Regions Of High HIV Prevalence Research Articles

Understanding sexual behaviors of youth from the lens of caregivers, teachers, local leaders and youth in Homabay County, Kenya

In Kenya similar to other countries in Eastern and Southern Africa There is a disproportionately high burden of the global HIV incidence among youth ages 15–24 years, and where adolescent girls and young women account for up to a third of all incident HIV infections and more than double the burden of HIV compared to their male peers. Previous work has shown early sexual debut as entry point into risks to sexual and reproductive health among young people including STI/HIV acquisition. This was a formative assessment of the local context of three sexual risk behaviors among youth ages of 15–24 years: early sexual debut, multiple sexual partnerships, and age-mixing /intergenerational sex for purposes of informing comprehensive combination HIV intervention program design. We conducted a cross-sectional formative qualitative study in four sub-counties within Homabay county a high HIV prevalence region of Kenya. Participants were recruited through youth groups, schools, government offices and, community gatekeepers using approved fliers, referred to a designated venue for focus group discussion (FGD). After oral informed consent, twelve FGDs of 8–10 participants were carried out. Transcripts and field notes were uploaded to Atlas.ti qualitative data analysis and research software (version 8.0, 2017, ATLAS.ti GmbH). Open coding followed by grouping, categorization of code groups, and thematic abstraction was used to draw meaning for the data. A total of 111 youth participated in the FGD, 65 males and 46 females. The main findings were that youth engaged in early sex for fear of being labeled ‘odd’ by their peers, belief (among both male and female) that ‘practice makes perfect’, curiosity about sex, media influence, need to prove if one can father a child (among male), the notion that sex equals love with some of the youth using this excuse to coerce their partners into premature sex, and the belief that sex is a human right and parents/guardians should not intervene. Male youth experienced more peer-pressure to have sex earlier. Female youths cited many reasons to delay coitarche that included fear of pregnancy, burden of taking care of a baby, and religious doctrines. Having multiple sexual partners and intergenerational sexual relationships were common among the youth driven by perceived financial gain and increased sexual prowess. HIV prevention strategies need to address gender vulnerabilities, as well as promoting a protective environment, hence application of combination prevention methods is a viable solution to the HIV pandemic.Trial registration number: The study was approved by the KNH/UoN Ethics review committee (KNH/UoN ERC-P73/03/2011) and New York University (NYU Reg no.–00000310).

How does HIV-related stigma correlate with HIV prevalence in African countries? Distinct perspectives from individuals living with and living without HIV

BackgroundPopulation-level research evaluating HIV-related stigma among countries with varied national HIV prevalence is scarce. To better understand HIV-related stigma and mitigate its potential negative effects, it is necessary to evaluate its relationship with HIV prevalence, as well as the mechanisms that influence it. This study aimed to analyze how HIV-related stigma correlates with subnational HIV prevalence in three African countries with varied HIV epidemics.MethodsThis paper used data from the nationally representative Population-based HIV Impact Assessment (PHIA) surveys conducted from 2015–2017 in Malawi, Zambia, and Tanzania. Each country's sub-national geographic divisions were used to categorize them as low (0–5.4%), middle (5.5–11.2%), and high (11.3–17.1%) HIV prevalence regions in the main analysis. Questions from the survey stigma module were used to measure HIV-related stigma. Logistic regression and multilevel models were performed to assess the associations between the level of sub-national HIV prevalence and HIV-related stigma measures among persons living with, and without, HIV.ResultsThe results show that the odds of people living without HIV expressing stigmatizing behavior towards PLWH was significantly lower in regions of middle (OR = 0.80, 90%CI = (0.68–0.96)) and high (OR = 0.65, 90%CI = (0.53–0.80)) HIV prevalence when compared to low prevalence regions. The odds of reporting discriminatory attitudes were also lower for those in middle (OR = 0.87, 90%CI = (0.78–0.98)) and high (OR = 0.64, 90%CI = (0.56–0.73)) HIV prevalence regions compared to others. Living in middle and high HIV prevalence regions was associated with lower odds of expressing prejudice toward PLWH (OR = 0.84, 90%CI = (0.71–0.99) and OR = 0.60, 90%CI = (0.45–0.80), respectively) among people living without HIV. Notably, PLWH living in high prevalence regions had higher odds of reporting internalized stigma (OR = 1.48, 90%CI = (1.02–2.14)) compared to those living in low prevalence regions.ConclusionsThe results indicate that among people not living with HIV, subnational HIV prevalence was negatively associated with discriminatory attitudes and prejudice towards PLWH, but HIV prevalence was positively associated with self-reported internalized stigma among PLWH. These results provide insight on how resources could be invested to reduce HIV related stigma among both PLWH and those not living with HIV.

