HIV Infection In sub-Saharan Africa Research Articles

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THE HIV–POVERTY THESIS RE-EXAMINED: POVERTY, WEALTH OR INEQUALITY AS A SOCIAL DETERMINANT OF HIV INFECTION IN SUB-SAHARAN AFRICA?

Although health is generally believed to improve with higher wealth, research on HIV in sub-Saharan Africa has shown otherwise. Whereas researchers and advocates have frequently advanced poverty as a social determinant that can help to explain sub-Saharan Africa's disproportionate burden of HIV infection, recent evidence from population surveys suggests that HIV infection is higher among wealthier individuals. Furthermore, wealthier countries in Africa have experienced the fastest growing epidemics. Some researchers have theorized that inequality in wealth may be more important than absolute wealth in explaining why some countries have higher rates of infection and rapidly increasing epidemics. Studies taking a longitudinal approach have further suggested a dynamic process whereby wealth initially increases risk for HIV acquisition and later becomes protective. Prior studies, conducted exclusively at either the individual or the country level, have neither attempted to disentangle the effects of absolute and relative wealth on HIV infection nor to look simultaneously at different levels of analysis within countries at different stages in their epidemics. The current study used micro-, meso- and macro-level data from Demographic and Health Surveys (DHS) across 170 regions within sixteen countries in sub-Saharan Africa to test the hypothesis that socioeconomic inequality, adjusted for absolute wealth, is associated with greater risk of HIV infection. These analyses reveal that inequality trumps wealth: living in a region with greater inequality in wealth was significantly associated with increased individual risk of HIV infection, net of absolute wealth. The findings also reveal a paradox that supports a dynamic interpretation of epidemic trends: in wealthier regions/countries, individuals with less wealth were more likely to be infected with HIV, whereas in poorer regions/countries, individuals with more wealth were more likely to be infected with HIV. These findings add additional nuance to existing literature on the relationship between HIV and socioeconomic status.

The ethical concerns of using medical male circumcision in HIV prevention in sub-Saharan Africa

This position paper seeks to explore the ethical concerns surrounding the use of medical male circumcision as an effective method of preventing HIV infection in sub-Saharan Africa. The study explores research that looked at the effectiveness of medical male circumcision in clinical trials. While clinical trials reveal that medical male circumcision showed statistically significant results in HIV prevention, there is still a paucity of studies that take into consideration the ethical challenges posed by medical male circumcision in sub-Saharan Africa. This paper argues that rolling out medical male circumcision to the larger community without adequately addressing the ethical concerns could weaken programme initiation, implementation and evaluation in sub-Saharan Africa.

Migration, marital change, and HIV infection in Malawi.

Research on the relationship between migration and HIV infection in sub-Saharan Africa often suggests that migrants are at higher risk of HIV infection because they are more likely to engage in HIV risk behaviors than nonmigrants, and they tend to move to areas with a relatively higher HIV prevalence. Although migration may be a risk factor for HIV infection, I instead focus on the possibility that the HIV positive are more likely to migrate. Using a longitudinal data set of permanent rural residents and migrants from Malawi, I find that migrants originating from rural areas are indeed more likely than nonmigrants to be HIV positive and to have engaged in HIV risk behaviors. The increased HIV risk among migrants may be due to the selection of HIV-positive individuals into migration; I find that HIV-positive individuals are more likely to migrate than those who are HIV negative. The explanation for this phenomenon appears to be marital instability, which occurs more frequently among HIV-positive individuals and leads to migration after marital change.

Current Perspectives on HIV-Related Pain and its Management: Insights from Sub-Saharan Africa

SUMMARYSub-Saharan Africa is the region worst affected by the HIV epidemic and we estimate that at least 10 million HIV-positive individuals in sub-Saharan Africa live with significant pain related to their disease. Until recently there was a lack of studies specifically addressing pain related to HIV infection in sub-Saharan Africa, which limited our understanding of the scope of the problem. Here we describe the current nature of the epidemic of HIV-related pain in sub-Saharan Africa, including the systematic under-recognition and undertreatment of the pain.

Malaria and HIV infection in subSaharan Africa: Another match made in Hell?

