Adult HIV Prevalence Research Articles

Antiretroviral Adherence Perspectives of Pregnant and Postpartum Women in Guyana.

The Caribbean region has the second highest HIV prevalence after Sub-Saharan Africa. Guyana's adult HIV prevalence is 1.9% among pregnant women, with women accounting for an estimated 58% of all persons living with HIV. However, there are few studies on ART adherence in the Caribbean, none from Guyana, and none focusing on adherence in pregnancy and the postpartum period. The objective of this study was to explore the perspectives of HIV-infected pregnant and postpartum women and healthcare providers in Guyana about barriers and facilitators to ART adherence. Data was collected using semi-structured interviews with 24 HIV-infected pregnant and postpartum women and nine healthcare professionals at five clinics between February and April 2012. The Framework Method for analysing qualitative data identified facilitators and barriers related to five core themes: (i) Concern for wellbeing of children; (ii) ART-related factors; (iii) Disclosure; (iv) Socio-economic issues; and (v) Religious and cultural beliefs. Non-disclosure did not adversely affect adherence, contrary to other studies in the literature. Two broad categories emerged from the lived experiences of women in Guyana. The first is related to the act of actually taking their medication where their tenacity is displayed in efforts made to ensure ART is taken. The second relates to the significance of ART to them in terms of reduced risk of MTCT, and the possibility of better health for themselves to enable them to care for their children. However, issues related to poverty, food insecurity and side effects reduced adherence need to be adequately addressed.

The Effect of HIV and the Modifying Effect of Anti-Retroviral Therapy (ART) on Body Mass Index (BMI) and Blood Pressure Levels in Rural South Africa.

BackgroundHigh BMI and blood pressure are leading chronic disease risk factors in South Africa. Longterm effects of HIV and ART on adiposity and blood pressure are poorly understood, and direct comparisons of risk factor trajectories in HIV- versus HIV+ populations are rare.MethodsIn 2003 and 2010, height, weight, and blood pressure were recorded in a study population (n = 505) in KwaZulu-Natal, South Africa (30% adult HIV prevalence). We modeled change in BMI and BP longitudinally in HIV- individuals (n = 315), seroconverters (n = 32), HIV+ patients not on ART (HIV+ART−; n = 52), HIV+ patients on ART for 0–<2 years as of 2010 (HIV+ART0–<2 yrs; n = 18), patients on ART for 2–5 years (HIV+ART2–5yrs; n = 44), and a subgroup with unknown HIV status (n = 44). Difference-in-differences were assessed in reference to the HIV- population.ResultsBetween 2003 and 2010, BMI increased significantly in the HIV- group, by 0.874 (95% CI 0.339, 1.41; p = 0.001), to 30.4. BMI drop was significantly greater in HIV+ART0-<2yrs than in HIV+ART2–5yrs (p = 0.005). DID in BMI in HIV+ART0-<2yrs versus the reference was -5.21 (95% CI -7.53, -2.90; p = 0.001), and DID in HIV+ART2–5yrs versus reference was -1.35 (95% CI -2.89, 0.189; p = 0.086). DID in SBP in HIV+ART−vs HIV- DID was -7.55 mmHg (95% CI -13.2 to -1.90; p = 0.009).ConclusionShort-term ART (0–<2 years) was associated with larger weight loss than either no ART or long-term ART. Once on ART for 2+ years, individuals ‘caught up’ on weight gain with the HIV- population. Our results showcase the importance of health system readiness to address the burgeoning double burden of disease in South Africa.

Investing in the health workforce to increase access to and use of HIV and AIDS services in Uganda.