Clinic-based interventions to increase preexposure prophylaxis awareness and uptake among United States patients attending an obstetrics and gynecology clinic in Baltimore, Maryland

Cisgender women account for one of every five new U.S. HIV diagnoses, with the majority (86%) attributed to heterosexual contact. HIV pre-exposure prophylaxis (PrEP) is an effective prevention strategy; however, PrEP awareness and prescriptions among women are low. Our objective was to increase PrEP counseling and uptake among cisgender women attending obstetrics/gynecology (OB/GYN) clinics. The study included three OB/GYN clinics within a single health system in a high HIV prevalence region. There were three phases: baseline (three-month period before the clinical trial that included provider education and training of a registered nurse about PrEP [PrEP-RN]), clinical trial (three-month period during which eligible patients were randomized to an active control or PrEP-RN intervention), and maintenance (three-month period after the trial ended). Electronic medical record (EMR) clinical decision support tools (CSTs) were available to both arms during the clinical trial, which included best practice alerts (BPAs), order sets, progress note templates, and written and video PrEP educational materials for patients. In the intervention arm, a PrEP-nurse contacted and counseled patients, and was equipped to prescribe PrEP. We evaluated the phases through the RE-AIM framework (Reach-Effectiveness-Adoption-Implementation-Maintenance). The primary outcome of the study was effectiveness (e.g., percentage of eligible patients with documented HIV prevention counseling in the EMR or PrEP prescriptions). Secondary outcomes included reach (e.g., percentage of BPAs that providers acted upon or the percentage of eligible patients who spoke with the PrEP-RN), adoption (e.g., percentage of eligible patients with a BPA that triggered or the percentage of eligible patients the PrEP-RN attempted to contact), and maintenance (e.g., percentage of patients with documented HIV prevention counseling or PrEP prescriptions during the maintenance phase). There were 904 unique patients in all phases with a mean age of 28.8+/-7.7 years, and 46% were pregnant; 436 patients were randomized in the clinical trial phase. Reach/Adoption: BPAs were triggered for 100% of eligible encounters; however, providers acted on 52% of them. The PrEP nurse attempted to contact every patient and successfully spoke with 81.2% of them in the PrEP-RN arm. Compared to the active control, there were significantly more patients counseled about PrEP in the PrEP-RN group (66.5% vs. 12.3%, p<0.001), while PrEP prescriptions were equivalent (p=1.0). Among the subgroup of patients who were counseled about PrEP, 18.5% of patients in the active control and 3.4% in the PrEP-RN arm were prescribed PrEP (p=0.02). Maintenance: CSTs alone resulted in PrEP counseling of 1.0% of patients during the maintenance phase versus 0.6% during baseline and 11.2% during the clinical trial (p<0.001). PrEP prescriptions were not statistically different between the three phases (p=0.096). A PrEP nurse effectively increased HIV prevention discussions but did not lead to more PrEP prescriptions than the PrEP-focused CSTs used by providers. The decrease in PrEP counseling following the trial phase suggests that persistent interventions are needed to maintain effects.

