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

Improving access and retention in programs aimed at reducing the transmission of HIV from mothers to children is a key focus area for HIV care and prevention. Despite these efforts, retention in the prevention of mother-to-child transmission (PMTCT) programming in Rwanda is suboptimal. This study gathered nuanced information on the experiences of patients and providers of PMTCT services to identify strategies for improving retention. 25 interviews were conducted across 14 health facilities in Rwanda. The data were analyzed using a thematic analysis. Both patients and providers described resource deficiencies that impeded their ability to attend or provide optimal PMTCT services. Specifically, patients described struggling with poverty (e.g., ensuring access to food and shelter), let alone covering transportation fees to attend PMTCT appointments. Providers described not having enough space or personnel to attend to patients. They also described the absence of the required equipment and medications. Participants also identified facilitators of patient retention in PMTCT services, including acceptance of HIV status, knowledge of PMTCT services, and social support. These findings highlight the persistence of known barriers to the successful implementation of PMTCT services, suggesting that new strategies are needed to address the context-specific challenges experienced by patients and providers in Rwanda.

Adolescent and young women (AYW) in Sierra Leone face high HIV risk and low testing rates, hindering progress toward the 95-95-95 targets. This study examines the spatial distribution and factors influencing recent HIV testing among AYW in Sierra Leone using the 2019 Sierra Leone Demographic and Health Survey, which included 6,062 participants aged 15-24. Techniques such as spatial autocorrelation (Moran's I), hotspot analysis (Getis-Ord GI*), and Kriging interpolation identified testing clusters, alongside a multilevel logistic regression model for associated factors. Hotspots for testing were found in Kailahun and Kenema, while cold spots were noted in Karene, Falaba, and Tonkolili. Approximately 24.3% of AYW reported recent testing. Key factors linked to recent testing included being aged 20-24, having multiple sex partner, age at first sex (before age 18), age at first sex (18 and above), history of sexually transmitted infections (STIs), and HIV knowledge. Regional disparities were evident, with lower testing odds in the Northern, Northwestern, and Southern regions compared to the Eastern region. The study recommends a multilevel approach, integrating targeted outreach in high-risk areas with community education and awareness campaigns to address disparities in HIV testing among AYW in Sierra Leone.

North American societies recommend that Pregnant People Living with Human Immunodeficiency Virus (PLWHIV) use formula to feed their infants to eliminate the risk of perinatal HIV transmission. However, many Canadian PLWHIV have migrated from HIV-endemic countries, where the World Health Organization recommends exclusive breastfeeding. These opposing recommendations, along with the complex interplay of social, cultural, and personal factors, create tension when making decisions regarding infant feeding. This study describes the experiences of PLWHIV in making decisions to inform healthcare providers and enhance guidelines for the use of breast milk. In-depth interviews were conducted with patients (n = 10) from a tertiary hospital in Toronto, Ontario. All participants were immigrants to Canada, with the majority (n = 8) self-identifying as African or Caribbean. Regarding their most recent pregnancy, 6 exclusively formula-fed, three exclusively used breast milk, and one used a combination of both feeding methods. The thematic analysis revealed four key themes: values and facilitators in the decision-making process, challenges experienced with infant feeding choices, reflections on these decisions, and recommendations for enhanced care. The findings highlight the need for socially and culturally inclusive evidence-based counseling, a safe environment, multidisciplinary care, and access to information that supports the best possible outcomes for both mothers and babies through informed decision-making.

Bangladesh exhibits a low prevalence of HIV; however, socioeconomic and gender disparities contribute to an increased vulnerability among women, primarily due to limited awareness of transmission methods, preventive measures, and testing services. This study employs data from the Multiple Indicators Cluster Survey (MICS) 2019, utilizing descriptive statistics, Chi-square tests, and logistic regression analyses to examine the influence of socio-demographic factors, educational attainment, and media exposure on HIV awareness. The findings indicate a moderate level of awareness, albeit accompanied by widespread misconceptions; only 27.5% of women knew where to access testing services. Women residing in urban areas, possessing higher education levels, belonging to wealthier households, and with media exposure demonstrated significantly higher awareness levels. Disparities are evident across different regions, notably in Barishal and Mymensingh. Futhermore, women with higher secondary education exhibited a 17.5-fold increase in HIV knowledge compared to those with primary education. The study underscores the importance of targeted educational initiatives, media campaigns, and enhanced testing acessibility, particularly in underserved regions, to improve awareness and mitigate stigma.

People living with HIV (PLWH) are at risk for mental health (MH) disorders and pain, but this burden is largely unknown in low/middle-income countries. From February-October 2023, we conducted a cross-sectional survey at a large HIV clinic in Lima, Peru to quantify the prevalence of MH disorders and pain amongst PLWH established in care and to explore relationships between MH and well-managed HIV. At clinic visits, PLWH were invited to complete validated measures for depression, post-traumatic stress disorder (PTSD), alcohol use disorder (AUD), and pain (PHQ-8, PCL5, AUDIT-C, and BPISF). We abstracted data on treatment and viral suppression from medical charts. We calculated the prevalence of depression (PHQ8 ≥ 10), PTSD (PCL-5 ≥ 30), AUD (AUDIT-C ≥ 4 for men, ≥ 3 for women), and pain severity/interference (none, mild, moderate, or severe). We conducted logistic regression analyses to determine associations between MH/pain and viral suppression. Among 397 participants, 32% (95% CI: 27-37%) reported AUD, 21% (17-26%) reported depression, and 13% (9.5-16%) reported PTSD; 14% (11-18%) and 12% (9.3-16%) reported moderate/severe pain intensity and interference, respectively. There were no associations between MH/pain and viral suppression. High levels of MH disorders and pain among PLWH established in care suggest screening is needed for all PLWH, even those with well-controlled HIV.