Malaria and HIV are the most important infections in subSaharan Africa, in terms of the morbidity and mortality they cause. Current data suggest a possible interaction between the two diseases. Cellular immunodeficiency due to HIV infection might increase the frequency and severity of malaria, as local populations in endemic areas become less resistant. Likewise, the onset and repetition of malaria episodes might activate HIV replication and thus decrease the number of CD4 lymphocytes and accelerate the disease course. Despite their geographical coincidence, the epidemiological profiles of malaria and HIV differ considerably. The entanglement of these two diseases has epidemiological, clinical and therapeutic consequences in subSaharan Africa that raise concerns that HIV with malaria, as with tuberculosis, is a match made in Hell.

The Scourge of HIV Infection in Sub-Saharan Africa — A Rheumatological Perspective

Alzheimer9s disease is the most common neurodegenerative disorder in today9s developed world that is also increasingly picked out as a focal theme in fictional literature. In dealing with the subjectivity of human experience, such literature enhances the reader9s empathy and is able to teach about moral, emotional and philosophical issues, offering the chance to see situations from a position otherwise possibly never taken by the reader. The understanding and insight so gained may well be unscientific, but the literary approach offers an insight into the whole person9s perspective and the particularity and uniqueness of a situation that includes ethical conflicts. A key motif of fictional literature centred around dementia remains the burden the adult-child carer is confronted with, considering the parent9s remorseless decline and personality change, the sudden demand for devoted and continuous care, and the constantly changing relationship with the declining parent. In the context of an ever increasing demand for a constructive public discussion regarding end-of-life treatment of demented patients, Christine Devars (<i>Le Piano Désaccordé</i>) and Andrés Barba (<i>Ahora Tocad Música de Baile</i>) illustrate how powerful and burdensome the impact of Alzheimer9s disease is on both patient and carer and what extremes may be reached under such truly exceptional circumstances.

Knowledge and Perceptions of Couples' Voluntary Counseling and Testing in Urban Rwanda and Zambia: A Cross-Sectional Household Survey

BackgroundMost incident HIV infections in sub-Saharan Africa occur between cohabiting, discordant, heterosexual couples. Though couples' voluntary HIV counseling and testing (CVCT) is an effective, well-studied intervention in Africa, <1% of couples have been jointly tested.MethodsWe conducted cross-sectional household surveys in Kigali, Rwanda (n = 600) and Lusaka, Zambia (n = 603) to ascertain knowledge, perceptions, and barriers to use of CVCT.ResultsCompared to Lusaka, Kigali respondents were significantly more aware of HIV testing sites (79% vs. 56%); had greater knowledge of HIV serodiscordance between couples (83% vs. 43%); believed CVCT is good (96% vs. 72%); and were willing to test jointly (91% vs. 47%). Stigma, fear of partner reaction, and distance/cost/logistics were CVCT barriers.ConclusionsThough most respondents had positive attitudes toward CVCT, the majority were unaware that serodiscordance between cohabiting couples is possible. Future messages should target gaps in knowledge about serodiscordance, provide logistical information about CVCT services, and aim to reduce stigma and fear.

Knowledge of blood-borne transmission risk is inversely associated with HIV infection in sub-Saharan Africa

Accurate, comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e., countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level, respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk, independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west, central, and east Africa. In parallel analyses, knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West, central, and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge.

Update on microbicide research and development-seeking new HIV prevention tools for women

Women and girls are especially vulnerable to HIV infection in sub-Saharan Africa, and in some of those countries, prevalence among young women can be up to 3 times higher than among men of the same age. Effective HIV prevention options for women are clearly needed in this setting. Several ARV-based vaginal microbicides are currently in development for prevention of HIV transmission to women and are discussed here. The concept of pre-exposure prophylaxis for the prevention of HIV transmission to women is introduced.

Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya

A large proportion of new HIV infections in sub-Saharan Africa occur in stable HIV-discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour despite knowledge of discordant serostatus. Our objective was to compare HIV transmission between discordant couples who did and did not conceive during participation in a clinical trial. Five hundred and thirty-two HIV-discordant couples were followed for up to 2 years in Kisumu, Kenya as part of the Partners in Prevention HSV/HIV Transmission Study. Quarterly HIV-1 antibody and urine pregnancy test results were analysed. Forty-one HIV-1 seroconversions occurred over 888 person-years of follow-up, resulting in an annual incidence of 4.6/100 person-years. Twenty seroconversions occurred among 186 HIV-1-uninfected individuals in partnerships in which pregnancy occurred (10.8% of HIV-1-negative partners in this group seroconverted), in comparison to 21 seroconversions among 353 uninfected individuals in partnerships in which pregnancy did not occur (5.9% of HIV-1-negative partners seroconverted), resulting in a relative risk of 1.8 [95% confidence interval (CI) 1.01-3.26; P<0.05]. Pregnancy was associated with an increased risk of HIV seroconversion in discordant couples. These data suggest that the intention to conceive among HIV discordant couples may be contributing to the epidemic.

Preventing HIV Transmission in Married and Cohabiting HIV-Discordant Couples in Sub-Saharan Africa through Combination Prevention

Most new HIV infections in sub-Saharan Africa now occur in married and cohabiting couples, many of whom do not realize that only one of them may be infected with HIV. HIV-negative individuals living in stable HIV-discordant partnerships (in which one partner is HIV-infected while the other one is not) are twice as likely to get infected with HIV as those living in concordant HIV-negative relationships. Since HIV transmission occurs mainly from HIV-infected persons who are unaware of their status, a combination of interventions including behavioral and biomedical interventions is urgently needed to increase knowledge of HIV status as well as reduce the risk of HIV transmission within married and cohabiting couples. Behavioral interventions include promotion of couples' counseling, testing and disclosure; condom promotion as well as alcohol risk-reduction, while biomedical interventions include provision of antiretroviral treatment to the HIV-infected partner, medical male circumcision and treatment of sexually transmitted infections. Since no single intervention can turn around the current HIV tide in married and cohabiting couples, we argue for the inclusion of these interventions in a combination prevention package for married and cohabiting HIV-discordant couples in sub-Saharan Africa.

Ocular surface squamous neoplasia in patients with HIV infection in sub-Saharan Africa

Ocular surface squamous neoplasia (OSSN) in sub-Saharan countries is an aggressive tumor that affects younger patients and appears to be increasing in incidence. There are data to suggest the association of this disease with solar radiation exposure, HIV, and human papilloma virus (HPV). This trend possibly reflects the association of the high incidence of HIV, concomitant high incidence of exposure to HPV, and the solar radiation exposure that people in this region of the world receive. We undertook a PubMed search with the terms 'ocular surface squamous neoplasia', 'conjunctival carcinoma', 'HIV' and 'HPV', and 'sub-Saharan/Africa' to ascertain the scope of the problem and to review the available data, with an emphasis on publications of 2009 and the first quarter of 2010. There is increasing evidence of a significant association between HIV seropositivity and OSSN. The role of HPV as contributing to the cause of OSSN is being investigated. Patients with conjunctival cancer in sub-Saharan Africa are typically younger and more than 50% have underlying HIV infection. Initial presentation can be asymptomatic; however, many of these patients have advanced disease before they seek medical help and OSSN appears to have a more aggressive clinical course in sub-Saharan Africa. Treatment in Africa is primarily surgical. Chemotherapy and antiviral agents have been used. A diagnosis of OSSN in younger patients in sub-Saharan Africa should prompt HIV serotesting.

ART in low-resource settings: how to do more with less

In The Lancet today, Margaret May and colleagues 1 May M Boulle A Phiri S et al. for IeDEA Southern Africa and West AfricaPrognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 2010; (published online July 16.)https://doi.org/10.1016/S0140-6736(10)60666-6 Summary Full Text Full Text PDF Scopus (185) Google Scholar report prognostic models for patients starting antiretroviral therapy in sub-Saharan Africa. The group analysed data from four large scale-up cohorts in the Southern and West African regions that participate in the International epidemiologic Databases to Evaluate AIDS (IeDEA). On the basis of identified risk factors for death, May and colleagues constructed two prognostic models: one with CD4 cell count, clinical stage, bodyweight, age, and sex; and one that replaced CD4 cell count with total lymphocyte count and haemoglobin concentration in the blood. The group concluded that both models provide similarly strong discrimination for prediction of early mortality in patients starting antiretrovirals in sub-Saharan Africa. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmesPrognostic models should be used to counsel patients, plan health services, and predict outcomes for patients with HIV-1 infection in sub-Saharan Africa. Full-Text PDF