Dissolution of transactional sex relationships during COVID-19: a qualitative study of Ugandan men’s experiences during COVID-19 lockdowns

The COVID-19 pandemic and subsequent mitigation measures led to social disruption and negative economic shocks for a large proportion of Uganda’s population. The social and economic consequences of COVID-19 on Ugandan men’s sexual behaviours, including transactional sex relationships, are unclear. We conducted in-depth interviews between November 2021–February 2022 with 26 men in a high HIV prevalence region of Uganda. Data were analysed thematically to understand how sexual relationships, including transactional sex, were impacted by COVID-19. We found that COVID-19 mitigation measures had far-reaching social and economic impacts on most respondents, particularly those employed in the informal economy. Men described experiencing job loss, food insecurity and restricted mobility, which limited opportunities to provide for and meet with transactional sex partners. Inability to provide financial resources meant that men could not form new transactional sex relationships and men who could no longer provide for their existing transactional sex partners consistently reported relationship dissolution. Men who reported stable employment during the pandemic described few changes in transactional sex relationships. Similarly, men in non-transactional relationships did not report relationship dissolution despite decreased financial provision. Further research should assess the potential short- and long-term impacts of COVID-19 mitigation measures on transactional sex relationships.

To what extent do people living with HIV, people on pre-exposure prophylaxis, doctors and pharmacists endorse 90-day dispensing of antiretroviral therapy in France?

JustificationThe WHO 95-95-95 targets for 2030 do not imply that people living with HIV (PLHIV) achieve a good quality of life. The current 30-day dispensing interval for antiretroviral (ART) burdens the healthcare system. Lengthening dispensing intervals could alleviate this burden as well as enhance patient well-being.ObjectivesTo capture perceptions on 90-day dispensing interval (90D) for ART from the perspective of PLHIV, people on pre-exposure prophylaxis (PrEP), doctors, and pharmacists.MethodsMulti-centre observational survey led in France from 16 to 20 October 2020, among doctors agreeing to participate via regional coordinated care organisations for HIV, all PLHIV or people on PrEP consulting these outpatient-clinic doctors, and pharmacists doing ART dispensing.ResultsThe survey was completed by 220 doctors who saw 1087 people (999 PLHIV; 88 on PrEP) and 176 pharmacists from 55 centres. Among the PLHIV, 855 (85.6%, 95% CI: 83.2%–87.7%) and among the patients on PrEP, 70 (79.5%, 95% CI: 69.6%–87.4%) stated they would be interested in 90D. All in all, patients who were more likely to endorse 90D are those who opt exclusively for hospital dispensing (OR 3.22 [1.57–6.58]) and who rotate between hospital and community pharmacy dispensing (OR 3.29 [1.15–9.32]). Patients who were less likely to endorse 90-D were those who consult in a city located outside the 3 French high HIV prevalence regions (OR 0.66 [0.44–0.99]), receive 2 vs 1 pill QD regimens (OR 0.53 [0.31–0.91]), and anticipate at least one vs no limitation to 90D (OR 0.27 [0.17–0.42]). 90D was perceived as possible by 152 pharmacists (86.4%), including 8 (5%) without restriction, and 219 doctors (99.6%), including 42 (19.2%) regardless of PLHIV’s immunovirologic status or social conditions (health insurance coverage, access to housing or accommodation, access to rights, resources). Comparison of the benefits and limitations of a 90-day ART dispensing interval as perceived by PLHIV and people on PrEP, doctors and pharmacists shows that doctors anticipate a higher number of benefits than people on ART and/or pharmacists, chiefly that 90D would be more convenient and create less risk of drug shortages and that patients would gain autonomy and a better quality of life. Pharmacists were found to clearly perceive the economic benefits (90D would be less expensive) but anticipate more drawbacks than doctors and the people on ART themselves: more administrative burdens, more non-dispensing if doses get lost, harder to track adherence and more drug–drug interaction issues, and more work as they shall have to warn the patient of potential risks of shortages due to the cost of the stock.ConclusionA clear majority of PLHIV, people on PrEP, doctors, and pharmacists endorsed 90D of ART. Most patients thought that 90D would be a good option, whereas most pharmacists and doctors thought that eligibility for 90D dispensing should depend on immunovirologic factors and social condition criteria. Moreover, pharmacists thought it would be necessary to commit regulatory resources and a better follow-up on adherence and drug–drug interactions.

Asymptomatic Adolescent HIV: Identifying a Role for Universal HIV Screening in the Pediatric Emergency Department

Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.

