Persons Living With HIV And AIDS Research Articles

Clinical Course of Kaposi Sarcoma in Persons Living with HIV And Aids (PLWHA) Treated with Combined Antiretroviral Therapy (cART) in Cameroon

Kaposi sarcoma (KS) is a low-grade vascular tumor believed to be caused by a virus known as Kaposi sarcoma herpesvirus/ human herpesvirus 8 (KSHV/HHV8) and is usually but not always associated with HIV infection. Although it can affect any organ or anatomical location, kaposi sarcoma lesions are most frequently found in mucosal surfaces and the skin.

Substance use and HIV: some considerations in a global context

ABSTRACT This brief report calls attention to the relationship between substance use and HIV from a global perspective. The epidemiology of substance use disorders among persons living with HIV and AIDS (PLWHA) is discussed along with specific caveats in the assessment of these disorders. Important macro-interventions include needle and syringe exchange programs (NSEP) and medication assisted therapy (MAT). Yet, structural interventions such as social welfare, child protection and support services for survivors of violence and abuse are necessary to reduce HIV incidence and enhance engagement in care among those living with HIV. To this extent health systems strengthening is necessary, as is integrating services provided by health and social development departments.

A Narrative Systematic Literature Review: A Focus on Qualitative Studies on HIV and Medication-Assisted Therapy in the United States

Over the last two decades, the United States (U.S.) has experienced an opioid crisis that has had a significant negative societal and economic impact. Due to the high utilization of opioids in Persons Living with HIV and AIDS (PLWHA), there is a need for a qualitative literature review that presents opioid-use related problems in this population. This study aims to present and identify a thematic overview of the qualitative manuscripts on PLWHA who take opioid medications in the U.S., with a focus on perceptions surrounding medication assisted therapy. The systematic literature search was performed in December 2019. Four databases were searched: PubMed/MEDLINE, Scopus, Web of Science, and Cumulative Index to Nursing & Allied Health Literature (CINAHL). A total of 5348 results were exported from databases into EndNote x9, and duplicates were removed for a total of 3039 unique abstracts to screen. The records were imported into Rayyan, an online platform designed to expedite the screening process. Three authors screened titles and abstracts and determined 19 articles that would be screened in full text. On 9 April 2020, it was determined that eight articles would be included for review. The analysis of the eight manuscripts that fit the inclusion and exclusion criteria revealed barriers and facilitators to medication assisted therapy (MAT) in PLWHA. This review communicates or describes the story of PLWHA who might have delayed access to HIV healthcare providers and the commencement of antiretroviral therapy. In the literature, several studies have focused on the role of physicians in prescribing and addressing the medication regimens but none of the studies examined the role of pharmacists in access to care in this population. Therefore, further research is needed for a better understanding of the social aspects of taking opioid medications in PLWHA and the role of pharmacists within the continuum of care.

HIV TESTING AND COUNSELLING AMONG THE YOUTH OF GHANA: THE CASE OF TARKWA-NSUAEM AND FANTEAKWA DISTRICT

ABSTRACT This study was conducted to examine the factors that contribute to the utilization of HIV Testing and Counselling (HTC) among the youth in Ghana focusing on Fanteakwa District and Tarkwa-Nsuaem Municipality in light of the Health Belief Model. The study involved 424 youths between the ages of 15 - 24. The quantitative approach was used in the study. Multi-stage sampling technique was adopted for the study involving the purposive sampling which was used to select the two districts and then the simple random sampling method which was also used to select the communities and participants. A structured questionnaire made up of 30 items was administered to the respondents to collect data and processed using STATA 15. The results showed that majority of the respondents (over 80%) had heard about HTC and also knew where to go for HIV testing. Again, It was also revealed from the study that as little as 25% had ever taken HIV test at the time of the study with the males being in majority than the females. In addition, more than half of the respondents (57.6%) have been given pre-counselling service before the test and majority of them (67.3%) went back for their test results. It was also found that sex (p = -0.52854), place of residence (p = - 0.67824) of respondents and perceived susceptibility (p = -0.07187) were significantly associated with HTC participation . It was recommended that social media should be used as a tool for disseminating information on HTC and also, the development and mass distribution of Self-test kits for HIV for the youth. Keywords: HIV Testing and Counselling (HTC), Confidentiality, Persons Living with HIV and AIDS (PLWHA), Health Belief Model (HBM).

