HIV Response Research Articles

Framing HIV and AIDS in competitive authoritarian democracies. Case study of the print press in Mozambique, 1986–2020

Mozambique has the sixth highest prevalence of HIV in the world and ranks fourth in new infections. The government-owned print press Notícias has played an important role in the social construction of HIV and AIDS in the country as it was entrusted with the role of disseminating HIV and AIDS information to the public since the outbreak of the pandemic in the country in 1986. Using Notícias’ articles and frame analysis perspective, the article analyses the way Notícias has framed HIV and AIDS in the country since the late 1980s. The choice of media results from the fact that the way a phenomenon is constructed influences the way it is understood, as well as the way people may behave before it. The study found that Notícias’ frames on HIV and AIDS have suffered from a threefold tension: the need to maintain the Frelimo government’s former centralised and grassroots-orientated socialist ideology of health services in the context of the liberal market; the need to balance the influence of the global multilateral and bilateral actors and the Frelimo government’s political interest of translating HIV and AIDS response to the Mozambican context; and the need to portray a nationalist and positive image of the government’s performance in HIV and AIDS response before Mozambique’s non-fully plausible societal practices for an effective HIV and AIDS response. In a top-down approach, Notícias’ frames reflect not only the African post-independence ancillary and nationalist role of government-owned print press but also the power of global actors. Less is done from the societal bottom-up perspective.

Cytokine and chemokine receptor profiles in adipose tissue vasculature unravel endothelial cell responses in HIV.

Chronic systemic inflammation significantly increases myocardial infarction risk in people living with HIV (PLWH). Endothelial cell dysfunction disrupts vascular homeostasis regulation, increasing the risk of vasoconstriction, inflammation, and thrombosis, contributing to cardiovascular disease. We aimed to characterize endothelial cell (EC) chemokines, cytokine, and chemokine receptors of PLWH, hypothesizing that in our cohort, glucose intolerance contributes to their differential expression implicated in endothelial dysfunction. Using single-cell transcriptomic analysis, we phenotyped chemokine and cytokine receptor expression on arterial ECs, capillary ECs, venous ECs, and vascular smooth muscle cells (VSMCs) in subcutaneous adipose tissue of 59 PLWH with and without glucose intolerance. Our results show that arterial and capillary ECs express significantly higher interferon and tumor necrosis factor (TNF) receptors than venous ECs and VSMCs. Venous ECs exhibited more interleukin (IL)1R1 and ACKR1 receptors, and VSMCs showed significant IL6R expression than arterial and capillary ECs. When stratified by group, arterial ECs from PLWH with glucose intolerance expressed significantly higher IL1R1, IL6R, CXCL12, CCL14, and ICAM2 transcripts than arterial ECs from PLWH without diabetes. Of the different vascular cell types studied, arterial ECs as a proportion of all ECs in adipose tissue were positively correlated with plasma fasting blood glucose. In contrast, venous ECs and VSMCs were positively correlated with plasma IL6. To directly assess the effect of plasma from PLWH on endothelial function, we cultured human arterial ECs (HAECs) in plasma-conditioned media from PLWH and performed bulk RNA sequencing. Plasma from PLWH stimulated ECs with the upregulation of genes that enrich for the oxidative phosphorylation and the TNF-α via NFK-β pathways. In conclusion, ECs in PLWH show heterogeneous cytokine and chemokine receptor expression, and arterial ECs were the most influenced by glucose intolerance. Further research must explicate cytokine and chemokine roles in EC dysfunction and identify biomarkers for disease progression and therapeutic response.

IAPAC-Lancet HIV Commission on the future of urban HIV responses.

IAPAC-Lancet HIV Commission on the future of urban HIV responses.

HIV prevalence and associated factors among adolescent boys and young men in South Africa: 2017 nationally representative household-based population survey

IntroductionThere is growing recognition that adolescent boys and young men (ABYM) have been left behind in the HIV response and are under-represented in HIV services, leading to poor outcomes across...