Suicide behaviour among adolescents in a high HIV prevalence region of western Kenya: A mixed-methods study

ABSTRACT The study purpose was to determine the prevalence and determinants of suicidal thoughts and behaviours in a rural community sample of 15–19-year-old Kenyan adolescents in a region with high HIV burden. Data were from an observational study examining ethical issues in adolescent HIV research (N=4084). Participants reporting suicidal ideation were assessed for suicide risk. Directed content analyses were conducted using assessment reports. Logistic regression was used to identify factors associated with suicide outcomes. Prevalence of suicidal ideation was 16%. Of these, 38% were low risk and 12% were moderate/high-risk. Females and sexually active adolescents had higher odds of suicidal ideation and being categorised as moderate/high-risk. Adolescents with higher depression scores had higher odds of reporting ideation. Pregnancy was protective for females while impregnating a partner was a risk factor for males. Abuse from a family member, financial stress and health concerns were the most frequently mentioned precipitants of ideation. However, only abuse increased odds of suicide behaviour. Effective programmes to identify and support sexually active, pregnant, and distressed adolescents at risk for suicide are needed. Approaches involving families, schools, health facilities, and community gatekeepers may have the most promise in sub-Saharan African rural areas with limited mental health services.

Healthcare workers' perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa.

BackgroundVoluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention.AimTo analyse health care workers’ perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA.SettingThe study took place at six different health districts and their six respective rural clinics in the KZN province of SA.MethodsA qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure.ResultsParticipants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported.ConclusionThe implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers’ needs for training and preparation is crucial for successful implementation of VMMC.

Coital Frequency and Male Concurrent Partnerships During Pregnancy and Postpartum in Agbogbloshie, Ghana.

During pregnancy and postpartum, women in high HIV prevalence regions continue to be at high risk for acquiring HIV, due to both behavioral and biological mechanisms, despite declines in coital frequency as a pregnancy advances. We estimated differences in rates of partnership concurrency for men with and without pregnant or postpartum sexual partners. We used monthly retrospective panel data from Ghana from three perspectives: couple-level data, female reports of pregnancy and male partner concurrency, and male reports of concurrent partnerships and female partner pregnancy. Coital frequency increased during the first trimester and then declined with advancing pregnancy. However, in all three analyses, there was no compelling evidence that men with pregnant or postpartum partners had additional concurrent partnerships. Our findings suggest that even though women's sexual activity likely declines during pregnancy and postpartum, they may not be at increased risk of HIV/STI due to their partners seeking additional partnerships.

Variability of HIV Assisted Partner Services by Region, Urbanicity and Gender in Kenya: A Cluster Randomized Trial

Background: We previously reported results of a cluster randomized trial demonstrating that immediate assisted partner services (aPS) increases HIV testing and case-finding among partners of persons newly diagnosed with HIV. Here we present the variability of aPS effectiveness by demographic factors. Methods: Eighteen HIV testing sites were randomized to immediate versus 6-week delayed aPS. Participants were HIV- infected index clients and their partners. The primary outcomes were the number of partners per index participant who 1) tested for HIV, 2) tested HIV-positive and 3) enrolled in HIV care. We used generalized estimating equations to assess differences in aPS effectiveness by region (medium/low vs high prevalence), testing location (urban vs rural/peri-urban), and gender. Findings: From August 2013-August 2015, the study enrolled 1119 index participants, 625 of whom were in the immediate group and 1286 sexual partners. Immediate aPS was more effective than delayed aPS across regions, gender and locations, being 7·2-fold more effective in promoting testing among partners in high HIV prevalence regions compared to a 3·4-fold increase in medium/low prevalence regions (Nyanza incidence rate ratio [IRR] 7·2; 95% confidence interval [CI] 5·4, 9·6 vs Nairobi IRR 3·4 95%CI 2·3, 4·8). Differences were also seen comparing rural/peri-urban and urban sites (IRR 6.6; 95%CI 4.5, 9.6 vs IRR 3.5 95%CI 2.5, 5.0, respectively), and female versus male index participants (IRR 5.8 95%CI 4·2, 7·9 vs IRR 3·7; 95%CI 2·4, 5·8, respectively). Providing aPS to female versus male index participants also resulted in more newly diagnosed HIV cases (IRR 9·1; 95%CI 4·0, 20·9 vs IRR 3·2 95%CI 1·7, 6·0, respectively). Interpretation: APS is effective in promoting HIV testing and case-finding across populations in Kenya and has higher effectiveness when provided in higher HIV prevalence settings, rural areas and for female index cases. These populations and locations can be prioritized when resources are constrained. Clinical Trial Registry: ClinicalTrials.gov registration number is NCT01616420. Funding: This study was funded by grants from the US National Institutes of Health (NIH), R01 A1099974-04 and Fogarty International Center (FIC) D43 TW009580. Author Disclosure Statement: We declare no conflicts of interest. Ethics Statement: This trial was approved by the Kenyatta National Hospital/University of Nairobi Ethics Review Committee (P523/10/2012) and the University of Washington Human Subjects Institutional Review Board Committee (43628 C).

Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya

ABSTRACTHealth worker experience and community support may be higher in high HIV prevalence regions than low prevalence regions, leading to improved prevention of mother-to-child HIV transmission (PMTCT) programs. We evaluated 6-week and 9-month infant HIV transmission risk (TR) in a high prevalence region and nationally. Population-proportionate-to-size sampling was used to select 141 clinics in Kenya, and mobile teams surveyed mother-infant pairs attending 6-week and 9-month immunizations. HIV DNA testing was performed on HIV-exposed infants. Among 2521 mother-infant pairs surveyed nationally, 2423 (94.7%) reported HIV testing in pregnancy or prior diagnosis, of whom 200 (7.4%) were HIV-infected and 188 infants underwent HIV testing. TR was 8.8% (4.0%–18.3%) in 6-week and 8.9% (3.2%–22.2%) in 9-month cohorts including mothers with HIV diagnosed postpartum, of which 53% of infant infections were due to previously undiagnosed mothers. Of 276 HIV-exposed infants in the Nyanza survey, TR was 1.4% (0.4%–5.3%) at 6-week and 5.1% (2.5%–9.9%) at 9-months. Overall TR was lower in Nyanza, high HIV region, than nationally (3.3% vs. 7.2%, P = 0.02). HIV non-disclosure to male partners and incomplete ARVs were associated with TR in both surveys [aOR = 12.8 (3.0–54.3); aOR = 5.6 (1.2–27.4); aOR = 4.5 (1.0–20.0), aOR = 2.5, (0.8–8.4), respectively]. TR was lower in a high HIV prevalence region which had better ARV completion and partner HIV disclosure, possibly due to programmatic efficiencies or community/peer/partner support. Most 9-month infections were among infants of mothers without prior HIV diagnosis. Strategies to detect incident or undiagnosed maternal infections will be important to achieve PMTCT.

Contamination with HIV antibody may be responsible for false positive results in specimens tested on automated platforms running HIV 4th generation assays in a region of high HIV prevalence.

IntroductionIn South Africa where the prevalence of HIV infection is very high, 4th generation HIV antibody/p24 antigen combo immunoassays are the tests of choice for laboratory based screening. Testing is usually performed in clinical pathology laboratories on automated analysers. To investigate the cause of false positive results on 4th generation HIV testing platforms in public sector laboratories, the performance of two automated platforms was compared in a clinical pathology setting, firstly on routine diagnostic specimens and secondly on known sero-negative samples.MethodsFirstly, 1181 routine diagnostic specimens were sequentially tested on Siemens and Roche automated 4th generation platforms. HIV viral load, western blot and follow up testing were used to determine the true status of inconclusive specimens. Subsequently, known HIV seronegative samples from a single donor were repeatedly tested on both platforms and an analyser was tested for surface contamination with HIV positive serum to identify how suspected specimen contamination could be occurring.ResultsSerial testing of diagnostic specimens yielded 163 weakly positive or discordant results. Only 3 of 163 were conclusively shown to indicate true HIV infection. Specimen contamination with HIV antibody was suspected, based on the following evidence: the proportion of positive specimens increased on repeated passage through the analysers; viral loads were low or undetectable and western blots negative or indeterminate on problem specimens; screen negative, 2nd test positive specimens tested positive when reanalysed on the screening assay; follow up specimens (where available) were negative. Similarly, an increasing number of known negative specimens became (repeatedly) sero-positive on serial passage through one of the analysers. Internal and external analyser surfaces were contaminated with HIV serum, evidence that sample splashes occur during testing.ConclusionsDue to the extreme sensitivity of these assays, contamination with minute amounts of HIV antibody can cause a negative sample to test positive. Better contamination control measures are needed on analysers used in clinical pathology environments, especially in regions where HIV sero-prevalence is high.