Despite progress over the last decade, Uganda's achievement of key health indicators, including for HIV and AIDS, remains unsatisfactory and continues to represent leading causes of morbidity and mortality [1]. As the Government of Uganda works to improve healthcare across all service delivery areas, HIV and AIDS receives heightened attention because of the country's ranking in terms of the number of new HIV infections, people living with HIV (PLHIV), AIDS-related deaths, and adult HIV prevalence rate [2]. Intensive efforts in HIV prevention, care, and treatment led to a decrease in HIV prevalence from a high of 18% in the 1990s to 6.4% in 2002. After persisting at this level from 2002 to 2007, HIV prevalence rose to a national average of 7.3% (2011) [3,4]. Many regions experience an even higher burden of HIV, especially in central and mid-northern Uganda, with prevalence ranging from 8.3 to 10.6% [4]. Health workforce challenges undermine HIV service delivery Uganda's aim to strengthen and scale up its HIV and AIDS response to reduce new infections and achieve ‘a population free of HIV and its effects’ [5] is undermined by low utilization of health services and perceived low quality of healthcare [6]. A key element of quality service delivery and demand is a well performing and well trained health workforce [7]. Uganda's absolute shortage and inadequate geographic distribution of health workers with appropriate skill mix to provide services across the continuum hinders achievement of epidemic control. A national staff audit conducted by the Ministry of Health in 2009 found that 47% of established positions in government health facilities were vacant [8]. In addition, about 71% of doctors and 41% of nurses and midwives were working in urban areas, although 85% of the population reside in rural areas [9,10]. Factors contributing to high health worker vacancy and low retention include weak leadership and management, inadequate planning and human resources management systems, low levels of motivation, and poor working and living conditions in rural areas [6]. To address health workforce challenges affecting quality of care for HIV and AIDS, the United States Agency for International Development (USAID) and U.S. President's Emergency Plan for AIDS Relief-funded global CapacityPlus project and bilateral Uganda Capacity Program (UCP), both led by IntraHealth International, worked in close collaboration with the Ministry of Health to strengthen health workforce management to enable improved delivery of quality HIV and AIDS services. They also provided family planning, reproductive health and other health services with funding from PEPFAR and USAID's Population and Reproductive Health, Maternal and Child Health, and other programs. This field note describes selected interventions from a more comprehensive package of human resources management support provided to the Ministry of Health, to improve the utilization of data for evidence-based planning, deployment, and management of the health workforce. It also provides an example of how health workforce data can be analyzed alongside country-level HIV service statistics to ensure an adequate supply of human resources for health (HRH) where increased accessibility and scale-up of HIV services is needed to achieve 90–90–90 goals [11–13].

Modelling and estimation of HIV prevalence and number of people living with HIV in India, 2010-2011.

This paper provides HIV estimation methodology used in India and key HIV estimates for 2010-2011. We used a modified version of the Spectrum tool that included an Estimation and Projection Package as part of its AIDS Impact Module. Inputs related to population size, age-specific pattern of fertility, gender-ratio at birth, age and gender-specific pattern of mortality, and volume and age-gender distribution of net migration were derived from census records, the Sample Registration System and large-scale demographic health surveys. Epidemiological and programmatic data were derived from HIV sentinel surveillance, large-scale epidemiological surveys and the programme management information system. Estimated adult HIV prevalence retained a declining trend in India, following its peak in 2002 at a level of 0.41% (within bounds 0.35-0.47%). By 2010 and 2011, it levelled at estimates of 0.28% (0.24-0.34%) and 0.27% (0.22-0.33%), respectively. The estimated number of people living with HIV (PLHIV) reduced by 8% between 2007 and 2011. While children accounted for approximately 6.3% of total HIV infections in 2007, this proportion increased to about 7% in 2011. With changing priorities and epidemic patterns, the programme has to customise its strategies to effectively address the emerging vulnerabilities and adapt them to suit the requirements of different geographical regions.

Improving Health and Social Outcomes for Children through the Use of a Community Caregiver Service Provision Model in Côte d’Ivoire

Cote d’Ivoire has one of the highest adult HIV prevalence rates in West Africa; HIV has directly affected an estimated 440,000 orphans and vulnerable children (OVC). Some support programs use community caregivers (CC) to provide care and support to children left vulnerable by the epidemic. The purpose of this study was to examine the impact that the use of a CC service provision model had on outcomes for children orphaned or made vulnerable by HIV/AIDS in Cote d’Ivoire. A sequential mixed-methods design was used, making use of both quantitative (survey) and qualitative (focus group and interview) data collection and analysis. The study found that CC has had a significant impact on OVC’s lives, improving both social and clinical outcomes. OVC working with a CC had greater access to care than those not supported by a CC. Findings suggest the CC intervention model should be formalized and embedded into the government welfare and healthcare system in Cote d’Ivoire.