Quantification and factors associated with HIV-related stigma among persons living with HIV/AIDS on antiretroviral therapy at the HIV-day care unit of the Bamenda Regional Hospital, North West Region of Cameroon

BackgroundThe Human Immunodeficiency Virus /Acquired Immune Deficiency Syndrome (HIV/AIDS) is not just a medical problem but its social impact is increasingly affecting its effective management. The fear of HIV-stigma constitutes a major barrier to HIV testing, prevention, uptake and adherence to antiretroviral therapy (ART). We aimed to quantify HIV-related stigma, and identify the factors associated with high HIV-related stigma among persons living with HIV and AIDS (PLHIVA) and on ART.MethodsA hospital-based cross sectional analytic survey targeting PLHIVA on ART at the HIV-day care unit of the Bamenda Regional Hospital of Cameroon was conducted from February to April 2016. A total of 308 eligible and willing participants were consecutively included in the survey. Data were collected using a pretested questionnaire designed from the Berger HIV stigma scale and analyzed using Epi info 3.5.4.ResultsThe mean age of the 308 participants was 40.1±10.2 years. The mean overall HIV/AIDS related stigma score was 88.3 ± 18.80 which corresponds to a moderate level of stigma according to the Berger stigma scale. Further analysis revealed that most participants suffered from moderate forms of the different subtypes of stigma including: personalized (49.8%), disclosure (66.4%), negative self-image (50.0%) and public attitude (52.1%) stigmatization. It was estimated that 62.7% (95% confidence interval [CI] = 57.8–68.9%) of the participants lived with high levels of HIV-related stigma. After controlling for gender, religion, age and occupation, level of education below tertiary (Adjusted Odds Ratio [AOR] = 0.70 [95% CI = 0.44–0.91]; p = 0.036) and a duration from diagnosis below 5 years (AOR = 1.74 [95% CI = 1.01–3.00]; p = 0.046) were significantly associated with high HIV-related stigma.ConclusionAbout three out of every five PLHIVA receiving ART in Bamenda Regional Hospital still experience high levels of HIV-related stigma. This occurs more frequently in participants with low educational status, and who may have known their HIV status for less than 5 years. Anti-HIV-stigma programs in the North West Region need strengthening with intensified psychosocial follow-up of newly diagnosed cases.

Training the next generation of HIV providers: impact of trainees on patient satisfaction in an urban HIV clinic

ABSTRACTFor persons living with HIV and AIDS (PLWHA), care by an HIV-specialist improves outcomes and satisfaction with one's HIV primary care provider (PCP) promotes engagement with care. In the United States, we are facing a workforce shortage of HIV providers. As we aim to train a new generation of HIV providers, it is unclear how PLWHA perceive their experience when cared for by trainees compared to experienced providers. Therefore we assessed patient satisfaction with HIV providers, both trainees in an HIV Primary Care residency program and HIV-specialists. A secondary objective was to evaluate providers’ performance in adhering to standard management guidelines for HIV-associated and non-HIV-associated conditions. We surveyed 75 PLWHA, including 51 (68%) assigned to an HIV-specialist PCP and 24 (32%) to a trainee PCP. Overall patient satisfaction on a 10-point scale was similar (mean 9.6 HIV-specialist vs 9.7 trainee, p = 0.71) and remained similar in multivariate logistic regression analysis when controlling for patient age, gender, race, and recently establishing care (Odds Ratio 1.1, 95% Confidence Interval 0.3–5.0). Participants in the trainee group were more likely to feel their provider “always” spent enough time with them (100% vs 81%, p = 0.03). Adherence to HIV guidelines was similar, though trainees were more likely to document counseling on risk reduction (83% vs 47%, p = 0.005) and adherence to antiretroviral therapy (100% vs 66%, p = 0.001). In conclusion, in a structured HIV-training program, residents can provide subspecialty level care in an HIV continuity clinic with levels of performance and patient satisfaction equivalent to those of experienced specialists.