HIV status, fertility intentions, and contraception in the era of expanded access to antiretroviral therapy: A case study of rural Mozambique

ABSTRACTProvision of effective contraception to HIV-positive women of reproductive age is critical to effective management of HIV infection and prevention of both vertical and horizontal HIV transmission in developing countries. This exploratory retrospective study examines contraceptive use during the prolonged post-partum period in a sample of 285 HIV-positive and HIV-negative women who gave birth at four rural maternity clinics in a high HIV-prevalence region in Mozambique. Multivariate analyses show no significant variations by HIV status in contraceptive timing (mean time to first contraceptive use of 7.1 months) or prevalence (31% at time of survey) but detect a moderating effect of fertility intentions: while HIV status makes no difference for women wishing to stop childbearing, among women who want to continue having children, or are unsure about their reproductive plans, HIV-positive status is associated with higher likelihood of contraceptive use. Regardless of HIV status, virtually no condom use is reported. These results are situated within the context of a rapidly widening access to post-partum antiretroviral therapy in the study site and similar sub-Saharan settings.

CIDP in a HIV endemic population: A prospective case series from Johannesburg, South Africa

ObjectiveTo describe patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) in Johannesburg, South Africa, a setting of high HIV prevalence, and to determine the influence, if any, of HIV on CIDP. MethodsPatients were recruited prospectively. The study design was a hospital based case series of unselected consecutive CIDP patients. CIDP was diagnosed according to the European Federation of Neurological Societies/Peripheral Nerve Society criteria for the diagnosis of CIDP (First Revision). Demographic, clinical, laboratory and electrophysiological data were documented. ResultsTwenty three patients with CIDP were recruited over a two year period. Mean age was 38years. The female to male ratio was 3.6:1. Less than half (43%) had a raised cerebrospinal fluid (CSF) protein. All patients had idiopathic CIDP, three had associated diabetes mellitus. Ten patients (43%) were HIV positive. Thirteen patients were HIV negative. Clinical and electrophysiological characteristics were identical in the two groups. In the HIV positive group all the patients were black females. The CD4 counts ranged from 87 to 747cells/mm3. HIV positive status was associated with a progressive disease course and significantly with a CSF lymphocytic pleocytosis (p=0.007). Albuminocytological dissociation was associated with HIV negative status. ConclusionsTesting for HIV in patients with CIDP in a region of high HIV prevalence is recommended.CSF lymphocytic pleocytosis occurs in HIV associated CIDP.

Analysis of factors associated with antiretroviral therapy intiation and its timeliness among HIV sero-discordant couples in high HIV prevalence regions, China