Changing Antiretroviral Eligibility Criteria: Impact on the Number and Proportion of Adults Requiring Treatment in Swaziland.

Objective:Early initiation of antiretroviral treatment (ART) at CD4+ cell count ≥500 cells per microliter reduces morbidity and mortality in HIV-infected adults. We determined the proportion of HIV-infected people with high viral load (VL) for whom transmission prevention would be an additional benefit of early treatment.Design:A randomly selected subset of a nationally representative sample of HIV-infected adults in Swaziland in 2012.Methods:Eight to 12 months after a national survey to determine adult HIV prevalence, 1067 of 5802 individuals identified as HIV-infected were asked to participate in a follow-up cross-sectional assessment. CD4+ cell enumeration, VL measurements, and ART status were obtained to estimate the proportion of currently untreated adults and of the entire HIV-infected population with high VL (≥1000 copies/mL) whose treatment under a test-and-treat or VL threshold eligibility strategy would reduce HIV transmission.Results:Of the 927 (87% of 1067) participants enrolled, 466 (50%) reported no ART use. Among them, 424 (91%) had VL ≥1000 copies per milliliter; of these, 148 (35%) were eligible for ART at the then existing CD4+ count threshold of <350 cells per microliter; an additional 107 (25%) were eligible with expanded CD4+ criterion of <500 cells per microliter; and 169 (40%) remained ART ineligible. Thus, 36% of the 466 currently untreated and 18% of the total 927 had high VL yet remained ART ineligible under a CD4+ criterion of <500 cells per microliter.Conclusions:A test-and-treat or VL threshold for treatment eligibility is necessary to maximize the HIV transmission prevention benefits of ART.

Economic Dependency and HIV/AIDS Prevalence in the Developing World: A Comparative, Longitudinal Analysis

The HIV/AIDS pandemic has plagued global society for over three decades. While breakthroughs in antiretroviral treatments (ART) have proven effective in suppressing the virus and HIV/AIDS intervention outreach have widened, epidemic control remains unevenly achieved among countries. At least 95 percent of HIV/AIDS sufferers originate from developing countries. Dependency theory suggests that developing countries' reliance on debt, trade, and foreign investments pose negative effects on their populations' health. Guided by dependency theory's propositions, this cross‐national study assesses whether increasing dependence on trade, debt, and foreign direct investment potentially increases adult HIV prevalence in developing countries from 1989 to 2012. Using a sample of over 80 nations, we perform a two‐way fixed‐effects OLS regression to evaluate the impact of increasing debt, trade, and foreign investment on adult HIV prevalence. Total debt, short‐term debt, external debt, and GDP were found to increase HIV prevalence. The findings for debt support dependency theory's predictions concerning the ramifications of global economic inequality on HIV/AIDS prevalence.

Seroprevalence of Human Immunodeficiency Virus in Female Sex Worker in Yavatmal (Maharashtra) region

India has the third highest number of estimated people living with HIV in the world. According to the HIV Estimations 2012, the estimated number of people living with HIV/AIDS in India was 20.89 lakh, with an estimated adult (15-49 age group) HIV prevalence of 0.27% in 2011. India has demonstrated an overall reduction of 57% in the annual new HIV infections among adult population from 2.74 lakh in 2000 to 1.16 lakh in 2011, reflecting the impact of various interventions and scaled-up prevention strategies under the National AIDS Control Programme (NACP). This HIV infection is not only common in males but also in females and in female commercial sex workers facing the major problem. Hence the present study was conducted to study the impact of Targeted Interventions on HIV in female sex workers. A total of 351 commercial sex workers were screened for HIV. Seroprevalence of HIV in female sex workers was found to be 0.28%. Conclusion: The seroprevalence of HIV in high risk group can be reduced by the effective implementation of Targeted Intervention Programme of NACO. Key words: Female sex workers, HIV, AIDS, NACO

Seroprevalence of Human Immunodeficiency Virus Among Antenatal Women in One of the Institute of Northern India.

