Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv最新文献

Adolescents and young adults aged15 and 25 have the highest rates of STIs and HIV, yet they often do not seek testing or treatment. This study examined the factors influencing HIV and STI testing among sexually active high school students using data from the 2019 and 2021 Youth Risk Behavior Surveys (YRBS), which sampled students across all 50 states and the District of Columbia. Key variables included HIV and STI testing, sex, race/ethnicity, sexual identity, age of first sexual intercourse, and substance use during sex. Chi-square tests and multinomial logistic regression were used to identify predictors of testing. Results showed that only 14.4% of students were tested for HIV and 16.3% for other STIs. Factors associated with testing included age, number of sexual partners, and substance use. This study highlights the need for alternative methods of STI and HIV testing to improve screening rates among this at-risk age group.

Voluntary medical male circumcision (VMMC) was identified as an effective strategy in HIV prevention. Although circumcision reduces heterosexual acquisition of HIV by 60%, there is low uptake of VMMC services in Eswatini. This study applies the health belief model (HBM) in understanding perceptions of young men in Eswatini towards VMMC for HIV prevention to upscale its adoption. A qualitative design was followed. Uncircumcised males aged 20-29 years were recruited among university students. In-depth interviews were conducted, transcribed verbatim, and transcripts imported into NVivo12 for line-by-line analysis. Emerging codes were categorized under major constructs of the HBM. Condomless sex, having multiple sex partners, genital caressing and being uncircumcised were seen as susceptible exposure. Taking life-long treatment and stigma were perceived as severity. However, participants had no intent to circumcise in the near future even after acknowledging the severity. Hygiene, prevention of sexually transmitted infections including HIV were perceived as main benefits. Fear of pain was perceived as key barrier impeding adopting circumcision and seemed to outweigh the benefits for some participants. These findings will assist programme planners to review and promote VMMC services that will improve good health and well-being of young men to avert HIV new infections in Eswatini.

Disclosing one's HIV status or drug use in healthcare settings has significant implications for public and individual health. It is related to reduced occupational risk of infection for medical providers, improved care, reduction in disease transmission, and other clinical benefits for patients. However, disclosure can be challenging and problematic due to its discrediting aspects. We explored HIV and drug use disclosure experiences in clinical settings among Ukrainian women who live with HIV (WLWH) and inject drugs. This study was conducted in Kyiv, Ukraine. 309 surveys were completed between December 2019 and November 2020, followed by qualitative in-depth interviews with 18 participants. Some women in our study believed that disclosing their status ensured optimal medical care and necessary precautions by providers (e.g., sterilizing equipment). Other participants said they did not disclose after experiencing mistreatment in healthcare settings in the past. Still others utilized alternative strategies to disclose, such as using indirect language or cautiously informing about a less stigmatizing condition such as hepatitis. Clinical implications include training women who live with HIV to use communication skills to support disclosure in healthcare settings, taking into consideration consequences of disclosure to medical professionals to increase women's self-efficacy around this process.

Cardiovascular disease (CVD) represents a major cause of premature mortality in people living with HIV (PLWH). There is a need to characterize the cardiovascular health profiles of PLWH to appropriately guide primary prevention efforts, particularly in settings like Sub-Saharan Africa, where there is a high burden of HIV and limited resources. A cross-sectional analysis was conducted on a cohort of newly diagnosed PLWH and HIV-uninfected adults recruited from three HIV clinics in Mwanza, Tanzania. Modified Life's Simple 7 definitions were applied to the cohort to compare cardiovascular health profiles between the two study groups using Poisson regressions. Pooled cohort equation (PCE) scores were also calculated to compare the distribution of CVD risk between the two groups. Our study included 995 study participants (492 PLWH, 503 HIV-uninfected). PLWH had a higher prevalence of ideal body mass index (75%), ideal blood pressure (56%), and ideal total cholesterol but a lower prevalence of ideal smoking (84%) and ideal physical activity (39%) than HIV-uninfected counterparts. PCE scores were low throughout the study population (76.5%), regardless of HIV status. Primary prevention of CVD in newly diagnosed people living with HIV in Africa may need to focus on smoking cessation and optimization of physical activity levels.

Youth living with HIV (YLWH) have high rates of virologic failure due to medication non-adherence. PEERNaija is a novel, gamified mobile health (mHealth) application designed with user-centered principles to improve medication adherence by integrating medication reminders with social and financial incentives, virtual peer social support and early clinic outreach for non-adherent YLWH in Nigeria. Focus Group Discussions (FGDs) were conducted to identify reactions to key prototype features (user interface, medication reminders, incentives, and peer support), facilitators and barriers to app use, and how well the app would meet adherence needs. FGDs were analyzed using thematic analysis. Fifty-one Nigerian YLWH 15-27 years (29 females, 22 males), 14 parents of YLWH (11 mothers, 3 fathers), and 5 adolescent public health experts participated in FGDs. All groups expressed enthusiasm about PEERNaija and thought it would improve medication adherence. YLWH expressed excitement about gamified and incentive components. All participants highlighted the importance of maintaining privacy. The app was refined in response to feedback, prioritizing desired features of YLWH and addressing barriers across groups. Findings suggest that PEERNaija will be acceptable (to YLWH, parents of YLWH, and adolescent public health experts) and highlight the importance of user-centered design principles to adapt and refine mHealth interventions.