The unsung heroes in the fight to end HIV: The role of nurses in Indonesia

HIV new cases are continuing to be reported in Indonesia. Although progress in HIV prevention and control has been made, Indonesia continues to face significant challenges in its fight against HIV. Continued efforts to expand treatment, reduce stigma, and strengthen prevention initiatives by involving health care workers and all stakeholders are essential to controlling the epidemic and improving the lives of those affected by HIV in the country. As a healthcare worker, nurses are central to the country's efforts to control and eventually end the HIV epidemic. Their roles are diverse and impactful, ranging from direct patient care to community outreach, education, and policy advocacy. As Indonesia continues to face challenges in its HIV response, the contributions of nurses will remain essential in overcoming these barriers and improving the lives of those affected by HIV.

Healthcare practitioners' experiences in managing HIV among young people in Namibia.

Low viral load suppression rates among older adolescents and young adults with HIV are a global challenge, including in Namibia. Healthcare providers struggle with managing these age groups due to their unique demographic characteristics. Monitoring viral load suppression is vital for evaluating antiretroviral treatment effectiveness, making it essential to identify and address existing gaps. This study aimed to explore and describe healthcare practitioners' understanding and experiences in managing older adolescents and younger adults living with HIV in seven high-burden districts of Namibia. Qualitative descriptive phenomenological research was followed in this study. Healthcare practitioners directly managing older adolescents and younger adults living with HIV were purposively recruited. Telephonic individual interviews were conducted, and data saturation was achieved with the 29th participant. Colaizzi's seven-step analysis was used to analyse the data. Two themes emerged from the study: (1) healthcare practitioners' knowledge of viral load management and (2) the strategies employed to manage high viral load in these age groups. These strategies included implementing differentiated service delivery, adopting interprofessional and Ubuntu approaches, psychosocial support, community engagement, enhancing adherence counselling, and support from implementing partners. The findings revealed inadequate knowledge among healthcare practitioners regarding viral load management, which negatively impacts the provision of quality care and an effective HIV response within the spirit of Ubuntu.Contribution:This study enhances healthcare practitioners' capacity in viral load management and guides policy makers in supporting this unique population, thus improving their health outcomes.

Resistance and the regimen: The microthanatopolitics of Venezuelan antiretroviral scarcity and HIV drug adherence failures

The Venezuelan State does not provide adequate antiretroviral therapy (ART) for the population living with HIV, resulting in pharmaceutical scarcity, involuntary treatment pauses, and adherence failures. Such a situation may result in the development of resistance to certain ART drugs, meaning that Venezuelans with HIV may have their treatment options reduced for the remainder of their lives. It can take a number of years for a person to acquire late-stage HIV/AIDS and for death to occur, and so I focus on the microbiological death of CD4 cells over time – a concept I call ‘microthanatopolitics’.In this paper I argue that the microthanatopolitics of ART scarcity deprives those living with HIV of future treatment options, encourages resistance to ART drugs, and ultimately may contribute towards ill health long after treatment availability changes in Venezuela. To explore this in depth, the paper draws upon 6 interviews with Venezuelan HIV activists in Venezuela (2024), supported by 40 testimonies from Venezuelan migrants living with HIV in Colombia (2021–2024), with and without known ART resistance.It will be concluded that not only is this an issue for those currently living in Venezuela, but also for migrants and the global HIV response who will suffer from the promotion and circulation of ART-resistant viral strains in the long run. This microthanatopolitics is influenced by both the current Venezuela political system as well as humanitarian aid from the Global North; an important consideration of coloniality in post-colonial Latin America.

A Case Study on the Community ART Group Model of Care: Does It work for People Living with HIV and Healthcare Service Providers in Lesotho

The Community ART Group (CAG) model is a community-led model implemented to support people living with HIV to address barriers to HIV treatment continuity which remain a challenge in Lesotho. This study sought to explore the perspectives of people living with HIV and that of the healthcare service providers, regarding the CAG model in selected health facilities in Lesotho. An explorative descriptive qualitative study was conducted among purposively selected 20 people living with HIV and 8 healthcare service providers at 3 healthcare facilities. Qualitative data were collected through face-to-face in-depth interviews using semi-structured interview guides. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used following an inductive approach and sub-themes and themes were developed. The CAG model was relevant and acceptable to most of the respondents. They felt that it provided support to people living with HIV, promoted good adherence to treatment, improved treatment access, reduced transport costs, saved time, and reduced stigma. Good retention, favorable clinical outcomes and decongestion of health facilities were identified as key achievements linked to the CAG model. Age, proximity to the health facilities, readiness to disclose positive HIV status, availability of a variety of differentiated service delivery models, family support, and the level of trust emerged as factors affecting the acceptability of the model. Conflicts arising among members of the groups compromised service delivery quality and insufficient resources emerged as challenges. The results confirmed that the Community ART Group model can deliver intended peer-led support to People Living with HIV, resulting in the achievement of favorable clinical outcomes. It is therefore recommendable to consider investing in this community-led model for a sustained HIV response in the country.

Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania.

Adolescent girls and young women (AGYW) continue to experience a high incidence of HIV in southern and eastern Africa, even in the context of large-scale HIV prevention interventions. In Tanzania, AGYW account for the largest proportion of new infections and have a higher risk of HIV acquisition than males of comparable age. We used routinely collected data from the PEPFAR/USAID-funded Sauti Project, a large combination HIV prevention program, to examine the relationship between transactional sex and sex with older partners among AGYW in Tanzania (2015-2020). Out-of-school AGYW 15-24 years completed a vulnerability index and were tested for HIV. We estimated weighted prevalence ratios (PR) and 95% confidence intervals (CI) for the associations of transactional sex (sex exchanged for money/services/gifts outside of sex work) and sex with older partners (≥5-years older, ≥10-years older) with prevalent HIV. Age cutoffs of 5 and 10 years were used to align partner age differences with age-disparate and intergenerational sex, respectively. We assessed potential synergism between exposures, and subgroup analyses explored associations among girls 15-19. Sixty seven thousand three hundred fifty seven AGYW completed the vulnerability index and 14,873 had captured HIV testing records. Median age was 20 years (IQR 18-22). Transactional sex and age-disparate sex were common (35% and 28%, respectively); 13% of AGYW reported both behaviors. HIV prevalence was associated with both transactional sex (PR: 1.28; 95% CI 1.00-1.63) and age-disparate sex (PR:1.26, 95% CI 0.99-1.60). In common referent analysis, transactional sex remained strongly associated with HIV, even in the absence of age-disparate sex (PR 1.41; 95% CI 1.02-1.94). Evidence of statistical synergism was not present, suggesting both transactional sex and age-disparate sex operate through similar pathways to increase HIV risk. Increased specificity within HIV prevention programs is needed to better meet the sexual and reproductive health needs of AGYW at high risk of HIV in Tanzania, including investment in tailored youth-friendly strategies for AGYW who have been marginalized from the current HIV response.

Fostering citizen-engaged HIV implementation science.

Successful implementation of evidence-based practices depends on contextual factors like stakeholder engagement, the socio-political environment, resource availability, and stakeholders' felt needs and preferences. Nevertheless, inequities in implementation exist and undermine efforts to address HIV in marginalized key populations. Implementation science shows promise in addressing such inequities in the HIV response, but can be limited without meaningful engagement from citizens or communities. We define the concept of a citizen-engaged HIV implementation science as one that involves citizens and communities deeply in HIV implementation science activities. In this commentary, we discuss how citizen science approaches can be leveraged to spur equity in HIV implementation science. Drawing on three areas previously defined by Geng and colleagues that serve to drive impactful implementation science in the HIV response, we discuss how citizens can be engaged when considering "whose perspectives?", "what questions are being asked?" and "how are questions asked?". With respect to "whose perspectives?" a citizen-engaged HIV implementation science would leverage participatory methods and tools, such as co-creation, co-production and crowdsourcing approaches, to engage the public in identifying challenges, solve health problems and implement solutions. In terms of "what questions are being asked?", we discuss how efforts are being made to synthesize citizen or community-led approaches with existing implementation science frameworks and approaches. This also means that we ensure communities have a say in interrogating and deconstructing such frameworks and adapting them to local contexts through participatory approaches. Finally, when considering "how are questions asked?", we argue for the development and adoption of broad, guiding principles and frameworks that account for dynamic contexts to promote citizen-engaged research in HIV implementation science. This also means avoiding narrow definitions that limit the creativity, innovation and ground-up wisdom of local citizens. By involving communities and citizens in the development and growth of HIV implementation science, we can ensure that our implementation approaches remain equitable and committed to bridging divides and ending AIDS as a public health threat. Ultimately, efforts should be made to foster a citizen- and community-engaged HIV implementation science to spur equity in our global HIV response.