As per NACO publication there are an estimated 2.08 Million HIV/AIDS cases in India as of February 2014. The estimated adult HIV prevalence in India is 0.27%, with a gender spit of 0.32% males and 0.22% females. Estimating the seroprevalence of HIV in a low risk population such as pregnant women provides essential information for an effective implementation of AIDS control programmes. In spite of an estimated adult HIV prevalence rate of 0.18% in Punjab, there are no previous studies among antenatal women to assess seroprevalence. To assess the prevalence of HIV infection, among otherwise healthy pregnant females. This retrospective study reviewed treatment records of 3686 antenatal women who underwent HIV testing. Demographic, obstetric and laboratory data was recorded into a preset proforma. Available data was analysed using SPSS version 13. Total of 38 subjects tested positive for HIV infection. Seroprevalence rate was 1.03%. A 25 -30 years age group had most number of infected individuals with 22 (57.89%) subjects. Seropositivity was common among rural domicile. Only 9 (23.68%) was aware of their seropositive status. A total of 20 (52.63%) subjects were illiterate, 14 (36.84%) had received primary school education. Seroprevalence rate of 1.03% reported in this study has been the highest among the contemporary articles published in last decade. Efficient surveillance along with proper implementation of Prevention of Parent to Child Transmission (PPTCT) is the need of the day. A prompt action at the hands of the authority will enable us to safeguard our present and future alike.

Association between spending on social protection and tuberculosis burden: a global analysis

The End TB Strategy places great emphasis on increasing social protection and poverty alleviation programmes. However, the role of social protection on controlling tuberculosis has not been examined fully. We analysed the association between social protection spending and tuberculosis prevalence, incidence, and mortality globally. We used publicly available data from WHO's Global Tuberculosis Programme for tuberculosis burden in terms of yearly incidence, prevalence, and mortality per 100,000 people, and social protection data from the International Labour Organization (ILO), expressed as the percentage of national gross domestic product (GDP) spent on social protection programmes (excluding health). Data from ILO were from 146 countries covering the years between 2000 and 2012. We used descriptive assessments to examine levels of social protection and tuberculosis burden for each country, then used these assessments to inform our fully adjusted multivariate regression models. Our models controlled for economic output, adult HIV prevalence, health expenditure, population density, the percentage of foreign-born residents, and the strength of the national tuberculosis treatment programme, and also incorporated a country-level fixed effect to adjust for clustering of datapoints within countries. Overall, social protection spending levels were inversely associated with tuberculosis prevalence, incidence, and mortality. For a country spending 0% of their GDP on social protection, moving to spending 1% of their GDP was associated with a change of -18·33 per 100,000 people (95% CI -32·10 to -4·60; p=0·009) in prevalence, -8·16 per 100,000 people (-16·00 to -0·27; p=0·043) in incidence, and -5·48 per 100,000 people (-9·34 to -1·62; p=0·006) in mortality. This association was mitigated at higher levels of social protection spending, and lost significance when more than 11% of GDP was spent. Our findings suggest that investments in social protection could contribute to a reduced tuberculosis burden, especially in countries that are investing a small proportion of their GDP in this area. However, further research is needed to support these ecological associations. National Institutes of Health National Center for Advancing Translational Science (University of California, Los Angeles [CA, USA] Clinical and Translational Science Institute).

Generating Evidence to Improve the Response to Neglected Diseases: How Operational Research in a Médecins Sans Frontières Buruli Ulcer Treatment Programme Informed International Management Guidance.