Obesity is increasingly prevalent in people with HIV (PWH) and associated with multiple metabolic derangements. Understanding body weight perceptions and discrepancies with actual body weight is an important step for better weight management interventions. The Silhouette Figure Rating Scale (SFRS) was used to assess self-perception of body weight and the Body Shape Questionnaire (BSQ) was used to rate body image concerns among participants in a low-income multiethnic HIV clinic in Houston, Texas. Of 202 participants, 60% underestimated their body mass index (BMI) category. A desired overweight silhouette was chosen by 30% of participants and an obese silhouette was desired by 7%. Only 2% of PWH and obesity perceived themselves as being obese and most (60%) were unconcerned with their current body weight. These findings highlight the importance of individualized weight loss strategies in PWH, taking into consideration desired body image.

Adolescents are disproportionately vulnerable to unintended pregnancies and delayed HIV treatment in low-resource settings. Tanzanian policies support adolescent access to contraception and HIV testing and counseling (HTC) without parental consent if needed; however, parent/guardian disapproval could lead to unmet service needs. This qualitative study explores factors that influence caregivers' attitudes towards adolescents accessing these services independently. VITAA is a cluster RCT testing a school-clinic partnership to provide adolescent health check-ups in Tanzania. Semi-structured interviews (n = 42) were conducted with a purposeful sample of parents/guardians (74% women) of VITAA participants. The extended theory of planned behavior for parent-for-child health behaviors informed thematic analysis. Many parents/guardians expressed hesitancy about adolescents accessing services independently. Contraception concerns included community norms about adolescents being too young for sex and fears that access to contraception decreases parents' behavioral control over adolescents. Conversely, many caregivers endorsed positive attitudes towards HTC, but they had worries about adolescents receiving positive test results alone. Parent/guardian attitudes shape adolescents' health-seeking behaviors and Tanzanian parents and guardians are hesitant about adolescents' independent service use for diverse reasons, including its potential relationship with sexual debut. Tailored communication interventions could encourage caregivers' support for adolescent service access to meet community goals for healthy adolescents.Trial registration: ClinicalTrials.gov identifier: NCT05306938..

This study aimed to explore the HIV risk perception of having unprotected sexual intercourse following traditional male circumcision (TMC), a practice known as sifon, in West Timor, Indonesia. Guided by the Health Belief Model, we interviewed 34 men who underwent TMC, 7 traditional practitioners and 13 women who had engaged and analysed them thematically. The result showed that most of the participants had low HIV risk perception towards sifon practice and had low perceived severity of the impact of HIV/AIDS, which was supported by a strong cultural belief in sifon practice and lack of knowledge of HIV/AIDS. Similarly, most of the participants who underwent sifon did not see the benefit of using condoms when performing sifon. The findings showed that participants are at high risk of acquiring HIV infection due to performing sifon without protection. The findings indicated the need for open, detailed and consistent health education on the risk of HIV transmission through sifon practice in communities practising TMC and sifon irrespective of their status.

Undetectable equals Untransmittable (U = U) is a pivotal tool for HIV prevention, stigma reduction, and improving quality of life for people living with HIV. This study examined awareness, acceptance, and impact of U = U among people living with HIV across Canada, and explored differences across sociodemographic characteristics. From 2018-2024, 1,083 participants were recruited in-person and online using snowball sampling. Peer researchers conducted interviews, initially in person and later mostly online due to COVID-19. Demographic data and U = U outcomes were collected and analyzed using multivariate logistic regression. Overall, 72% of participants had heard of U = U, 67% strongly accepted it, and 51% had discussed it with a healthcare provider. Awareness and acceptance were lower among heterosexual and bisexual participants. Cis-women and participants who were unemployed were less likely to report positive impacts from U = U. Black-identifying participants were more likely to report benefits, while Indigenous participants were more likely to believe U = U could reduce stigma and shift public opinion. Older participants were less likely to discuss U = U with a healthcare provider. Findings highlight U = U's potential to reduce stigma, but gaps remain in awareness, acceptance, and provider communication. Tailored strategies are needed to engage diverse communities and support healthcare providers in confidently sharing the zero-risk message.

Introduction: Cigarette smoking remains the leading preventable cause of death in the United States, with prevalence remaining dangerously high in at-risk groups, including people living with Human Immunodeficiency Virus (HIV). Military Veterans with HIV and receiving Veterans Health Administration (VHA) care have a high prevalence of smoking, and risk factors such as hazardous drinking and substance use disorder (SUD), despite access to smoking cessation treatment. Little is known about the prevalence of smoking and smoking cessation medication receipt among Veterans with HIV and co-occurring hazardous drinking or SUD. Methods: In this cohort study, we analysed nationwide VHA electronic health record (EHR) data from 1 October 2015 to 30 September 2021, to examine the prevalence of smoking among Veterans with HIV with and without hazardous drinking or SUD diagnoses. We then assessed VHA cessation prescription rates for the 12 months following the documentation of smoking in the VA EHR. Results: In the overall sample of Veterans with HIV who smoke and have co-occurring hazardous drinking or SUD, 33.9% (N = 3220) were prescribed smoking cessation medications in the 12 months following documented smoking. Among Veterans who smoke with HIV, 42.5% of those with hazardous drinking or SUD were prescribed medication compared to 29.6% of those without hazardous substance use. Discussion: These trends demonstrate that Veterans with HIV who smoke but do not have hazardous drinking or SUD have lower access to smoking cessation pharmacotherapy in VA care. Efforts to provide tobacco cessation pharmacotherapy to this population may improve smoking outcomes.Trial registration: Netherlands National Trial Register identifier: ntr206.