Implementation research for today's HIV response: from theory to applied insights

Implementation research for today's HIV response: from theory to applied insights

Implementation research and the HIV response: Taking stock and charting the way forward

Implementation research and the HIV response: Taking stock and charting the way forward

Programme Science in PEPFAR: a pathway to a sustainable HIV response.

Programme Science in PEPFAR: a pathway to a sustainable HIV response.

Harnessing big heterogeneous data to evaluate the potential impact of HIV responses among key populations in Sub-Saharan Africa: A Study Protocol for the Boloka Data Repository Initiative (Preprint)

Harnessing big heterogeneous data to evaluate the potential impact of HIV responses among key populations in Sub-Saharan Africa: A Study Protocol for the Boloka Data Repository Initiative (Preprint)

Expanding technical assistance: a call for a more nuanced approach for sustainable HIV programs in Sub-Saharan Africa

An anticipated decline in external funding in sub-Saharan Africa (SSA) necessitates a re-evaluation of HIV response sustainability strategies. While institutional capacity building (ICB) has yielded positive outcomes, including strengthened technical expertise and institutional frameworks, it faces challenges. These include overemphasis on technical expertise neglecting resource mobilization, and a limited focus on policy advocacy. To achieve long-term sustainability, ICB efforts must equip local institutions with skills for tailored donor engagement, data-driven advocacy, and collaborative policy influence. This multi-pronged approach, coupled with efforts to diversify funding and integrate HIV responses, is crucial to empower local ownership and ensure the long-term viability of effective HIV responses in SSA.

Qualitative description of interpersonal HIV stigma and motivations for HIV testing among gays, bisexuals, and men who have sex with men in Ghana's slums-BSGH-005.

Despite significant progress in Ghana's HIV response, disparities in HIV prevalence persist among different populations. Gays, bisexuals, and other men who have sex with men (GBMSM) in the country remain vulnerable to HIV infection due to high levels of stigma and discrimination, limited access to healthcare services, and low HIV knowledge levels. While limited studies focus on HIV prevention and care in the Ghanaian GBMSM context, we did not find studies on GBMSM in slums. We, therefore, explored stigma and motivations of HIV testing among GBMSM in slums. In collaboration with our community partners, we recruited and conducted face-to-face interviews among 12 GBMSM from slums in Accra and Kumasi, Ghana. Our multiple-reviewer summative content analysis identified the following: under HIV stigma, we identified two categories, avoidance of GBMSM living with HIV and fear of testing positive for HIV. Under motivations for HIV testing, we identified three categories; HIV vulnerability, knowing one's HIV status, and positive messaging about HIV. Our findings provide valuable insights into stigma and motivations for HIV testing among GBMSM in Ghanaian slums. They also highlight the importance of targeted HIV education interventions to empower GBMSM to take responsibility for their sexual health and address the unique challenges they face accessing HIV testing services.

2023 Undetectable = Untransmittable global policy roundtable report: a multistakeholder perspective on Undetectable = Untransmittable research and policy priorities.

Background Launched in 2016 by Prevention Access Campaign, the 'Undetectable=Untransmittable' (U=U) campaign empowers people living with HIV to live full social, sexual and reproductive lives, dismantle stigma, promote increased treatment access, and advocate for updated HIV guidelines. Methods Key priorities for promoting improvements to community-centred, evidence-informed U=U policy and research were the focus of a half-day global roundtable held in 2023 alongside the 12th International AIDS Society Conference in Brisbane, Australia. After a series of presentations, experts in U=U research, policymaking, advocacy and HIV clinical care participated in facilitated discussions, and detailed notes were taken on issues related to advancing U=U policy and research. Results Expert participants shared that knowledge and trust in U=U remains uneven, and is largely concentrated among people living with HIV, particularly those connected to gay and bisexual networks. It was agreed that there is a need to ensure all members of priority populations are explicitly included in U=U policies that promote U=U. Participants also identified a need for policymakers, healthcare professionals, advocates and researchers to work closely with community-based organisations to ensure the U=U message is relevant, useful, and utilised in the HIV response. Adopting language, such as 'zero risk', was identified as crucial when describing undetectable viral load as an effective HIV prevention strategy. Conclusion U=U can have significant benefits for the mental and physical wellbeing of people living with HIV. There is an urgent need to address the structural barriers to HIV care and treatment access to ensure the full benefits of U=U are realised.

