Human Immunodeficiency Virus In Africa Research Articles

Prevalence and Determinants of Suicidal Ideation and Suicide Attempt in People With Human Immunodeficiency Virus in Africa: a Systematic Review

People with human immunodeficiency virus (HIV) are at higher risk of suicidal ideation and suicide attempts. We reviewed the literature for the prevalence and determinants of suicidal ideation and suicide attempt in people with HIV in Africa. The PubMed, Scopus, and Google scholar were searched for original studies published in peer-reviewed journals in English language between January 2015 to July 2020, using the key words: 'suicidal behavior', 'suicidal attempt', 'suicidal ideation', 'HIV/AIDS', and/or 'Africa'. The quality of included studies was assessed using the Newcastle-Ottawa scale. 12 cross-sectional studies published in the past 5 years in African countries were included. The quality of studies was high, with score ranging from 6 to 9. The prevalence of suicidal ideation ranged from 8.8% to 39%. The prevalence of suicide attempt ranged from 2.8% to 20.1%. The most common risk factors for suicidal behaviour were mental health-related problems. Other factors included high clinical stage of HIV, being unmarried, poor medication adherence, poorer quality of life, not taking highly active antiretroviral therapy, female sex, no education, substance use, low CD4 level, and opportunistic infection. Patients with HIV/AIDS have an increased risk of suicidal ideation and suicide attempts. Early screening, treatment, and referral of suicidal patients are necessary for HIV clinics.

Epidemiology of hepatitis B virus and/or hepatitis C virus infections among people living with human immunodeficiency virus in Africa: A systematic review and meta-analysis.

Due to their common routes of transmission, human immunodeficiency virus (HIV) coinfection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) has become a major public health problem worldwide, particularly in Africa, where these viruses are endemic. Few systematic reviews report the epidemiological data of HBV and/or HCV coinfection with HIV in Africa, and none provided data on the case fatality rate (CFR) associated with this coinfection. This study was conducted to investigate the prevalence and case fatality rate of HBV and/or HCV infections among people living with human immunodeficiency virus (PLHIV) in Africa. We conducted a systematic review of published articles in PubMed, Web of Science, African Journal Online, and African Index Medicus up to January 2022. Manual searches of references from retrieved articles and grey literature were also performed. The meta-analysis was performed using a random-effects model. Sources of heterogeneity were investigated using subgroup analysis, while funnel plots and Egger tests were performed to assess publication bias. Of the 4388 articles retrieved from the databases, 314 studies met all the inclusion criteria. The overall HBV case fatality rate estimate was 4.4% (95% CI; 0.7-10.3). The overall seroprevalences of HBV infection, HCV infection, and HBV/HCV coinfection in PLHIV were 10.5% [95% CI = 9.6-11.3], 5.4% [95% CI = 4.6-6.2], and 0.7% [95% CI = 0.3-1.0], respectively. The pooled seroprevalences of current HBsAg, current HBeAg, and acute HBV infection among PLHIV were 10.7% [95% CI = 9.8-11.6], 7.0% [95% CI = 4.7-9.7], and 3.6% [95% CI = 0.0-11.0], respectively. Based on HBV-DNA and HCV-RNA detection, the seroprevalences of HBV and HCV infection in PLHIV were 17.1% [95% CI = 11.5-23.7] and 2.5% [95% CI = 0.9-4.6], respectively. Subgroup analysis showed substantial heterogeneity. In Africa, the prevalence of hepatotropic viruses, particularly HBV and HCV, is high in PLHIV, which increases the case fatality rate. African public health programs should emphasize the need to apply and comply with WHO guidelines on viral hepatitis screening and treatment in HIV-coinfected patients. PROSPERO, CRD42021237795.