Objective measures of oral PrEP adherence - especially point-of-care (POC) measures that enable real-time assessment, intervention, and feedback - have the potential to improve adherence. Our team previously developed and validated a novel urine-based POC metric of PrEP adherence. In this study, we sought to determine whether this assay is acceptable and feasible among women taking PrEP and PrEP providers in Kenya. We conducted a trial comparing PrEP adherence counseling using the assay (intervention) versus standard-of-care counseling. We conducted in-depth interviews (IDIs) with intervention-arm participants (n = 20), and focus group discussions (n = 18) after the final (12-month) follow-up visit. We also conducted IDIs with purposively-sampled healthcare providers (HCPs) (n = 8) who administered the assay. The assay was highly acceptable among participants and HCPs as it was perceived to be accurate, could provide evidence of adherence, provides real-time results, and improves participant and provider relationship. HCPs reported that the assay facilitated counseling, seemed to increase adherence, and would be feasible to implement in routine care settings. Both participants and HCPs reported concerns about the assay related to the fear of being stigmatized for negative results, and test accessibility. Future studies should evaluate the impact of this novel test on adherence patterns over time in diverse populations.Trial registration: ClinicalTrials.gov identifier: NCT03935464.

Limited data exists concerning the fertility desires of young people living with HIV/AIDS (PLWHA) in China, making it difficult to develop appropriate reproductive health service policies and interventions for them. Extensive fieldwork was carried out from April to May 2021 in 10 selected survey sites across five provinces, targeting all young men aged between 18 and 24 years living with HIV. The association between independent variables and fertility desires was determined using Chi-square tests and Multivariate binary logistic regression models. In total, we obtained valid responses from 436 individuals, yielding a response rate of 74.9%. Nearly half of the respondents (48.6%) expressed a future desire to have children. The multivariate logistic regression models pointed to rural registered residence (AOR = 1.595, CI: 1.073, 2.371), heterosexual (AOR = 3.098, CI: 1.523, 6.301) or bisexual orientation (AOR = 2.302, CI: 1.396, 3.794), among others, as significant correlates of fertility desires. This study represents the first exploration of fertility desires among young men living with HIV in China. Evaluating these desires allows healthcare providers to anticipate patients' potential marriage and family plans, thereby facilitating timely provision of reproductive services designed to prevent HIV transmission.

ABSTRACTAlthough the biomedical advancements in HIV treatment have improved the original prognosis of the illness, people living with HIV (PLHIV) continue to encounter psychosocial challenges that impact their quality of life (QoL), including HIV-stigma and social connectedness. The present study investigates how different types of HIV-related stigma, as per the Conceptual Model of Perceived Stigma, respectively relate to QoL in the context of social connectedness in PLHIV. A total of 213 PLHIV attending a tertiary HIV clinic in Sydney Australia, completed questionnaires assessing HIV-related stigma, social connectedness, and QoL. After controlling for illness duration, the results revealed that overall HIV-related stigma and social connectedness were predictors of reduced QoL. Specifically, negative self-image, one of the four stigma types, was associated with decreased QoL, while personalized stigma, concerns about public attitudes, and disclosure concerns were not significant predictors. Furthermore, social connectedness partially mediated the relationship between negative self-image and QoL. This study enhances understanding of the impact of various forms of HIV-related stigma in an Australian cohort, including the role of social relationships, providing novel insights for clinical interventions.

Living with HIV can affect mothers' wellbeing, functioning, and experiences of caregiving. Most research about caregiving in the context of HIV comes from studies of dyads where both mother and child are living with HIV. Less is known about how mothers experience caregiving when their children are HIV exposed, but their HIV-status is not yet known. We conducted a scoping review to map out existing evidence on this topic. Systematic database search was conducted combined with a purposive hand search and expert consultation to identify relevant peer-reviewed literature. Title and abstract screening followed by a full-text review was done to select eligible studies. Studies were eligible for inclusion if they related to maternal caregivers; young children exposed to HIV, confirmed to be uninfected or whose HIV-status is unknown; and caregiving including any maternal involvement with her child. We identified 19 relevant studies. Analysis revealed that many mothers' caregiving experience was marked by feelings of fear and stress in the early months of motherhood, mostly to do with the possibility of the child receiving a positive HIV diagnosis. Two dominant themes emerged - (1) experiences related to feeding and (2) experiences related to HIV testing, medications and health care utilization. Mothers had concerns pertaining to HIV transmission, feeding choices, efficacy of antiretrovirals and infant testing at multiple stages. Finally, any kind of support received from family, community or health workers, acted as a facilitator to improve caregiving experiences. This review highlights the need to provide additional support to mothers in their caregiving roles, especially before a child's negative HIV-status is confirmed. Further investigation is warranted to determine if mothers' concerns and challenges with caregiving persist even after HIV has been ruled out in the child.

Self-management refers to the behaviors and strategies individuals employ to manage their health conditions. For people living with HIV (PLWH), it encompasses medication adherence, health monitoring, symptom management, lifestyle maintenance and seeking emotional support. While previous studies on the factors influencing self-management in PLWH are predominantly cross-sectional, longitudinal studies are scarce. This nine-year longitudinal study aimed to investigate the trajectories of psychosocial characteristics in PLWH and their effects on self-management. A total of 265 PLWH were assessed for psychosocial factors, including stigma, depression, anxiety, and social support, at baseline and at one-, five- and nine-year follow-ups. Self-management was evaluated at the nine-year follow-up. Psychosocial trajectories were identified using latent growth trajectory models (LGMM), and associations with self-management were analyzed via multiple linear regression. The majority of participants exhibited a low-level decline in depression (79.6%) and rising social support (54.3%). The high-level decline depression group demonstrated the lowest self-management scores (b = -4.67, 95% CI: -8.166 to -1.175). Multivariate analysis revealed significant associations between self-management and exercise (b = 5.360, 95% CI: 3.934-6.786), depressive symptoms (b = -0.168, 95% CI: -0.305 to -0.031) and social support (b = 0.182, 95% CI: 0.101-0.264). These findings emphasize the need for continuous monitoring and targeted interventions to improve self-management in PLWH.