Neglected Tropical Diseases (NTDs) are estimated to cause more than 500,000 deaths per year, almost exclusively affecting those living in impoverished rural and urban areas of low-income countries [1]. They are also characterised by a lack of research support and development of specific drugs, diagnostics, and vaccines [2,3]. For many NTDs, scientific information is lacking due to a paucity of research, often because they occur in settings with little access to the resources required to conduct high-quality research such as randomised trials. This lack of research in turn limits the development of evidence-based guidance to inform clinical and programme responses. Humanitarian organisations often work in these settings and commonly have access to the extra resources and collaborations with academic institutions needed to support such activities. Therefore, these organisations have a relatively unique opportunity to obtain important, new information on NTDs through the performance and publication of operational research using observational data. While observational studies cannot be used to make causal claims due to the inherent risk of bias and confounding, such data can nevertheless provide valuable information for health care management, hypothesis generation, and trend analysis [4]. Here we describe how operational data generated from a Medecins Sans Frontieres (MSF) Buruli ulcer (BU) management programme provided important information that contributed to the development of a global BU treatment guidance that addressed a number of complex management issues involving BU-HIV coinfection. BU is a necrotising infection of skin and subcutaneous tissue caused by Mycobacterium ulcerans. It commonly affects children in remote, resource-limited settings and, when severe, is associated with prolonged illness and long-term disability [5]. The main burden of BU is in West and Central Africa—regions also burdened with high HIV prevalence. All 15 countries in West and Central Africa reporting BU cases have an adult HIV prevalence of 1%–5%. Therefore, there is a significant potential for BU and HIV to occur in the same individual. Until recently, however, there has been very little known about the epidemiology, clinical consequences, and management implications of BU-HIV coinfection. Critical unanswered questions include the following: Is HIV a risk factor for BU? Does HIV affect BU disease presentation and severity, or does it influence outcomes such as mortality, BU cure rates, and healing times? How should BU-HIV coinfected patients be managed, when should antiretroviral treatment (ART) start, and what BU treatment regimens should be used in the face of potential interactions with antiretroviral drugs? In 2013, due to an increasing recognition of the importance and complexity of managing BU-HIV co-infection and the lack of guidance to aid in its management, World Health Organization (WHO) initiated the process of developing some core guidance principles, informed by a panel of experts [6,7]. Recommendations were based on their experience managing BU-HIV coinfection and what little scientific information was available on BU-HIV coinfection. The main body of available published information from which to draw guidance came from the Medecins Sans Frontieres BU treatment programme in Akonolinga, a town lying in the Nyong River basin in the central province of Cameroon [8]. The programme was based in a Ministry of Health district hospital and began treating BU patients in 2002. From the outset, a prospective observational database of routinely collected data was implemented for all patients treated for BU. HIV testing was initially introduced in 2002 for cases where clinical suspicion was high. However, it began to be recognised that BU-HIV coinfection was a significant issue, and in 2008 systematic HIV testing was introduced. Thus, the opportunity arose to acquire unique data on this coinfection. By May 2013, 1,130 patients had been treated for BU, and since the introduction of systematic HIV testing 29% of adults and 4% of children tested positive.

Higher risks of mother-to-child HIV transmission in countries with lower HIV prevalence: UNAIDS 2013 results for 32 countries with generalised epidemics