Examining transdiagnostic vulnerabilities among HIV positive smokers seen at three inner city community based organizations

ABSTRACTInvestigators have proposed a “transdiagnostic vulnerability framework” that examines the relationship between smoking and broader emotional factors, including anhedonia, anxiety sensitivity, and distress tolerance. Because smoking and depression are more common in persons living with HIV and AIDS (PLWHA) than in the general population, understanding the relationship between smoking and mental health is critical. The following study aims to characterize levels of clinically significant depressive symptoms and these broader emotional factors as well as the relationship between these factors and smoking-related variables in a sample of PLWHA. This cross-sectional study employed convenience sampling to survey adult clients who attended one of three AIDS service organizations in New York City. The questionnaires assessed sociodemographic and HIV health care variables, tobacco use, and anxiety – and depression-related constructs. 150 PLWHA completed surveys. Among the 118 smokers, the prevalence of clinically depressive symptoms was 53%. Participants with clinically significant depressive symptoms had significantly higher mean anhedonia scores and anxiety sensitivity scores and lower mean distress tolerance total scores compared to participants without clinically significant depressive symptoms (p < 0.001). Smoking cessation treatment for persons with co-morbid psychiatric disorders has been suboptimal and treatment for co-morbid mental health conditions tends to align with disorder-specific treatment. Given that PLWHA are a priority population, further research should address how to best tailor interventions to a group with multiple obstacles to successful tobacco cessation.

Subjective Well-Being Among HIV-Positive South Africans: The Influence of Resilience and Social Capital

Living with HIV in a context of adversity may impact on a person’s sense of well-being. Little is however known about factors associated with subjective well-being (SWB) among persons living with HIV and AIDS (PLWHAs) in sub-Saharan Africa. This study examined the relationship between SWB, resilience and social capital. Participants were 263 HIV-positive, black South Africans living in poverty. Data were collected using three questionnaires measuring resilience, social capital and SWB, and analyzed using correlations and multiple regressions. The results showed that for all participants, SWB was associated with household income, the resilience factor being able to plan for the future, the social capital factors trust, reciprocity, solidarity, collective action, and perceived support and close ties to family and people of different religious groups. However, household income, resilience as a whole and the social capital factors reciprocity, solidarity and perceived support did not account for the any significant variation in SWB. For women, SWB was related to low collective action, having contacts of different religions and being able to plan for the future. For men, SWB was related to low trust in neighbors and being able to plan for the future. In conclusion, this indicates that what matters in terms of SWB among these PLWHAs is who and how they trust and relate to at a community level. It is proposed that through factors of social capital, HIV-positive persons living in contexts of adversity can secure access to resources and social support that are important for their sense of well-being.

Experiences of Stigmatization and Discrimination in Accessing Health Services: Voices of Persons Living With HIV in Ghana

Drawing on Earnshaw and Chaudoir’s HIV stigma framework, this study explored the experiences of persons living with HIV and AIDS regarding stigmatization and discrimination in accessing health services. Using a qualitative research methodology, 42 participants were purposively recruited during support group meetings of persons living with HIV and AIDS (PLWHA) at Amasaman in Accra, Ghana. Four focus group discussions (n = 22) and 10 in-depth interviews were conducted. Discussions and interviews were audio-taped, transcribed, and categorized based on the objectives of the study. The findings indicated that PLWHAs had knowledge of stigma that was experienced through enacted, anticipated, and internalized stigma mechanisms. Evidence showed that PLWHA did not experience stigma and discrimination when they accessed services at the Korle-Bu Teaching Hospital, the largest hospital in Ghana. However, the situation was different when they accessed services at other public health facilities. Based on the findings, implications are discussed for policy, social work, and public health practices.

