AIDS Response Research Articles

About the Contributors

About the Contributors

First Aid Education for Opioid Overdose Poisoning: Scoping Review.

Effective health education needs ongoing evidence to support policy development and action in a public health crisis, like the opioid epidemic in the United States. Opioid Education and Naloxone Distribution (OEND) programs work to change behaviors through information, education, and resources to empower people to prevent and respond to opioid overdose poisonings. In this review, we sought to identify the first aid educational components of OEND to address opioid overdose poisoning, identify gaps in the existing literature, and support the development of future studies that could then be systematically reviewed.From a systematic review that identified 2057 peer-reviewed manuscripts, 59 studies demonstrated that the educational literature is sparse, of low quality, lacks quality measures and effective methodologies, and suffers from self-reported and highly inconsistent endpoints, making outcome comparisons challenging, if not impossible. The reviewed OEND programs generally used a public health/health education approach focusing on people who inject opioids, their family and friends, first responders, and rarely the general public. Depending on the learners, interventions were broken down to those <15, 16-90, and >90 minutes, which categorically showed differences in knowledge and first aid response actions. Only eight studies used comparison groups which provide a slightly higher level of evidence. Reports of survival appeared to positively correlate with naloxone kit distribution. Opportunity exists to develop policies and plans that support individual and community efforts through evidence-based guidelines, particularly to the domains of first aid education, so that educators and organizations can deliver efficacious programming that meets the needs of their learners.

In-Flight Medical Events and Cabin Crew First Aid Response.

INTRODUCTION: In-flight medical events (IMEs), although rare, are challenging due to the limited onboard resources and the time needed to reach an airport. Cabin crewmembers (CCMs) are trained to provide first aid, but their effectiveness has not been appropriately studied.METHODS: IMEs occurring in the biggest airline of Greece were prospectively recorded during a 5-yr period (20142018) and categorized according to a symptom-based taxonomy.RESULTS: During the study period 990 IMEs were recorded corresponding to 16 IMEs for each million passengers or 1.8 IMEs for every thousand flights. The most frequent events were loss of consciousness (38.4%) followed by injuries (8.6%), gastrointestinal problems (8.3%), respiratory symptoms (7.3%), anxiety (5.7%), and burns (5.9%). Diversion was decided in 3% of the cases while death on board was rare (0.3% of events). CCMs responded in 33.5% of IMEs without assistance by a volunteer health professional, achieving a 97% success rate.DISCUSSION: IMEs are rare events and the majority can be treated with simple first aid measures. CCMs acting according to a simplified algorithm were very efficient in providing first aid. A standardized symptom-based IME form will assist in creating a reliable registry for further studies.Paxinos O, Savourdos P, Alexelis V, Anastasopoulos A, Karantoni E, Grigoropoulos P, Konstantinou X. In-flight medical events and cabin crew first aid response. Aerosp Med Hum Perform. 2021; 92(1):3238.

A model to understand HIV-related stigma and the psychosocial well-being of children orphaned by AIDS: a theory generative approach

ABSTRACT HIV-related stigma has negatively impacted the psychosocial well-being of children who have been orphaned by AIDS-related causes. Response to reducing stigma and ensuring child well-being is hindered by the limited understanding of HIV-related stigma and how it affects the psychosocial well-being of children. Due to the call for a comprehensive understanding of HIV-related stigma, this study aimed to develop a model to understand the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS. The study implemented a mixed method, exploratory, sequential design within a theory generative approach that included concept development, statement development, model description, and model evaluation. The developed model indicated that HIV-related stigma is embedded in social interaction and mediated by children orphaned by AIDS response to stigma. HIV-related stigma and maladaptive coping strategies collectively affect several domains of child psychosocial well-being and elevate psychosocial distress. This is the first model to provide a child-centred understanding of HIV-related stigma and its consequences for psychosocial well-being. The model may be used to guide future research and inform the development of appropriate interventions.