ObjectivesDiagnosis and treatment of HIV-infected mothers significantly lower rates of mother-to-child transmission (MTCT) of HIV. Early infant diagnosis (EID) is required to monitor success of prevention of MTCT (pMTCT) programmes. Our aim was to compare rates of MTCT, EID and pMTCT in countries with generalised epidemics. MethodsThe UNAIDSinfo database includes country-level information on epidemic size, prevalence of HIV infection, EID rates and pMTCT coverage. The AIDS Spectrum model was used to estimate the number of children infected with HIV in 2013, for 32 countries with generalised epidemics. Least squares linear regression, weighted by epidemic size and controlling for GDP/capita, was used to correlate national adult HIV prevalence with estimated MTCT rates. ResultsThere were 32 countries with generalised epidemics included in the analysis (31 in Africa). Higher-prevalence countries (≥5%) had significantly lower rates of MTCT (P<0.01) than lower-prevalence countries (<5%). For 20 lower-prevalence countries (total 7.4 million HIV-infected people), there were 105,300 childhood (0–14 years) infections in 2013. In 12 higher-prevalence countries (total 17.1 million HIV-infected people), there were an estimated 107,500 childhood infections in 2013. Regression analysis suggests that if all countries achieved the same MTCT rate as Botswana (2.0%), childhood HIV infections could be cut by 88% (from 105,300 to 12,300 per year) in lower-prevalence countries, and by 82% (from 107,500 to 19,700 per year) in higher-prevalence countries. ConclusionsIn this analysis of 32 countries with generalised HIV epidemics, 49.5% (105,500/213,000) of childhood HIV infections in 2013 were in lower-prevalence countries. Targeting of prevention of MTCT in lower-prevalence countries needs to be prioritised, despite challenges, to reduce the number of children infected.

Assessment of epidemic projections using recent HIV survey data in South Africa: a validation analysis of ten mathematical models of HIV epidemiology in the antiretroviral therapy era.

Mathematical models are widely used to simulate the effects of interventions to control HIV and to project future epidemiological trends and resource needs. We aimed to validate past model projections against data from a large household survey done in South Africa in 2012. We compared ten model projections of HIV prevalence, HIV incidence, and antiretroviral therapy (ART) coverage for South Africa with estimates from national household survey data from 2012. Model projections for 2012 were made before the publication of the 2012 household survey. We compared adult (age 15-49 years) HIV prevalence in 2012, the change in prevalence between 2008 and 2012, and prevalence, incidence, and ART coverage by sex and by age groups between model projections and the 2012 household survey. All models projected lower prevalence estimates for 2012 than the survey estimate (18·8%), with eight models' central projections being below the survey 95% CI (17·5-20·3). Eight models projected that HIV prevalence would remain unchanged (n=5) or decline (n=3) between 2008 and 2012, whereas prevalence estimates from the household surveys increased from 16·9% in 2008 to 18·8% in 2012 (difference 1·9, 95% CI -0·1 to 3·9). Model projections accurately predicted the 1·6 percentage point prevalence decline (95% CI -0·3 to 3·5) in young adults aged 15-24 years, and the 2·2 percentage point (0·5 to 3·9) increase in those aged 50 years and older. Models accurately represented the number of adults on ART in 2012; six of ten models were within the survey 95% CI of 1·54-2·12 million. However, the differential ART coverage between women and men was not fully captured; all model projections of the sex ratio of women to men on ART were lower than the survey estimate of 2·22 (95% CI 1·73-2·71). Projections for overall declines in HIV epidemics during the ART era might have been optimistic. Future treatment and HIV prevention needs might be greater than previously forecasted. Additional data about service provision for HIV care could help inform more accurate projections. Bill & Melinda Gates Foundation.

Development of a New Experimental Model to Improve Daily Living Performance Ability in TB Patients