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

The purpose of this review was to identify and assess studies that have quantified the association between alcohol consumption and HIV infection in sub-Saharan Africa. PubMed, CAB s and article references were searched to identify studies published in English between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. Twenty-one eligible studies were described in detail and information on study characteristics extracted. All of the identified studies were conducted either in east or southern Africa, and varied substantially regarding study population and alcohol use definitions. Overall, users of alcohol and especially problem drinkers were more likely to be HIV seropositive (HIV+) than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence. The findings of this review of sub-Saharan African research strongly support an association between alcohol consumption and HIV infection. Although a causal relationship could not be established with certainty from the mainly cross-sectional studies, the negative consequences of such an association have profound implications for the burden of disease in this region. To confirm causality, future research should use prospective study designs, use clearly defined standardised measures of alcohol use (and problematic drinking) and an ‘event-specific’ approach to examine the situational links between alcohol use and HIV acquisition.

Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile-vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2-38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.

Screening for HSV-2 Infection in STD Clinics and Beyond: A Few Answers But More Questions

Screening for HSV-2 Infection in STD Clinics and Beyond: A Few Answers But More Questions

HIV and kidney disease in sub-Saharan Africa

A wide clinical spectrum of renal diseases affects individuals with HIV. These conditions include acute kidney injury, electrolyte and acid-base disturbances, HIV-associated glomerular disease, acute-on-chronic renal disease and adverse side effects related to treatment of HIV. Studies employing varying criteria for diagnosis of kidney disease have reported a variable prevalence of these diseases in patients with HIV in sub-Saharan Africa: 6% in South Africa, 38% in Nigeria, 26% in Côte d'Ivoire, 28% in Tanzania, 25% in Kenya, 20-48.5% in Uganda and 33.5% in Zambia. Results from these studies also suggest that a broader spectrum of histopathological lesions in HIV-associated kidney disease exists in African populations than previously thought. Strategies to prevent or retard progression to end-stage renal disease of HIV-associated kidney conditions should include urinalysis and measurement of kidney function of all people with HIV at presentation. Renal replacement in the form of dialysis and transplantation should be implemented as appropriate. This Review focuses on the available evidence of renal diseases in patients with HIV infection in sub-Saharan Africa and offers practical guidelines to treat these conditions that also take into consideration challenges and obstacles that are specific to sub-Saharan Africa.

Print media reporting of male circumcision for preventing HIV infection in sub-Saharan Africa

To review the types, content and accuracy of print media reports on male circumcision for preventing HIV infection among men in sub-Saharan Africa. We conducted a trilingual search (English, French, Portuguese) of LexisNexis(R) with the phrase 'male circumcision' for the period from 28 March 2007 to 30 June 2008. The articles identified were screened for the central theme of male circumcision for preventing HIV infection in men in sub-Saharan Africa and for publication types targeting lay audiences - newspapers, magazines, newswires or newsletters. We judged the accuracy of the reports and determined the context, public perceptions, misconceptions and areas of missing information in the print media. We also explored whether the media could be better used to maximize the impact of male circumcision. We identified 412 articles, of which 219 were unique and 193 were repeats. 'Peaks and valleys' occurred in the volume of articles over time. Most articles (56.0%) presented male circumcision for the prevention of HIV infection in a positive light. Those that portrayed it negatively had an overall repeat rate 2.9 times higher than positive articles. Public health messages formulated by international health agencies were few but generally accurate. The accuracy of the reports was good, although the articles were few and frequently omitted important messages. This suggests that public health authorities must help the media understand important issues. A communication strategy to sequence important themes as male circumcision programmes are scaled up would allow strategic coverage of accurate messages over time.

Increase in clinical prevalence of AIDS implies increase in unsafe medical injections

A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12-17%, and up to 34-47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.