Law, Criminalization and HIV in the World: Have Countries That Criminalize Achieved More or Less Successful Pandemic Response?

How do choices in criminal law and rights protections affect disease-fighting efforts? This long-standing question facing governments around the world is acute in the context of pandemics like HIV and COVID-19. The Global AIDS Strategy of the last 5 years sought to prevent mortality and HIV transmission in part through ensuring people living with HIV (PLHIV) knew their HIV status and could suppress the HIV virus through antiretroviral treatment. This article presents a cross-national ecological analysis of the relative success of national AIDS responses under this strategy, where laws were characterised by more or less criminalisation and with varying rights protections. In countries where same-sex sexual acts were criminalised, the portion of PLHIV who knew their HIV status was 11% lower and viral suppression levels 8% lower. Sex work criminalisation was associated with 10% lower knowledge of status and 6% lower viral suppression. Drug use criminalisation was associated with 14% lower levels of both. Criminalising all three of these areas was associated with approximately 18%–24% worse outcomes. Meanwhile, national laws on non-discrimination, independent human rights institutions and genderbased violence were associated with significantly higher knowledge of HIV status and higher viral suppression among PLHIV. Since most countries did not achieve 2020 HIV goals, this ecological evidence suggests that law reform may be an important tool in speeding momentum to halt the pandemic.

Remarks by Katherine Meighan

I am delighted to join this insightful ASIL event and want to begin by discussing the global context and multilateralism, fully supporting the remarks of the previous speaker, Mr. Jay Pozenel. I then turn to the role of International Fund for Agricultural Development (IFAD) lawyers in innovating international aid responses in this time of global crisis, and end with two specific examples of these legal innovations.

Celebrating small victories – My journey through two decades of AIDS response

Celebrating small victories – My journey through two decades of AIDS response

State Aid Junkies, Viruses and the Aviation Industry:

During the pandemic, many Member States have engaged in more interventionist policies tosustaintheireconomiesthroughtoughpublichealthrestrictions.Thishasmanifesteditself in the provision of large quantities of State aid to elements of the aviation industry by Member States, facilitated by the relatively permissive policies of the European Commission. The Irish low-cost airline Ryanair has been a notable and outspoken critic of these measures, describing them as‘ state aid crack cocaine’ and their beneficiaries as‘ state aid junkies’ and has launched an aggressive programme of litigation to annul the decisions approving the aid. This article reviews the first nine of the judgments of the General Court that this litigation has produced to date, three of which have led to the annulment of the Commission’s approval of the aid. This article will go on to assess the impact of these decisions and examine the contribution they make towards understanding the State aid response of the EU and –its Member States to the pandemic. It will be suggested that the General Court has generally taken a tolerant attitude towards pandemic-related aid for aviation, upholding the approval of individual aid and allowing Member States to confine the aid to recipients with a close connection to their own economies. © 2021, Lexxion Verlagsgesellschaft mbH. All rights reserved.

Kropotkin-19: A Mutual Aid Response to COVID-19 in Athens

The current health crisis, triggered by the spread of COVID-19, has mobilized activist groups and individuals within social movements worldwide to respond with actions of solidarity and mutual aid. In Greece, during the lockdown between March and May 2020, several mutual aid initiatives emerged in Athens to offer support to those who needed it. Based on ethnographic fieldwork, this paper traces the emergence of Kropotkin-19, a mutual aid initiative in the central neighborhood of Exarcheia, that has provided food, essential goods, and legal and psychological support to families and individuals. The paper offers insight into how a preestablished solidarity network has “mutated” in response to the urgency of the COVID-19 pandemic while addressing several long-term and emerging crises. The paper concludes that affective infrastructures are integral to the vision of radical social change in a post-COVID world.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Students of the Faculty of Education.