To analyze factors associated with antiretroviral therapy (ART) initiation and its timeliness among HIV sero-discordant couples in high HIV prevalence regions in China. Data from the national HIV epidemiology and treatment databases by Dec 31, 2013 were used to collect HIV serodiscordant couples' baseline and follow-up informations in 40 counties which had reported 200 HIV cases cumulatively from Yunnan, Guangxi, Sichuan, Henan, and Xinjiang. Positive couples were divided into ART group and Non-ART group based on their ART initiation status. Sero-discordant couples that were reported between January 1, 2012 and October 31, 2013 and initiated ART treatment by 2013, were classified into two categories: 'having initiated ART within two months of receiving their HIV diagnosis', and not accessing timely treatment as 'having not initiated ART within two months of receiving their HIV diagnosis'. Multivariate logistic regressions were used to analyze potential factors associated with ART initiation and serodiscordant couples' timeliness to treatment. Odds ratios (95% confidence internal) were used to measure the associations. A total of 10 213 HIV-positive individuals were included in this study, among whom 73.9% (7 550/10 213) were males and 26.1% (2 663/10 213) were females, 66.4% (6 780/10 213) had initiated ART and 33.6% (3 433/10 213) had not. There were 1 733 serodiscordant couples who were reported during January 1, 2012 to October 31, 2013 had initiated ART. Among those 64.9% (1 125/1 733) had successfully initiated ART within two months of receiving their HIV diagnosis and 35.1% (608/1 733) had not. Multivariate logistic regression analysis showed that those being male were 0.81(0.71-0.92) less likely to initiate ART, as compared with those being female. Those being Yi ethnicity were 0.29(0.25-0.35) less likely to initiate ART, as compared with those being Han ethnicity. Those being Uygur ethnicity were 1.57 (1.28-1.93) times more likely to initiate ART, as compared with those being Han ethnicity. Those engaging the other jobs were 0.85(0.75-0.96) less likely to initiate ART, as compared with those being peasant. Those being diagnosed in medical institutions were 0.61 (0.53-0.71) less likely to initiate ART, as compared with those being diagnosed in VCT. Those having CD4⁺ T cells of 250-349, 350-550 and > 550 were 0.75 (0.64-0.89), 0.17 (0.14-0.19), 0.10 (0.08-0.11) less likely to initiate ART, respectively, as compared with those having CD4⁺ T cells of < 250. Those having duration of follow-up of 13-36 months and ≥ 37 months were 0.55(0.48-0.63) and 0.32 (0.28-0.37) less likely to initiate ART respectively, as compared with those having duration of follow-up of ≤ 12 months. Multivariate logistic regression analysis showed that those being Yi and Uygur ethnicity were 0.63 (0.44-0.91) and 0.40(0.29-0.56) less likely to initiate ART timely respectively, as compared with those being Han ethnicity. Those being infected through injecting drug use were 0.64 (0.47-0.86) less likely to initiate ART timely, as compared with those being infected through heterosexual intercourse. Those being diagnosed in other institutions were 0.58(0.43-0.78) less likely to initiate ART timely, as compared with those being diagnosed in VCT. Those having CD4⁺T cells of 250-349, 350-550 and > 550 were 0.75(0.56-1.00), 0.44(0.34-0.58), and 0.31(0.22-0.45) less likely to initiate ART timely respectively, as compared with those having CD4⁺ T cells of < 250. Being males, being Yi ethnicity, engaging other jobs, being diagnosed in medical institutions, having high CD4⁺ T cells and having long duration of follow-up were risk factors for initiating ART among serodiscordant couples.Being Yi and Uygur ethnicity, being infected through injecting drug use, and having CD4⁺ T cells were risk factors for initiating ART timely among serodiscordant couples.

Promoting reproductive options for HIV-affected couples in sub-Saharan Africa.

HIV-affected couples face unique challenges that require access to information and reproductive services to prevent HIV transmission to the uninfected partner and offspring while allowing couples to fulfil their reproductive goals. In regions of high HIV prevalence in sub-Saharan Africa, HIV-affected couples require multipurpose prevention technologies (MPTs) to enhance their reproductive healthcare options beyond contraception and prevention of HIV/sexually transmitted infections (STIs) to include assistance in childbearing. The unique characteristics of the condom and its accepted use in conjunction with safer conception interventions allow HIV-serodiscordant couples an opportunity to maintain reproductive health, prevent HIV/STI transmission, and achieve their reproductive goals while timing conception. Re-thinking the traditional view of the condom and incorporating a broader reproductive health perspective of HIV-affected couples into MPT methodologies will impact demand, acceptability and uptake of these future technologies.