“We have to create our own community”: Addressing HIV/AIDS among Men who have Sex with Men (MSM) in the Neuropolis

The inclusion of Men who have Sex with Men (MSM) in global health policies has resulted in significant resource prioritisations in order to treat and prevent the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). MSM policy inclusions and health prioritisations, however, are primarily motivated by an epidemiological understanding of male same‐sex sexual behaviours, based on biological risks associated with HIV infection. Owing to South Africa's high HIV rates and MSM policy prioritisations, we aimed to examine experiences of engagement in urban MSM‐targeted HIV interventions. Qualitative interviews were conducted with participants (n = 20) who previously engaged in MSM‐HIV interventions, across a variety of historically marginalised “township” spaces in Cape Town, South Africa. Interviews were audio‐recorded with the consent of all participants, transcribed verbatim, and verified, and anonymised using alpha‐numeric codes. Data were analysed for core themes and in this paper we describe interactions between biological and social risks that shape city life for MSM in diverse township spaces. When positioned against the background of the Neuropolis, a recent sociological intervention by Des Fitzgerald, Nikolas Rose and Ilina Singh, our results portray urban life among MSM as a form of biological citizenship: (1) constructed by experiences that are constitutive of biosocial stressors, based on (2) health‐seeking attitudes and behaviours, and (3) reinforced through socio‐spatial engagements in peer‐led and community‐based HIV interventions. We conclude by offering critical insight into recent calls for the development of comprehensive and localised peer‐led health programmes as a current void in the geographies of health and sexualities in the global south.

Why communities must be at the centre of the Coronavirus disease 2019 response: Lessons from Ebola and human immunodeficiency virus in Africa.

As the Coronavirus disease 2019 (COVID-19) pandemic has spread globally, with no effective treatment or vaccine yet available, governments in many countries have put in place social interventions to control the outbreak. The various lockdown measures may have devastating impacts on economies and livelihoods. This approach risks undermining public trust in government responses and therefore undermines efforts to promote behaviour change, which is key to the success of social interventions. Important lessons can be drawn from past Ebola outbreaks and the human immunodeficiency virus pandemic on how communities should be central to COVID-19 responses. Communities are complex and only their members can inform public health experts about their lived realities, the community’s understanding of the outbreak and what will work locally to reduce transmission. The public should be encouraged to take positive actions to ensure their own health and well-being, rather than made to feel powerless. Communities should be supported to develop their own response plans, community leaders should be recognised as vital assets, community representatives should have equal inclusion in strategic meetings and greater empathy should be built into decision-making processes.

Reply

We appreciate the insightful comments on our report. The Shang Ring was invented by Dr. Jianzhong Shang in 2008 and has been widely used worldwide. The procedure has been playing an important role in preventing the spread of human immunodeficiency virus in Africa. Related researches have received much attention in China and abroad. Circumcision using the Shang Ring is safe and easy to operate, with less bleeding, minimal trauma, and no visible scar after healing. However, the description in the introduction was about the outcome in adult patients.

Mycotic aneurysm of the inferior gluteal artery caused by non-typhi Salmonella in a man infected with HIV: a case report

IntroductionNon-typhi Salmonellae infections represent major opportunistic pathogens affecting human immunodeficiency virus-infected individuals residing in sub-Saharan Africa. To the best of our knowledge, we report the first documented case in the medical literature of a Salmonella-induced mycotic aneurysm involving an artery supplying the gluteal region.Case presentationA 37-year-old black, Kenyan man, infected with human immunodeficiency virus with a CD4 count of 132 cells per microliter presented with a pulsatile gluteal mass and debilitating pain progressing over one week. He was receiving prophylaxis with trimethoprim-sulfamethoxazole. Aspiration of the mass yielded gross blood. An ultrasound examination revealed a 37 ml vascular structure with an intra-luminal clot. Upon exploration, a true aneurysm of the inferior gluteal artery was identified and successfully resected. A culture of the aspirate grew a non-typhi Salmonellae species. Following resection, he was treated with oral ciprofloxacin for 10 weeks. He later began anti-retroviral therapy. Forty-two months after the initial diagnosis, he remained alive and well.ConclusionsClinicians caring for patients infected with human immunodeficiency virus in Africa and other resource-limited settings should be aware of the invasive nature of Salmonella infections and the potential for aneurysm formation in unlikely anatomical locations. Rapid initiation of appropriate anti-microbial chemotherapy and surgical referral is needed. Use of trimethoprim-sulfamethoxazole prophylaxis does not routinely prevent invasive Salmonella infections.