The purpose of this study was to evaluate the knowledge regarding tooth avulsion and dental first aid response among Croatian students of the Faculty of Education. A cross-sectional study was conducted among students. Participants (N = 235) were female with an average age of 21.9 ± 2.7 years. The questionnaire contained 10 close-ended questions with two to eleven possible answers. Every participant chose one correct answer. Statistical significance was determined using a Chi-square test. Majority of participants had never received any kind of information on management of a knocked-out tooth. Questions in the nature of tooth injuries, a knocked-out tooth, tooth replantation and whether the knocked-out tooth should be placed back were answered confirmatively by 40.43%, 83.40%, 57.02% and 62.55% of participants, respectively. The questionnaire showed that 18.78% of participants were aware that replantation should be performed within 30 min. The appropriate cleaning and transport medium was chosen by 40.85% and 35.31% of participants, respectively. A nearby dentist would be visited by 66.38% of students. Only 8.08% of participants provided a correct answer to all of the knowledge-based questions. The “I do not know” answer was chosen by 18.30% of participants whenever it was offered. This indicates that the majority (89.78%) were not aware of the fact that the procedure they chose would be inappropriate. The current study confirmed that future primary school teachers have a lack of knowledge for immediate response to tooth avulsion, leaving small chances for a successful prognosis of tooth replantation.

Safeguarding gains in the sexual and reproductive health and AIDS response amidst COVID-19: The role of African civil society

This article outlines the role of African civil society in safeguarding gains registered to date in sexual and reproductive health and the response to HIV. The case is made for why civil society organizations (CSOs) must be engaged vigilantly in the COVID-19 response in Africa. Lockdown disruptions and the rerouting of health funds to the pandemic have impeded access to essential sexual and reproductive health (SRH) and social protection services. Compounded by pre-existing inequalities faced by vulnerable populations, the poor SRH outcomes amid COVID-19 call for CSOs to intensify demand for the accountability of governments. CSOs should also continue to persevere in their aim to rapidly close community-health facility gaps and provide safety nets to mitigate the gendered impact of COVID-19.

Legal and human rights-based approaches to healthy diets and sustainable food systems

IssueMalnutrition in all its forms poses daunting challenges to global health and development. The agriculture sector is a significant contributor to global warming. COVID-19 has pushed many people into poverty, including food poverty. A radical rethink of business models, food systems, civil society involvement, and national and international governance is required to address the interlinked crises of COVID-19, obesity, undernutrition, and climate change. International human rights law, institutions and mechanisms provide important opportunities for norm setting, advocacy and accountability. Yet these pathways are under-utilised by both governments and civil society.DescriptionThe global AIDS response demonstrated the power of a human rights-based approach. United Nations' HIV/AIDS and Human Rights Guidelines greatly influenced the global consensus for effective, evidence-based approaches. The Guidelines also informed resolutions of the UN General Assembly and its Human Rights Council, contributing to more affordable medicines, an unprecedented increase in people on treatment, less stigmatising health services, the empowerment of marginalised groups, and the institutionalisation of norms, including “no one left behind.” Human rights-based approaches have also been successfully utilised in tobacco control.ResultsIn 2019, 180 experts from 38 countries published an open call on WHO and the UN Office of the High Commissioner for Human Rights (OHCHR) to initiate an inclusive process to develop guidelines on human rights, healthy diets and sustainable food systems. Most signatories were from the health and development sectors, demonstrating the increasingly broad interest in using human rights mechanisms to address global health challenges.LessonsOpportunities exist to transform food systems and create healthier food environments and a healthier planet by clarifying existing international obligations to progressively realise the right to food and the right to health.Key messages Market forces, alone, are failing to deliver healthy diets and sustainable food systems. International legal frameworks and accountability mechanisms provide opportunities for engagement and action.Human rights guidelines can help mobilize multisectoral action, strengthen State and private sector accountability, and deepen community engagement in the urgent task of achieving Agenda 2030.

Understanding and comparing HIV-related law and policy environments: cross-national data and accountability for the global AIDS response

Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure...