Millennium Development Goal 6: AIDS and the International Health Agenda

Millennium Development Goal (MDG) 6, ‘to combat HIV/AIDS, malaria and other diseases’, is unique among the MDGs because it emerged in the context of unprecedented prior international mobilization, especially around HIV/AIDS, thus both reflecting and facilitating an expanding international health agenda. MDG 6 built on the idea of “health as development”, originally articulated at the 1978 conference on primary health at Alma-Ata, but was profoundly shaped by the political traction and fund-raising successes of AIDS activism and the international AIDS response. This underpinned the expansion of MDG 6 targets to include antiretroviral treatment, helped forge partnerships to reduce the prices of antiretroviral treatment and essential medicine, thereby contributing to MDG 8 (“building partnerships for development”) and, in high HIV-prevalence regions, also to MDGs 4 and 5 (maternal and child health). The UN High-Level Panel on the post-2015 development agenda recommends setting country-level health targets to achieve healthcare for all. Targets can help citizens hold governments to account by providing a focus for mobilization and a yardstick to measure progress. The data collection and policy monitoring pioneered by UNAIDS, and the involvement and support for civil society organizations achieved through the AIDS response, must be continued for this broader health agenda to succeed.

Transmission of Tuberculosis in Resource-Limited Settings

Unrecognized transmission is a major contributor to ongoing TB epidemics in high-burden, resource-constrained settings. Limitations in diagnosis, treatment, and infection control in health-care and community settings allow for continued transmission of drug-sensitive and drug-resistant TB, particularly in regions of high HIV prevalence. Health-care facilities are common sites of TB transmission. Improved implementation of infection control practices appropriate for the local setting and in combination, has been associated with reduced transmission. Community settings account for the majority of TB transmission and deserve increased focus. Strengthening and intensifying existing high-yield strategies, including household contact tracing, can reduce onward TB transmission. Recent studies documenting high transmission risk community sites and strategies for community-based intensive case finding hold promise for feasible, effective transmission reduction. Infection control in community settings has been neglected and requires urgent attention. Developing and implementing improved strategies for decreasing transmission to children, within prisons and of drug-resistant TB are needed.

Gender Disparities in HIV Risk Behavior and Access to Health Care in St. Petersburg, Russia

Over 40,000 HIV-infected individuals live in St Petersburg, Russia. Population characteristics and barriers to care are largely undefined. 152 consecutive patients receiving HIV care at two sites completed a questionnaire in Spring 2011. Rates of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, alcohol use, and rates of antiretroviral uptake were similar by gender. Males reported a higher history of injection drug use (80.3% vs. 48.7%; p<0.01) and tuberculosis infection (18.8% vs. 1.6%; p<0.01). Females were more likely to have had a child (63.3% vs. 31.5%; p<0.01) and be currently raising that child within their residence (49.3% vs. 15.3%; p<0.01). Unprotected sex (60.5% vs. 17.8%; p<0.01) and a history of sexually transmitted infection (37.7% vs. 20.3%; p=0.03) were more common in females. Females utilized social services more frequently (34.2% vs. 11.9%; p<0.01). There is a heavy burden of concurrent infectious disease, substance use and abuse, mental health illness, and need for social service support in this population. Important differences exist between genders in service uptake and utilization. Further evaluation of these differences may help inform the allocation of limited resources in this high HIV prevalence region of Russia.

HIV Prevention in Action on the Football Field: The Whizzkids United Program in South Africa

The Africaid Trust is a grassroots South African non-profit organization that engages youth in HIV prevention by harnessing the popularity of football (i.e. soccer). WhizzKids United, the organization's primary program, operates a 12-week program in elementary schools in Pietermaritzburg, South Africa, which aims to impart knowledge and life skills critical to HIV prevention. The goal of this research was to compare elementary school youth who received the program to youth who only received traditional classroom-based HIV education on health behaviors and HIV-related knowledge and stigma. A secondary objective was to evaluate HIV knowledge, sexual behaviors, attitudes towards HIV and health care seeking behaviors among South African youth in grades 9-12. Elementary students who participated in the program reported greater HIV knowledge and lower HIV stigma (p < .001) than those who had not. The majority of youth in grades 9-12 report having sexual relations (55.6%), despite low levels of HIV testing (29.9%) in this high HIV prevalence region of South Africa. The results highlight the importance of supporting community-based HIV educational initiatives that engage high-risk youth in HIV prevention and the need for youth-friendly health services.