Rethinking HIV exceptionalism: the ethics of opt-out HIV testing in sub-Saharan Africa

Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefits will likely outweigh the potential negative consequences of individuals experiencing HIV-related stigma. These justifications appeal to consequentialist moral theories that the acceptability of an action depends upon its outcomes. On the other hand, liberal moral theories state that the autonomy of individuals should always be protected unless restricting autonomy is necessary to protect the welfare of others. Opt-out consent may restrict autonomy and it is unclear whether it would benefit people other than those being tested. Yet, the doctrine of libertarian paternalism proposes that it is justifiable and desirable to use unobtrusive mechanisms to help individuals make choices to maximize their own welfare. Central to this idea are the premises featured by supporters of opt-out consent that individuals will not always make the best choices for their own welfare but they may be influenced to do so in ways that will not compromise their freedom of choice. Also important is the premise that all policies inevitably exert some such influence: opt-in consent encourages test refusal just as opt-out consent encourages acceptance. Based on these premises, opt-out testing may be an effective and ethically acceptable policy response to Africa's HIV epidemic.

Religion and HIV/AIDS Prevention in Nigeria

Religion and HIV/AIDS Prevention in Nigeria Jude Aguwa The spread of the human immunodeficiency virus in Africa has reached epic proportions, and the controversy over the use of condoms as a preventive measure has also escalated. In South Africa, 5.7 million of the nation’s 50 million people are infected with HIV. In 2001, 5.8 percent of Nigeria’s 140 million were infected with the virus.1 In dealing with this problem, which has been described as the twenty‐first plague, some faith‐based organizations have denounced condom use based on their sexual ethical teachings, while government and other secular agencies that pursue preventive programs endorse it based on its proven efficacy. The issues involved in this controversy will be the focus of this article. These issues include the following topics: religious beliefs, marital fidelity, abstinence, and condom use. The purpose of this study is to examine how religious teachings and policies affect the implementation of preventive programs of governments and civil organizations that advocate the use of condoms as an essential ingredient of a comprehensive prevention program. Furthermore, the study hopes to provide some insight that can be helpful in fostering more effective collaboration between faith‐based organizations on the one hand, and governments and social organizations on the other. The roots of controversy In the Western world, the thinking about AIDS as a death sentence has changed. This is as a result of the development of treatments that enable persons infected with the virus to operate normally and to live out their life span. Hence, HIV/AIDS is treated as a manageable chronic disease. In Africa, however, the “death sentence” picture about HIV/AIDS continues to dominate. In a country such as Nigeria, there is still limited availability of preventive and treatment programs. Furthermore, there has been an insignificant drop in the number of deaths from AIDS. The euphemisms for HIV/AIDS denoting wasting, disappearance, and death are still used, and their images continue to fuel sentiments of fear and confusion and encourage stigmatization of victims. To change this death‐sentence image in Africa, the spread of the virus must be contained and death from AIDS reduced. Government and social organizations involved in preventive and treatment programs advocate the use of condoms with the hope that especially youth can practice safe sex. On the contrary, some religious groups that are also involved in preventive programs condemn the use of condoms. According to religious views, especially in Catholicism, the condom is a form of contraception and so its use is viewed as immoral.2 Second, the availability of condoms is viewed as a contributing factor in early initiation of sex for young people as well as encouragement of extramarital sex. The position taken by some religious groups with respect to condom use has been seen as subversive, myopic, and unrealistic. In a recent study involving four hundred and forty‐three people, mostly young university students, half of them agree that the Catholic Church’s teaching on contraceptives and condom use limits the effectiveness of preventing the spread of HIV.3 An eminent Nigerian medical practitioner had expressed grave concerns on what amounted to a negative impact of religion: The steps being taken by all the governments of West Africa are basically along the ones that medical practice normally follows: prevention, treatments and rehabilitation. In terms of prevention, we are trying to change the sexual practices of the people. You have heard of ABC. ABC is a rational approach. A: Abstinence, B: Being faithful to one’s partner and, of course, C: use of condoms in situations where those two are not possible. It’s unfortunate that some people have brought religion into the whole thing. We are talking about the life and the death of people and we need to be practical about it and actually accept that the three approaches are important.4 Other authors such as Chinyere Okunna and Ifeoma Dunu have also indicted religion with a negative appraisal of its role in the battle against HIV/AIDS. Sadly, there are clear indications that although religion seems to show sympathy for people living with HIV/AIDS (PPLWHA), it has blindly and steadfastly continued to...