Current status analysis of bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Qinhuangdao region based on Utstein model

To analyze the status quo of bystander cardiopulmonary resuscitation (BCPR) for out-of-hospital cardiac arrest (OHCA) in Qinhuangdao area and its influence on the prognosis of cardiopulmonary resuscitation (CPR). Based on the Utstein model CPR database of Qinhuangdao, data of 1 162 OHCA patients admitted to the Health Emergency Dispatch Center of Qinhuangdao City from January 2018 to January 2019 were collected, and they were divided into two groups according to whether BCPR was performed or not. The patients' demographic parameters (gender, age), precardiac arrest parameters (location of cardiac arrest), the parameters of the CPR (first aid response time before hospital, initial diagnosis of causes of cardiac arrest, initial cardiac rhythm) and the parameters of the CPR results [whether to achieve on-site restoration of spontaneous circulation (ROSC) and 30-day survival rate] were collected. Multivariate Logistic regression analysis was performed for the relationship between BCPR and on-site ROSC rate. The social characteristics of bystanders implementing BCPR, including gender, age, occupation, educational background, and acquisition method of CPR knowledge, were analyzed. Among the 1 162 OHCA patients, the patients witnessed by professional medical personnel in nursing homes, hospitals and other places and pre-hospital emergency personnel were excluded. 852 OHCA patients were enrolled, among which only 24 patients obtained BCPR (2.8%), and the remaining 828 patients did not obtain BCPR (97.2%). There were no statistically significant differences in gender, age, location of cardiac arrest, pre-hospital emergency response time, primary diagnosis of cardiac arrest causes and initial cardiac rhythm between the two groups. Compared with the non-BCPR group, the on-site ROSC rate and the 30-day survival rate of the BCPR group were significantly increased [on-site ROSC rate: 16.7% (4/24) vs. 5.2% (43/828), 30-day survival rate: 8.3% (2/24) vs. 1.3% (11/828), both P < 0.05]. Multivariate Logistic regression analysis showed that BCPR [odds ratio (OR) = 32.132, 95% confidence interval (95%CI) was 11.129-65.471], location of cardiac arrest (OR = 0.080, 95%CI was 1.212-3.125) and response time during pre-hospital emergency treatment (OR = 0.121, 95%CI was 0.174-0.816) were important factors for on-site ROSC of OHCA patients (all P < 0.01). A total of 30 bystanders participated in the implementation of OHCA patients' BCPR, excluding 2 bystanders of lost follow-up, 28 bystanders with effective return visit. The 28 bystanders of BCPR practitioners were mainly male (85.7%), the age was mainly 18-40 years old (57.1%), the occupation was mainly in the tourism service industry (21.5%), students (17.9%), soldiers (14.3%) and bus drivers (10.7%), and the education background was mainly junior college or above (85.7%), the methods of acquiring CPR knowledge mainly included APP and new media (42.9%) and lectures (21.4%). The BCPR implementation rate of OHCA in Qinhuangdao was only 2.8%. BCPR can improve the success rate of pre-hospital CPR and the 30-day survival rate of OHCA patients. Targeted selection of tourism service industry, students, military personnel and bus drivers as CPR training targets may obtain more significant social benefits.

What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa.

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

The epidemiological situation of morbidity and mortality on HIV / AIDS cases in Poland and globally in recent years