P5-S1.01 Perceptions and practices of employers of labour in Ibadan North Local Government Area towards persons living with HIV/AIDS

The epidemic of HIV and AIDS constitute one of the major challenges to development worldwide. The disease condition reduces the productivity of Persons Living with HIV and AIDS (PLWHA) in the labour force and imposes a huge socio-economic burden on employers of labour. In Nigeria, employers of labour's perceptions and practices relating to HIV and AIDS have not been adequately explored. This study therefore determined public and private employers of labour's perceptions, practices and attitudes to persons who are living with HIV and AIDS in Ibadan North Local Government Area, Oyo state, Nigeria. The study was cross-sectional in design. A multistage sampling technique was used to select 400 study participants in the public (38) and private (362) sectors for interview. The instrument for data collection was a pre-tested semi-structured questionnaire. Data were analysed using descriptive statistics and the χ2test. There were more males (68.2%) than females (31.8%) among the participants. A majority, (79.0%), of the participants in the public sector (PuS) and 72.9% in the private sector (PrS) knew that an infected healthy looking person could harbour and transmit HIV to others. Overall, deep kissing (89.8%) topped the list of perceived mode of transmission of HIV; blood transfusion was mentioned by 46.3% of the participants while unprotected sex (30.4%) was the least mentioned. The listed ways of preventing HIV were: use of condom (85.9%); avoiding deep kissing (71.3%); keeping one uninfected sexual partner (21.2%); and sexual abstinence (15.4%). Avoidance of unscreened blood transfusion (6.2%) was the least mentioned means of transmitting HIV. The perception of 77.0% of the entire participants was that HIV and AIDS do not reduce workers' productivity. A majority, (80.0%), of which 2.3% with no formal education, 1.0% primary education, 13.5% secondary education, 41.5% HND/B.Sc, 21.0% postgraduate and 0.8% with other qualifications were of the view that workers infected with HIV and AIDS should not be sacked. Slightly less than half (48.0%) would keep their staff's HIV status secret while more than half, (57.0%), would not recruit a PLWHA. More than half of the participants, (56.5%), expressed a positive attitude to staff who is a PLWHA. More respondents in the private sector, (47.8%), claimed to have ever organised HIV and AIDS-related educational programmes for their staff than those in the public sector (42.1%) (p&lt;0.05). Almost equal number of participants in the public (36.8%) and private (36.2%) sectors would require mandatory test for HIV before employment. Only 1.8% of participants in the PuS and 6% in the PrS (p&lt;0.05) reported that their organisations had a workplace HIV and AIDS policy. Although the participants would tolerate staff with HIV and AIDS, their perceptions are indicative of limited knowledge about the mode of transmission and prevention of HIV. Health education strategies such as training and workplace HIV and AIDS education are needed to address these shortcomings.

Socio-Demographic and Anthropometric Variables of Persons Living with HIV and AIDS in Uyo, South Eastern Nigeria

The socio-demographic and anthropometric characteristics of 290 (154 females and 136 males) Persons Living with HIV and AIDS (PLWHA) has been assessed. They were randomly selected from a total of 1280 infected persons who registered for anti retroviral therapy at the University of Uyo Teaching Hospital, Uyo, South Eastern Nigeria. The results revealed that the age group 31-43 years were the most affected, females (53.1%) were significantly (p 0.05) in the BMI values of both males and females and MUAC values of females of the different age groups. The difference in MUAC values of males of the different age groups was statistically significant (p<0.05). It was concluded that anthropometric parameters alone were not a good index of the health status of PLWHA. It is recommended that effective health education programmes be instituted in tertiary institutions. Voluntary counseling and testing and antiretroviral treatment centers should be readily available and easily accessible to facilitate prompt intervention. Food supplementation programmes should be urgently incorporated into the national effort to curb the impact of the HIV and AIDS pandemic.

