A review of measures used to assess HIV-related stigma among young people living with HIV: missing accounts of sex and gender

Most studies of HIV-related stigma focus on adult populations. This study reviews empirical studies that measure HIV-related stigma among young people living with HIV (YLHIV). Using Earnshaw and Chaudoir’s (2009) framework, studies that assessed, enacted, internalized, perceived and anticipated stigma were coded and then evaluated on their use of sex or gender according to the following criteria: (i) recruiting equal number of young men and women; (ii) asking some questions/subsections of young men/women only; (iii) treating sex/gender as a covariate, or stratifying by or controlling for sex/gender; (iv) acknowledging the importance of sex/gender considerations in the discussion. Of the 2272 abstracts initially screened, 27 papers were eligible for analysis. While several studies (n = 12) measured all four types of stigma, four measured anticipated and internalized stigma and one measured perceived and internalized stigma. Moreover, two measured perceived and enacted stigma and two others measured only enacted stigma. Two studies measured only perceived stigma, and two assessed only internalized stigma. Most (n = 15) studies did not account for sex- or gender-based differences regarding HIV-related stigma and 10 did not report on participants’ sexual orientation. Of the 19 studies that included both male and female YLHIV, 6 did not account for sex/gender in their analyses. Very few (n = 6) studies reported on transgender YLHIV. Overall, a limited amount of HIV-related stigma research involved young people, despite the fact that this population experiences over 40% of annual incident rates globally. Additionally, overlooking sex- and gender-based differences is concerning given the evidence on gender differences regarding perceived HIV stigma and social rejection, discrimination, shame and psychological distress. Gender-specific stigma should be considered in future studies. A failure to do so leaves open the possibility of missing (or misunderstanding) relevant considerations (e.g. sex/gender-based differences or similarities) that may be amenable to stigma-reduction interventions.     

Effect of hepatitis C infection on progression of HIV disease and early response to initial antiretroviral therapy

OBJECTIVES: To describe the effect of hepatitis C virus (HCV) on the progression of HIV disease and on early changes in the CD4 cell count and HIV viral load after HAART initiation. DESIGN AND METHODS: Data were from a longitudinal medical records review project conducted in over 100 US medical clinics from 1998 to 2004. We analysed data from HIV-infected patients who received antiretroviral therapy (ART), calculated adjusted hazard ratios describing the hazard of death or progression to an AIDS-defining opportunistic illness (AIDS-OI) associated with prevalent HCV infection, and estimated the change in CD4 cell count and HIV viral load after HAART initiation, stratified by HCV status. RESULTS: A total of 10 481 HIV-infected individuals were followed for a median of 1.9 years; 19% had HCV. HCV infection was not associated with progression to AIDS-OI or death after controlling for important confounding conditions. Factors significantly confounding the risk of both death and diagnosis of an AIDS-OI were alcoholism, drug-induced hepatitis, and the type of ART prescribed. Acute and chronic hepatitis B infection confounded the risk of AIDS-OI diagnosis. During the 12 months after starting HAART, proportional increases in CD4 cell counts did not differ between HCV-infected and HCV-uninfected individuals. Likewise, the short-term change in viral load did not differ. CONCLUSION: In our cohort, HCV did not increase the risk of death or AIDS-OI, and did not affect the early immunological or virological response to initial HAART. Clinicians should evaluate patients with HCV for other, manageable problems, including alcoholism and other viral hepatitis.     

Specific mRNA lipid nanoparticles and acquired resistance to ticks

Acquired resistance to ticks can develop when animals are repeatedly exposed to ticks. Recently, acquired resistance to Ixodes scapularis was induced in guinea pigs immunized with an mRNA-lipid nanoparticle vaccine (19ISP) encoding 19 I. scapularis proteins. Here, we evaluated specific mRNAs present in 19ISP to identify critical components associated with resistance to ticks. A lipid nanoparticle containing 12 mRNAs which included all the targets within 19ISP that elicited strong humoral responses in guinea pigs, was sufficient to induce robust resistance to ticks. Lipid nanoparticles containing fewer mRNAs or a single mRNA were not able to generate strong resistance to ticks. All lipid nanoparticles containing salp14 mRNA, however, were associated with increased redness at the tick bite site – which is the first manifestation of acquired resistance to ticks. This study demonstrates that more than one I. scapularis target within 19ISP is required for resistance to ticks, and that additional targets may also play a role in this process.