Aim: The aim of this review is to summarize the data on the morbidity and mortality of HIV / AIDS in the years 2000-2020 in Poland and in the world. As a result of continuous insufficient diagnostics, still millions of people are not aware of the disease, which often results in regions or countries with a significantly increased incidence. We were looking for information about the impact of the current COVID-19 pandemic on the production, distribution, and prices. Availability of drugs, especially in middle and low income countries, was also examined.Materials and methods: PubMed databases and statistics from the National Institute of Public Health (NIZP- PZH) and global data from the websites of WHO, UNAIDS - Global HIV &amp; AIDS statistics and HIV.gov were searched in June and July 2020. The UNAIDS 90-90-90 program was also assessed. This programme was run until 2020. In the PubMed database, we used medical terms "hiv", "aids", "hiv / aids". No language restrictions were added.Conclusion:UNAIDS report on the global AIDS epidemic shows that 2020 targets will not be met because of deeply unequal success; COVID-19 risks blowing HIV progress way off course. Missed targets have resulted in 3.5 million more HIV infections and 820 000 more AIDS-related deaths since 2015 than if the world was on track to meet the 2020 targets. In addition, the response could be set back further, by 10 years or more, if the COVID-19 pandemic results in severe disruptions to HIV services. Currently, the world is plunged into the fight against COVID-19 and people are forgetting that the HIV pandemic also carries a large number of deaths. Nevertheless, the spread of both viruses is different and in developed countries the possibility of significant spread of HIV is much lower than in poor countries. The spread of Sars-Cov2 virus is much more difficult to control. Although the risk of serious illness from COVID-19 for people with HIV is not known, people with HIV may have concerns and questions related to their risk. COVID-19 pandemic has seriously impacted the AIDS response and could disrupt it more. Progress in prevention of HIV transmission remains too slow and the estimated total number of new infections in 2019 is more than three times higher than the UNAIDS 2020 target. Despite advances in the scientific understanding of HIV and its prevention and treatment, and many years of significant efforts by the global health community and governmental and community organizations, too many HIV-positive people still lack access to prevention, care and treatment. There is still no cure for everybody with HIV / AIDS. Moreover, the HIV epidemic not only affects human health, but also strikes households, communities, and the development and economic growth of nations.

Scoping the potential for earthquake early warning in Aotearoa New Zealand: A sectoral analysis of perceived benefits and challenges

Earthquake Early Warning (EEW) systems are used to detect earthquakes and provide advanced notice of strong shaking intensity, allowing people to take pre-emptive actions that benefit the health of infrastructure and the life-safety of the public. With the advancement of technical research of EEWs, there is also an increasing need to understand EEW's potential impacts on society. In this study, we investigated the perspectives of various sectors in Aotearoa New Zealand on EEW. We used focus groups and interviews with multiple sectors, including but not limited to utilities, infrastructure, emergency management, health and education. We found that participants generally supported the idea of EEW. Participants perceived EEW to provide benefits to (1) life-safety and health & safety (i.e. death and injury); (2) psychological preparedness; (3) activation of emergency plans and situational assessment; and (4) organisational and site-specific actions to reduce impacts and aid response and recovery. Furthermore, our findings also showed that despite support from the sectors, there are challenges in introducing and applying EEW. Participants acknowledged challenges that need to be addressed, such as: (1) users' confidence in the EEW system; (2) the threshold and delivery for sending warnings; and (3) the content and comprehension of an EEW message that would result in people taking appropriate or inappropriate action. As EEW technological research and deployment is rapidly advancing internationally, future research should keep in mind the societal benefits and challenges of EEW when looking to develop useful sectoral applications.

Reconstructing tourism in the Caribbean: connecting pandemic recovery, climate resilience and sustainable tourism through mobility justice

Caribbean islands that are highly dependent on tourism are facing compounding crises from climate-related disasters to the Covid-19 pandemic travel disruption. The rebuilding of tourism infrastructure has often been one of the main aims of international development aid and regional government responses to natural disasters. This article seeks to identify other ways in which Caribbean small island states and non-independent territories might rebuild more sustainable ecologies and economies as they come out of the pandemic within the ongoing climate crisis. The first part shows the historical grounding of climate change vulnerability in colonial histories, neoliberal capitalism and ongoing practices of “extractive” tourism. This analysis of the “coloniality of climate” centers on a critique of disaster tourism during these “unnatural disasters,” and allows for re-framing the ethical and political implications of tourism recovery when other human im/mobilities (such as migration) are severely curtailed. The article then elaborates on the theoretical concept of “mobility justice” as a way to think through the problem of sustainability transitions in relation to tourism mobilities, climate change and disaster recovery. The final section considers alternative visions for disaster reconstruction in the Caribbean centering food sovereignty, agroecology and regenerative economies, as promoted by community-based organizations and people’s assemblies.