Access to treatment and care associated with HIV infection among members of AIDS support groups in Thailand

To examine the types and distributions of treatment received among persons living with HIV and AIDS (PLWHAs) in Thailand, we analyzed data collected during 2000 from 412 members of PLWHA support organizations in Bangkok and three upcountry northern provinces. Most (74%) of the respondents report ever receiving modern medical care for their HIV-related symptoms; 31% report ever using herbal treatments. Small proportions of those experiencing severe symptoms related to activity limitations report treatments with anti-retroviral medication, treatment for opportunistic infections or treatment for pain. Multivariate analysis suggests that the government's health card system plays an important role in keeping treatment costs down for PLWHAs and their families, that being open about one's HIV status to one's community is positively associated with receiving modern treatment for HIV-related ailments, that being female is negatively associated with receiving modern treatment and that living upcountry (as opposed to living in Bangkok) is associated with using herbal remedies. Policy implications of the findings are discussed.

Preliminary development of the World Health Organsiation's Quality of Life HIV instrument (WHOQOL-HIV): analysis of the pilot version

The assessment of quality of life (QoL) is central to understanding how people's lives are affected by HIV infection. A reliable and valid measurement tool developed for cross-cultural use will be important in evaluating the global impact of the disease. This paper reports on the development and preliminary assessment of the WHOQOL-HIV pilot instrument that is designed for use with the WHOQOL-100 for persons living with HIV and AIDS (PLWHA). In this study, 900 people with a mean age of 32 from six culturally diverse sites completed the WHOQOL-100 along with 115 HIV specific items. Respondents were HIV asymptomatic (23%), HIV symptomatic (23%), had AIDS (20%) or were well (34%). Analyses to select the best items from the piloted instrument resulted in the inclusion of 33 items covering 12 new facets for a field trial version of the WHOQOL-HIV instrument; e.g. symptoms of HIV, body image, social inclusion, death and dying, and forgiveness. The results indicate excellent internal consistency for the scale ( α=0.98) and its domains ( α=0.87–0.94). For PLWHA, pain and discomfort, positive feelings, dependence on medication, sexual activity, financial resources and spiritual connection were particularly poor, indicating that the severest impact of HIV extends beyond physical well-being to the psycho–social–spiritual and environmental areas of QoL. Comparisons using ANOVA showed that persons who are at later stages of HIV infection, or are currently ill report poorer QoL than those that were well ( p<0.01). Women report poorer QoL than men for almost every facet ( p<0.01) and older persons (>30) reported lower negative feelings, and better social inclusion, spiritual connection, forgiveness and spiritual experience than younger persons. Finally, those with no education, or only primary education showed some of the poorest means. It is concluded that these new items and facets add value for measurement of QoL in PLWHA.

Becoming partners: the meaning of caring for patients with HIV and AIDS

The purpose of this study was to understand and describe what constitutes caring as experienced by persons living with HIV and AIDS (PLWAs) along their illness trajectory. Interpretative phenomenology was employed. Six men and one woman living with HIV or AIDS participated in open-ended interviews. Interviews were analyzed according to Benner (1994) through paradigm cases, thematic analyses, and analyses of examples. Convenience sampling was used to select participants. Two distinct categories were interpreted: Letting go step by step and becoming partners. Letting go step by step encompasses the entire time people are living with HIV/AIDS illness trajectory. Becoming partners describes the relationship and commitments between PLWAs and families, friends, and health care providers. These findings reinforce the need for families, friends, and health care providers to become partners with PLWASs and to work on this partnership along the entire illness trajectory.