This paper is to estimate the effects of a new experimental model to improve daily life performance ability in tuberculosis patients. The subjects of this paper were 126 patients who had visited a hospital which located in Metropolitan area. The pair wise t-test was done to compare the before and after intervention by a new experimental model for measurement of health promoting practice in tuberculosis patients. As a result, for symptoms in terms of dizziness in the physical status, subjects' score (27.46±1.52) after application significantly decreased than subjects (31.58±3.47) before application (t=2.68, p=.004). In conclusion, this experimental study will be used frequently for the prevention of tuberculosis and verification of new research. Tuberculosis is caused by mycobacterium tuberculosis that most often affect the lungs. Tuberculosis is one of the world's top health challenges. More than 2 billion people, a quarter of the world's population, are infected with tuberculosis. World Tuberculosis Day is a chance for new action in the global fight against one of the world's top infectious killers. Tuberculosis is contagious and airborne. It is a disease of poverty affecting mostly young adults in their most productive years. 95% of tuberculosis deaths are in the developing world. The number of people who fell ill with tuberculosis dropped to 8.8 million in 2010 including 1.1 million cases among people with HIV. The number has been falling since 2005. Over 95% of tuberculosis cases and deaths occur in low and middle-income countries. The progress in health status of the population indicates that about 80% of diseases in Ethiopia are attributable to preventable conditions related to infectious diseases, malnutrition, and personal and environmental hygiene. The prevalence of tuberculosis in Ethiopia is estimated to be 241 with incidence of 247 per 100,000 populations. The adult HIV prevalence is 1.5% in 2011 (4.2% for urban and 0.6% for rural) and is higher among females (1.9%) than males (1%). Environmental risk factors contribute of 31% of the total disease burden in the country (1-2). Korea recorded 40,000 new cases of tuberculosis infections last year. Previous studies showed tuberculosis still needs more attention on the disease usually found in developing countries. According to a report released by the Ministry of Health and Welfare, a total of 49,532 people were reported as tuberculosis patients in 2012. Among them, 39,545 were cases of new infections. The number of male patients was some 30 percent higher than that of female patients. By age, 16,033 of the new tuberculosis patients were between 20 to 40 years, accounting for 40.5 percent of the entire new tuberculosis cases last year. Patients older than 65 years marked 32.4 percent of the new patient figures. Among the new cases recorded last year, 78.6

Sustained High HIV Incidence in Young Women in Southern Africa: Social, Behavioral, and Structural Factors and Emerging Intervention Approaches.

Young women in southern Africa experience some of the highest incidence rates of HIV infection in the world. Across southern Africa, HIV prevalence among women increases rapidly between the teenage years and young adulthood. Adult HIV prevalence is 16.8 % in South Africa, 23 % in Botswana, 23 % in Lesotho, and 26.5 % in Swaziland. Existing research has illuminated some of the key social, behavioral, and structural factors associated with young women's disproportionate HIV risk, including gendered social norms that advantage male power in sexual relationships and age disparities in relationships between younger women and older male partners. Important structural factors include the region's history of labor migration and legacy of family disruption, and entrenched social and economic inequalities. New interventions are emerging to address these high levels of HIV risk in the key population of young women, including structural interventions, biomedical prevention such as PrEP, and combined HIV prevention approaches.

Poverty, Food Insufficiency and HIV Infection and Sexual Behaviour among Young Rural Zimbabwean Women

BackgroundDespite a recent decline, Zimbabwe still has the fifth highest adult HIV prevalence in the world at 14.7%; 56% of the population are currently living in extreme poverty.DesignCross-sectional population-based survey of 18–22 year olds, conducted in 30 communities in south-eastern Zimbabwe in 2007.ObjectiveTo examine whether the risk of HIV infection among young rural Zimbabwean women is associated with socio-economic position and whether different socio-economic domains, including food sufficiency, might be associated with HIV risk in different ways.MethodsEligible participants completed a structured questionnaire and provided a finger-prick blood sample tested for antibodies to HIV and HSV-2. The relationship between poverty and HIV was explored for three socio-economic domains: ability to afford essential items; asset wealth; food sufficiency. Analyses were performed to examine whether these domains were associated with HIV infection or risk factors for infection among young women, and to explore which factors might mediate the relationship between poverty and HIV.Results2593 eligible females participated in the survey and were included in the analyses. Overall HIV prevalence among these young females was 7.7% (95% CI: 6.7–8.7); HSV-2 prevalence was 11.2% (95% CI: 9.9–12.4). Lower socio-economic position was associated with lower educational attainment, earlier marriage, increased risk of depression and anxiety disorders and increased reporting of higher risk sexual behaviours such as earlier sexual debut, more and older sexual partners and transactional sex. Young women reporting insufficient food were at increased risk of HIV infection and HSV-2.ConclusionsThis study provides evidence from Zimbabwe that among young poor women, economic need and food insufficiency are associated with the adoption of unsafe behaviours. Targeted structural interventions that aim to tackle social and economic constraints including insufficient food should be developed and evaluated alongside behaviour and biomedical interventions, as a component of HIV prevention programming and policy.