Review of evidence from risk factor analyses associating HIV infection in African adults with medical injections and multiple sexual partners.

Studies of risk factors for human immunodeficiency virus (HIV) infections in sub-Saharan Africa present a wealth of evidence relevant to ongoing debates about the contributions of unsterile health care and sexual transmission to Africa's HIV epidemics. From studies which meet search criteria (n = 39) we calculate population attributable fractions (PAFs) for incident and prevalent HIV infections associated with exposure to medical injections and with having more than one sexual partner. Median and mean crude PAFs for injections for both incident and prevalent HIV exceed those for multiple partners. Evidence suggests that adjustments for reverse causation (people with HIV-related symptoms seeking injections) and confounding do not explain away the large PAFs for injections. Misreporting of sexual behaviour has an unknown impact on PAFs for multiple partners. However, most PAFs for incident HIV infections are from communities with low-growth epidemics; hence data about the most important risk factors fuelling high-growth epidemics are sparse. Empirical resolution of ongoing debates may be possible with the aid of future research-especially in high-growth epidemic settings-that investigates risks for HIV transmission through a full range of sexual and parenteral exposures with attention to reverse causation, confound, and quality of sexual behaviour data.

Serial human passage of simian immunodeficiency virus by unsterile injections and the emergence of epidemic human immunodeficiency virus in Africa.

There is compelling evidence that both human immunodeficiency virus (HIV) types emerged from two dissimilar simian immunodeficiency viruses (SIVs) in separate geographical regions of Africa. Each of the two HIVs has its own simian progenitor and specific genetic precursor, and all of the primates that carry these SIVs have been in close contact with humans for thousands of years without the emergence of epidemic HIV. To date no plausible mechanism has been identified to account for the sudden emergence in the mid-20th century of these epidemic HIVs. In this study we examine the conditions needed for SIV to complete the genetic transition from individual human SIV infections to epidemic HIV in humans. The genetic distance from SIV to HIV and the mutational activity needed to achieve this degree of adaptation to human hosts is placed within a mathematical model to estimate the probabilities of SIV completing this transition within a single SIV-infected human host. We found that the emergence of even one epidemic HIV strain, following a single human exposure to SIV, was very unlikely. And the probability of four or more such transitions (i.e. HIV-1 groups M, O and HIV-2 subtypes A and B) occurring in a brief period is vanishingly small. We conclude that SIV cannot become a zoonosis, but requires adaptive mutations to become HIV. Some modern event must have aided in the transition of SIV to HIV. Our research indicates that serial passage of partially adapted SIV between humans could produce the series of cumulative mutations sufficient for the emergence of epidemic HIV strains. We examined the rapid growth of unsterile injections in Africa beginning in the 1950s as a biologically plausible event capable of greatly increasing serial human passage of SIV and generating HIV by a series of multiple genetic transitions. We conclude that increased unsterile injecting in Africa during the period 1950-1970 provided the agent for SIV human infections to emerge as epidemic HIV in the modern era.