Situation of anal sex among low-tier female sex workers in the Demonstration Areas of Comprehensive AIDS Responses in Zhejiang province

Objective: To analyze the prevalence of anal sex and related factors in low-tier female sex workers (FSWs) in the demonstration areas of comprehensive AIDS responses (DACAR) in Zhejiang province. Method: In 2013, a survey on low-tier FSWs was carried out in 21 Demonstration Areas of AIDS Responses in Zhejiang. Experience of having anal sex with clients in the last month was taken as dependent variable while independent variables would include perception and characteristics related to behavior of the FSWs. The multivariate logistic regression analyses were conducted to identify the factors related to anal sex in low-tier FSWs. Results: A total of 2 645 low-tier FSWs were interviewed. Among these FSWs, 67.9% (1 796/2 645) were over 26 years old, 89.9% (2 378/2 645) were with education level of junior high school or below, 58.4% (1 546/2 645) were married, 78.2% (2 068/2 645) were from other provinces, 68.6% (1 814/2 645) had income level less than 4 000 Yuan, and rates of anal sex with client in the last month were 5.03% (133/2 645). Results from the multivariate logistic regression analysis of related factors of anal sex with client in the last month showed that among the low-tier FSWs, the venues of having commercial sex were in hair salons/massage parlors (OR=7.31, 95%CI: 2.27-23.59), roadside shops (OR=7.89, 95%CI: 2.27- 27.40) or other places (OR=4.65, 95%CI: 1.23-17.53), when compared with the street-women service. FSWs often engaged in commercial sex business in three or more counties (OR=1.68, 95%CI: 1.01-2.81), when compared with FSWs often engaged in commercial sex business just one county. FSWs had sex with only middle-aged and the elderly clients (OR=0.45, 95%CI: 0.30-0.66), when compared with FSWs had sex with young or middle-aged and the elderly clients. FSWs had risk perception for sexually transmitted disease (STD) (OR=2.00, 95%CI: 1.20-3.32), when compared with FSWs with no risk perception. FSWs had oral sex experience with their clients in the last month (OR=7.29, 95%CI: 4.78-11.12), when compared with the ones without oral sex. The above said factors were all related to the incidence of anal sex. Conclusions: Certain numbers of low-tier FSWs had anal sex experiences with their clients, especially those who had oral sex were more likely to have anal sex in DACAR in Zhejiang province. Attention should be paid to anal sex behavior when conducting behavior-related intervention programs, targeting on the low-tier FSWs.

Disease in a Debt Crisis: Financing Global Health, Development and AIDS between WHO and World Bank, 1978–87

This article examines how international organisations with mandates in health and development interpret global economic crises and respond to disease. It contributes the perspective of World Bank to emerging scholarship on the various factors leading to the decline of the World Health Organization (WHO) and its Health for All (HFA) mission during structural adjustment. It does so by telling a story of collaboration and conflict between WHO and World Bank’s Population, Health and Nutrition (PHN) Department following the ambitious Alma Ata Declaration in 1978 until the initial global AIDS response. As debt crises emerged in Latin America in the early 1980s, WHO tried to find a way forward for HFA. However, the African crisis of 1985 fractured the international community’s support, causing WHO and PHN to dialogue more closely regarding health sector financing. As AIDS became a global crisis, this culminated in their 1987 joint research on the disease’s macroeconomic and demographic impact. However, observing WHO’s continued hesitance regarding financing and its decision to act as a donor gatekeeper, the Bank ultimately opted to work separately in AIDS. Thus, the themes of the Alma Ata versus Selective Primary Health Care debate of the late 1970s continued throughout the 1980s into the early years of the global AIDS response: a perennial conflict of financing within resource constraints and the appropriate role of donors in the grand project of health and development.