The HIV response beyond 2030: preparing for decades of sustained HIV epidemic control in eastern and southern Africa

The HIV response beyond 2030: preparing for decades of sustained HIV epidemic control in eastern and southern Africa

Flip the Script: Rebranding ART and enhancing the U=U message in Malawi and Zimbabwe

Background Since 2009, global efforts have made significant strides in identifying and treating People Living with HIV (PLHIV), with the number on Antiretroviral Therapy (ART) surpassing 25 million by 2020. However, challenges persist as a substantial number of individuals enrolled in ART, particularly in countries like Zimbabwe and Malawi, are lost to follow-up, impeding the success of HIV response initiatives. Stigma and limited awareness continue to pose barriers to effective HIV management. Methods The methodology centres on identifying compelling messengers to bridge the gap between medical information and lived experiences in sub-Saharan Africa. Grounded in human-centered and co-design approaches, the initiative engages host country governments, stakeholders, influencers, and the target audience to create a globally resonant brand with country-specific adaptations. Results The "Undetectable = Untransmittable" (U=U) movement, founded in 2016, emphasizes that PLHIV with undetectable viral loads cannot transmit the virus, playing a crucial role in dismantling stigma and enhancing HIV prevention efforts. To address the low awareness of U=U in Malawi and Zimbabwe, the collaborative "Flip the Script" project was launched, involving public and various private sectors. This initiative aims to reshape perceptions around ART, presenting it as a key to a normalized, healthy life rather than a symbol of infection. "Flip the Script" seeks to boost ART initiation and re-initiation, promote effective ART use, and encourage viral load testing and result sharing among PLHIV. It also strives for consistent counseling on the prevention benefits of ART by health providers. Conclusions Ultimately, the initiative aims to increase the percentage of PLHIV achieving and sustaining viral suppression, leading to a reduction in HIV incidence. Its success hinges on effectively communicating the U=U message, challenging stigma, and empowering both PLHIV and health providers in the targeted regions.

Reduction in time to viral suppression among persons living with HIV in Jamaica between 2017-2019.

HIV viral suppression is important for effective treatment and for reducing new infections. In 2019, only 66% of persons on antiretroviral treatment (ART) in Jamaica were virally suppressed. We aim to compare time to viral suppression by ART initiation year and type of treatment site to understand the implications for programming. We assessed time to viral suppression among 4560 persons who received viral load testing either pre or post ART initiation from 2017-2019. We used descriptive statistics and Kaplan-Meier estimates to compare survival curves by ART year (2017, 2018, 2019), sex and type of treatment site (public and non-governmental organizations). Persons were censored if suppression was not achieved. Mixed effects Cox regression was used to determine the effect of covariates on the likelihood of viral suppression. We report hazard ratios and 95% confidence intervals. Pre-ART viral load testing decreased from 36% in 2017 to 30% in 2019. For post-ART viral load tests, approximately 78% (n = 1589) of persons achieved suppression, 51% (n = 809) were female and 86% (n = 1341) used a public treatment site. The median time to suppression decreased by 3 months from 2017 to 2019. The likelihood of suppression was almost 2 times greater in 2018 (HR = 1.56, CI = 1.39-1.75) and 3 times greater in 2019 (HR = 3.17, CI = 2.76-3.64) compared to 2017. NGO treatment sites were also significantly associated with the likelihood of viral suppression compared to public sites. Pre-ART viral load testing and the time to viral suppression decreased over three years. Initiating ART after 2017 and early use of NGO treatment sites were found to significantly increase the likelihood of achieving suppression. This demonstrates improvements in the national HIV response but there is need to increase the number of persons on ART and achieving viral suppression.