Squamous intraepithelial lesions of the cervix, invasive cervical carcinoma, and immunosuppression induced by human immunodeficiency virus in africa

BACKGROUND Squamous intraepithelial lesions (SILs) of the cervix are associated with human immunodeficiency virus (HIV) infection, but multiple risk factors must be considered in this context. The authors performed a cross-sectional study to assess the prevalence of and the factors associated with SILs and invasive cervical carcinoma (ICC). METHODS In Abidjan, Côte d'Ivoire, women were recruited from three outpatient gynecology clinics and screened for both cervical disease and HIV infection. A CD4 cell count was performed for HIV-infected women. RESULTS A total of 2198 women were included in the study. The prevalence of HIV infection was 21.7%. Of the 2170 women who underwent a cervical screening, 254 (11.7%) presented with a dysplasia or neoplasia: 7.6% had low grade SILs (LSILs), 3.3% had high grade SILs (HSILs), and 0.8% had ICCs. In multivariate analyses, factors associated with these lesions were as follows: for LSILs, HIV-1 seropositivity, age <24 years, parity >1, consultation for genital infection, and no use of oral contraception in the past; for HSILs, HIV-1 seropositivity, chewing tobacco use, low educational level, and parity >1; and for ICCs, age >33 years, parity >3, and illiteracy. In women infected with HIV-1, the prevalence of LSILs increased with a decrease in CD4 cell count, whereas this relation was not found among patients with HSILs. ICCs were linked to HIV-2 infection, but not to HIV-1 infection, in univariate analysis. CONCLUSIONS In Africa, the prevalence of SILs is high. The factors associated with precancerous and cancerous lesions are different. Cancers in women infected with HIV-1 often may not reach the invasive stage. These findings could have implications for cervical screening programs in the future. Cancer 1998;82:2401-2408. © 1998 American Cancer Society.

Squamous intraepithelial lesions of the cervix, invasive cervical carcinoma, and immunosuppression induced by human immunodeficiency virus in africa

Squamous intraepithelial lesions (SILs) of the cervix are associated with human immunodeficiency virus (HIV) infection, but multiple risk factors must be considered in this context. The authors performed a cross-sectional study to assess the prevalence of and the factors associated with SILs and invasive cervical carcinoma (ICC). In Abidjan, Côte d'Ivoire, women were recruited from three outpatient gynecology clinics and screened for both cervical disease and HIV infection. A CD4 cell count was performed for HIV-infected women. A total of 2198 women were included in the study. The prevalence of HIV infection was 21.7%. Of the 2170 women who underwent a cervical screening, 254 (11.7%) presented with a dysplasia or neoplasia: 7.6% had low grade SILs (LSILs), 3.3% had high grade SILs (HSILs), and 0.8% had ICCs. In multivariate analyses, factors associated with these lesions were as follows: for LSILs, HIV-1 seropositivity, age <24 years, parity >1, consultation for genital infection, and no use of oral contraception in the past; for HSILs, HIV-1 seropositivity, chewing tobacco use, low educational level, and parity >1; and for ICCs, age >33 years, parity >3, and illiteracy. In women infected with HIV-1, the prevalence of LSILs increased with a decrease in CD4 cell count, whereas this relation was not found among patients with HSILs. ICCs were linked to HIV-2 infection, but not to HIV-1 infection, in univariate analysis. In Africa, the prevalence of SILs is high. The factors associated with precancerous and cancerous lesions are different. Cancers in women infected with HIV-1 often may not reach the invasive stage. These findings could have implications for cervical screening programs in the future.

Use of pyocin to select a Haemophilus ducreyi variant defective in lipooligosaccharide biosynthesis.

