are mainly attributable to factors such as stigma, suicidal ideation, loss of means of livelihood due to PLHIV's \"new identities\", and thus poverty and malnutrition. These barriers, complicated by the COVID-19 pandemic and armed conflicts in the region, have made medication adherence further challenging. Therefore, we recommend the Nigerian government integrate non-biomedical support for PLHIV into people-centred HIV care.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10507729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-01-04DOI: 10.1080/09540121.2023.2299745
Kate Clouse, Sandisiwe Noholoza, Sindiswa Madwayi, Megan Mrubata, Natalie N Robbins, Carol S Camlin, Landon Myer, Tamsin K Phillips
This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother's family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.
{"title":"Peripartum mobility and maternal/child separation among women living with HIV in South Africa.","authors":"Kate Clouse, Sandisiwe Noholoza, Sindiswa Madwayi, Megan Mrubata, Natalie N Robbins, Carol S Camlin, Landon Myer, Tamsin K Phillips","doi":"10.1080/09540121.2023.2299745","DOIUrl":"10.1080/09540121.2023.2299745","url":null,"abstract":"<p><p>This prospective cohort study investigated the mobility patterns of 200 pregnant and postpartum women living with HIV in South Africa. Participants were enrolled during their third trimester from routine antenatal care near Cape Town, South Africa, and followed for six months postpartum. Quantitative data were collected at enrollment and follow-up. Mobility (self-reported) was common among the participants, despite the brief study period and the concurrent COVID-19 pandemic. While most reported stability in their current residence, 71% had a second main residence, primarily in the Eastern Cape (EC). Participants had a median of two lifetime moves, motivated by work, education, and family life. During the study period, 20% of participants met the study definition of travel (>7 days and >50 km), with trips predominantly to the EC, lasting a median duration of 30 days. Over one-third of participants with other living children reported that these children lived apart from them, with the mother's family being primary caregivers. These findings emphasize the need for targeted interventions to support continuity of care for mobile populations, particularly peripartum women living with HIV. The study contributes valuable insights into mobility dynamics and highlights unique barriers faced by this population, contributing to improved HIV care in resource-limited settings.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-03-06DOI: 10.1080/09540121.2024.2308745
Ohemaa B Poku, Afifa Ahmed, Lucy Liotta, Luke Kluisza, Reuben N Robbins, Elaine J Abrams, Claude A Mellins
Despite advances in HIV-treatment, adolescents and young adults (AYA) with HIV (AYAHIV) face myriad challenges. They are less likely than children and older adults to be virally suppressed and are at higher risk for mental health conditions compared to their peers who do not have HIV. AYA are also developing in the context of numerous biomedical, neurocognitive, and psychosocial developmental changes. Normative challenges during this time can be exacerbated by HIV and can result in significant physical and mental health problems. Yet, many AYAHIV have shown resilience with positive assets and resources and few health or mental health problems. Historically research has had a risk-focused approach to understanding AYAHIV needs. This paper discusses the rationale for a shift from a risk-focused only approach to one that examines AYAHIV needs from both a risk and resilience perspective. This paper presents: (1) epidemiological data on AYAHIV; (2) conceptual models for understanding both risk (e.g., poverty, stress, trauma, limited resources) and resilience/protective factors (e.g., family and peer support, future orientation, problem-solving skills); (3) global data examining risk and protective factors for physical and mental health challenges; and (4) promising interventions that incorporate elements of resilience to improve overall outcomes among AYAHIV.
{"title":"\"We did more than survive\": lessons learned from studies of risk and resilience of young people growing up with HIV and mental health needs.","authors":"Ohemaa B Poku, Afifa Ahmed, Lucy Liotta, Luke Kluisza, Reuben N Robbins, Elaine J Abrams, Claude A Mellins","doi":"10.1080/09540121.2024.2308745","DOIUrl":"10.1080/09540121.2024.2308745","url":null,"abstract":"<p><p>Despite advances in HIV-treatment, adolescents and young adults (AYA) with HIV (AYAHIV) face myriad challenges. They are less likely than children and older adults to be virally suppressed and are at higher risk for mental health conditions compared to their peers who do not have HIV. AYA are also developing in the context of numerous biomedical, neurocognitive, and psychosocial developmental changes. Normative challenges during this time can be exacerbated by HIV and can result in significant physical and mental health problems. Yet, many AYAHIV have shown resilience with positive assets and resources and few health or mental health problems. Historically research has had a risk-focused approach to understanding AYAHIV needs. This paper discusses the rationale for a shift from a risk-focused only approach to one that examines AYAHIV needs from both a risk and resilience perspective. This paper presents: (1) epidemiological data on AYAHIV; (2) conceptual models for understanding both risk (e.g., poverty, stress, trauma, limited resources) and resilience/protective factors (e.g., family and peer support, future orientation, problem-solving skills); (3) global data examining risk and protective factors for physical and mental health challenges; and (4) promising interventions that incorporate elements of resilience to improve overall outcomes among AYAHIV.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-01-03DOI: 10.1080/09540121.2023.2298768
Chiara Mariani, Fabio Borgonovo, Martina Gerbi, Giuliano Rizzardini, Amedeo F Capetti
This single-centre, single-cohort study examines hidden non-adherence to antiretroviral therapy in a setting of persistent optimal viral suppression but concordant absolute and percent CD4 decay by >10% from the previous test. After the finding of important drug holidays in two virologically suppressed patients, between January 2021 and January 2022 all PLWH who fulfilled CD4 decay criteria were asked for how long therapy was interrupted, how many days before re-testing CD4 and HIV RNA was it resumed and the reason for interruption. Of 668 HIV-infected subjects, 61 fulfilled the pre-specified criteria for significant CD4 decay and 15 (2.25% of the total, 25% of the CD4 decay group) admitted long-lasting treatment interruptions, compensated by treatment resumption before the subsequent testing. Eleven treatment interruptions exceeded 28 days, and none was shorter than 15 days. CD4 recovery was worse at 6 months in non-adherent subjects (-0.5 vs + 16/mmc, p < 0.0001) and in non adherence vs immune decay time-related with COVID-19 (0 vs + 22/mmc, p < 0.0001). Reasons for interrupting treatment were travel, psychological, poverty-related, addiction and sentimental sphere problems. Long-acting regimens, with stringent control of precision in timely administration, may protect PLWH from damaging their health status and possibly transmit HIV.