Estimating minimum adult HIV prevalence: a cross-sectional study to assess the characteristics of people living with HIV in Italy.

In 2012, we conducted a retrospective cross-sectional study to assess the number of people living with HIV linked to care and, among these, the number of people on antiretroviral therapy. The health authority in each of the 20 Italian Regions provided the list of Public Infectious Diseases Clinics providing antiretroviral therapy and monitoring people with HIV infection. We asked every Public Infectious Diseases Clinic to report the number of HIV-positive people diagnosed and linked to care and the number of those on antiretroviral therapy during 2012. In 2012, 94,146 people diagnosed with HIV and linked to care were reported. The majority were males (70.1%), Italians (84.4%), and aged between 25 and 49 years (63.4%); the probable route of transmission was heterosexual contact in 37.5% of cases, injecting drug use in 28.1%, and male-to-male contact in 27.9%. Among people in care, 20.1% had less than 350 CD4 cells/μl, 87.6% received antiretroviral therapy, and among these, 62.4% had a CD4 cell count higher than 350 cells/μl. The overall estimated prevalence of individuals diagnosed and linked to care in 2012 in Italy was 0.16 per 100 residents (all ages). Adding the estimated proportion of undiagnosed people, the estimated HIV prevalence would range between 0.19 and 0.26 per 100 residents. In Italy, the majority of people diagnosed and linked to care receive antiretroviral therapy. A higher prevalence of individuals diagnosed and linked to care was observed in Northern Italy and among males. More information for developing the HIV care continuum is necessary to improve the entire engagement in care, focusing on test-and-treat strategies to substantially reduce the proportion of people still undiagnosed or with a detectable viral load.

Increasing Coverage of Antiretroviral Therapy and Male Medical Circumcision in HIV Hyperendemic Countries: A Cost-Benefit Analysis

HIV continues to cause the largest number of disability-adjusted life years of any disease in HIV hyperendemic countries (i.e., countries with an adult HIV prevalence >15%). We compare the benefits and costs of two proven biological interventions to reduce the health losses due to the HIV epidemic in hyperendemic countries from 2015 through 2030: 1) increasing ART coverage to 90% among HIV-infected adults with a CD4-cell count

Antiviral activity of cystatin C against HIV.

Antiviral activity of cystatin C against HIV.

The effects of household wealth on HIV prevalence in Manicaland, Zimbabwe – a prospective household census and population‐based open cohort study

IntroductionIntensified poverty arising from economic decline and crisis may have contributed to reductions in HIV prevalence in Zimbabwe.ObjectivesTo assess the impact of the economic decline on household wealth and prevalent HIV infection using data from a population-based open cohort.MethodsHousehold wealth was estimated using data from a prospective household census in Manicaland Province (1998 to 2011). Temporal trends in summed asset ownership indices for sellable, non-sellable and all assets combined were compared for households in four socio-economic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). Multivariate logistic random-effects models were used to measure differences in individual-level associations between prevalent HIV infection and place of residence, absolute wealth group and occupation.ResultsHousehold mean asset scores remained similar at around 0.37 (on a scale of 0 to 1) up to 2007 but decreased to below 0.35 thereafter. Sellable assets fell substantially from 2004 while non-sellable assets continued increasing until 2008. Small-town households had the highest wealth scores but the gap to other locations decreased over time, especially for sellable assets. Concurrently, adult HIV prevalence fell from 22.3 to 14.3%. HIV prevalence was highest in better-off locations (small towns) but differed little by household wealth or occupation. Initially, HIV prevalence was elevated in women from poorer households and lower in men in professional occupations. However, most recently (2009 to 2011), men and women in the poorest households had lower HIV prevalence and men in professional occupations had similar prevalence to unemployed men.ConclusionsThe economic crisis drove more households into extreme poverty. However, HIV prevalence fell in all socio-economic locations and sub-groups, and there was limited evidence that increased poverty contributed to HIV prevalence decline.