Haemophilus ducreyi, a cause of genital ulcer disease in developing countries, appears to facilitate the heterosexual transmission of the human immunodeficiency virus in Africa. Despite an increase in studies of this gram-negative human pathogen, little is known about the pathogenesis of chancroid. Our studies have shown that the lipooligosaccharides (LOS) of H. ducreyi may play an important role in ulcer formation. Monoclonal antibody and mass spectrometric analyses identified a terminal trisaccharide present on H. ducreyi LOS that is immunochemically similar to human paragloboside. This epitope is present on the LOS of Neisseria gonorrhoeae, and it may be the site of attachment for pyocin lysis. We have used pyocin, produced by Pseudomonas aeruginosa, to select LOS variants with sequential saccharide deletions from N. gonorrhoeae. On the basis of the similarities between N. gonorrhoeae and H. ducreyi LOS, we employed the same technique to determine if H. ducreyi strains were susceptible to pyocin lysis. In this study, we report the generation of a pyocin N-resistant H. ducreyi strain which synthesizes a truncated version of the parental LOS. Further studies have shown that this H. ducreyi variant has lost the terminal LOS epitope defined by monoclonal antibody 3F11. This report demonstrates that H. ducreyi is sensitive to pyocins and that this technique can be used to generate H. ducreyi LOS variants. Such variants could be used in comparative studies to relate LOS structure to biologic function in the pathogenesis of chancroid.

Cultural Practices Contributing to the Transmission of Human Immunodeficiency Virus in Africa

Differences between the epidemiology of AIDS cases in Africa and that in Western societies have prompted speculation regarding risk factors that may be unique to Africa. Because of the age and sex distribution of AIDS cases in Africa, emphasis has been placed on sexual transmission of human immunodeficiency virus (HIV). Factors thought to influence this sexual transmission include (1) promiscuity, with a high prevalence of sexually transmitted disease; (2) sexual practices that have been associated with increased risk of transmission of AIDS virus (homosexuality and anal intercourse); and (3) cultural practices that are possibly connected with increased virus transmission (female "circumcision" and infibulation). Other nonsexual cultural practices that do not fit the age distribution pattern of AIDS but may expose individuals to HIV include (1) practices resulting in exposure to blood (medicinal bloodletting, rituals establishing "blood brotherhood," and possibly ritual and medicinal enemas); (2) practices involving the use of shared instruments (injection of medicines, ritual scarification, group circumcision, genital tatooing, and shaving of body hair); and (3) contact with nonhuman primates. At the current time promiscuity seems to be the most important cultural factor contributing to the transmission of HIV in Africa.

Seroepidemiology of human immunodeficiency virus in Africa: Wendler I, Scheider J, Gros B, et al Brit Med J 293:782-285, 1986

Seroepidemiology of human immunodeficiency virus in Africa: Wendler I, Scheider J, Gros B, et al Brit Med J 293:782-285, 1986

Seroepidemiology of human immunodeficiency virus in Africa.

Serum samples from 6015 African subjects without symptoms of the acquired immune deficiency syndrome (AIDS) or contact with the disease were examined for antibodies to the human immunodeficiency virus by a combination of an enzyme linked immunosorbent assay and radioimmunoprecipitation (2567 samples) or by immunofluorescence (3448 samples). Serum samples had been collected between 1976 and 1984 in Senegal (n = 789), Liberia (935), Ivory Coast (1195), Burkina Faso (299), Nigeria (536), Gabon (1649), Zaire (15), Uganda (164), and Kenya (433). Only four samples contained antibodies. Three of these were from attenders at the Lambarene clinic in Gabon and one from a villager in Senegal. By contrast, two out of six AIDS suspects from Guinea-Bissau, all 13 patients with AIDS from Kinshasa (Zaire), and two out of three of their contacts were seropositive, all these specimens having been collected in 1985. These data show that fewer than one in a 1000 subjects were seropositive for AIDS at the time of sampling before 1985 and do not support the hypothesis of the disease originating in Africa.