{"title":"Unexpected CD4 decay, hidden adherence gaps, resilience, and the need for long-acting therapy in a single HIV outpatients' cohort.","authors":"Chiara Mariani, Fabio Borgonovo, Martina Gerbi, Giuliano Rizzardini, Amedeo F Capetti","doi":"10.1080/09540121.2023.2298768","DOIUrl":"10.1080/09540121.2023.2298768","url":null,"abstract":"<p><p>This single-centre, single-cohort study examines hidden non-adherence to antiretroviral therapy in a setting of persistent optimal viral suppression but concordant absolute and percent CD4 decay by >10% from the previous test. After the finding of important drug holidays in two virologically suppressed patients, between January 2021 and January 2022 all PLWH who fulfilled CD4 decay criteria were asked for how long therapy was interrupted, how many days before re-testing CD4 and HIV RNA was it resumed and the reason for interruption. Of 668 HIV-infected subjects, 61 fulfilled the pre-specified criteria for significant CD4 decay and 15 (2.25% of the total, 25% of the CD4 decay group) admitted long-lasting treatment interruptions, compensated by treatment resumption before the subsequent testing. Eleven treatment interruptions exceeded 28 days, and none was shorter than 15 days. CD4 recovery was worse at 6 months in non-adherent subjects (-0.5 vs + 16/mmc, <i>p</i> < 0.0001) and in non adherence vs immune decay time-related with COVID-19 (0 vs + 22/mmc, <i>p</i> < 0.0001). Reasons for interrupting treatment were travel, psychological, poverty-related, addiction and sentimental sphere problems. Long-acting regimens, with stringent control of precision in timely administration, may protect PLWH from damaging their health status and possibly transmit HIV.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2024-01-24DOI: 10.1080/09540121.2024.2307391
Tawanda Makusha, Lesley Gittings
This paper highlights the pressing need to address the HIV epidemic among adolescent boys and young men (ABYM) in sub-Saharan Africa. Despite progress in HIV prevention, ABYM still experience low diagnosis rates, treatment adherence, and linkage to care. The paper emphasizes ABYM's vulnerability due to societal norms, limited healthcare access, and economic pressures. It calls for gender-responsive interventions, including comprehensive sexual education, youth-friendly health services, community engagement, and targeted outreach. Comprehensive sexual education is pivotal in HIV prevention for ABYM, providing them with age-appropriate sexual health knowledge and safer sexual practices to reduce HIV incidence. Harmful masculine norms must be countered to promote respectful relationships, benefiting boys, men, and their partners. Inadequate access to youth-friendly health services hampers HIV prevention. Establishing spaces with confidential, non-judgmental care offering testing, counselling, circumcision, and provision of pre-exposure prophylaxis (PrEP) is essential, especially considering ABYM's unique clinic experiences. Engaging communities, leaders, educators, and peers combats stigma and discrimination. ABYM's input in intervention design, targeted outreach, and innovative technology enhances effectiveness of HIV prevention programmes. Economic factors should also be addressed. Comprehensive multi-sectoral interventions, including conditional cash transfers, effective for AGYW, could benefit ABYM. Addressing structural factors alongside behaviour change and social support is key.
{"title":"The path towards an HIV-free generation: engaging adolescent boys and young men (ABYM) in sub-Saharan Africa from lessons learned and future directions.","authors":"Tawanda Makusha, Lesley Gittings","doi":"10.1080/09540121.2024.2307391","DOIUrl":"10.1080/09540121.2024.2307391","url":null,"abstract":"<p><p>This paper highlights the pressing need to address the HIV epidemic among adolescent boys and young men (ABYM) in sub-Saharan Africa. Despite progress in HIV prevention, ABYM still experience low diagnosis rates, treatment adherence, and linkage to care. The paper emphasizes ABYM's vulnerability due to societal norms, limited healthcare access, and economic pressures. It calls for gender-responsive interventions, including comprehensive sexual education, youth-friendly health services, community engagement, and targeted outreach. Comprehensive sexual education is pivotal in HIV prevention for ABYM, providing them with age-appropriate sexual health knowledge and safer sexual practices to reduce HIV incidence. Harmful masculine norms must be countered to promote respectful relationships, benefiting boys, men, and their partners. Inadequate access to youth-friendly health services hampers HIV prevention. Establishing spaces with confidential, non-judgmental care offering testing, counselling, circumcision, and provision of pre-exposure prophylaxis (PrEP) is essential, especially considering ABYM's unique clinic experiences. Engaging communities, leaders, educators, and peers combats stigma and discrimination. ABYM's input in intervention design, targeted outreach, and innovative technology enhances effectiveness of HIV prevention programmes. Economic factors should also be addressed. Comprehensive multi-sectoral interventions, including conditional cash transfers, effective for AGYW, could benefit ABYM. Addressing structural factors alongside behaviour change and social support is key.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}