Potential interventions for HIV/AIDS wasting: an overview

Although the HIV wasting syndrome has become a far less common manifestation of advanced disease since the introduction of highly active therapies, much has been learned about a number of potential therapeutic interventions. HIV wasting therapies are reviewed. The evaluation of some of these treatments for management of body habitus alterations associated with antiretroviral therapies may be appropriate.     

Designing effective HIV/AIDS social and behavioral interventions for the population of those age 50 and older

Social and behavioral HIV/AIDS prevention interventions designed to test their effects on older cohorts are sorely lacking in the scientific literature even though middle-aged and older people represent a significant minority of both existing and new AIDS cases. This article raises key issues relevant in developing and evaluating HIV/AIDS social and behavioral interventions for older cohorts. These interventions must build on our current understanding of behavior change and HIV prevention successes with younger populations while considering important intervention principles gathered from work with older populations in other health arenas. In addition, the authors expand on recent national panels and published reviews relevant to the topic and provide a set of intervention recommendations for use in tandem with these intervention principles. The article also calls for additional research into the sociocultural contexts that influence risk-taking among older cohorts and for the development of interventions at multiple levels. Pragmatic considerations such as identifying and dismantling ageism in interventions, delineating intervention outcomes, and planning for intervention transferability, dissemination, and sustainability also are raised.     

HIV/AIDS: 30 years of progress and future challenges

Acquired immune deficiency syndrome (AIDS) was first described 30 years ago in a report from the US Centers for Disease Control. Two years later the causative virus was identified and afterwards named the human immunodeficiency virus (HIV). This article reviews the progress made in the three decades since the recognition of AIDS and the discovery of HIV, with respect to the virus, the infected cell, and the host, as well as directions for future studies.     

HIV/AIDS surveillance in Denmark: the challenges ahead

In Denmark, AIDS has been a mandatory reportable disease since 1983, and confirmed HIV infection has been the same since August 1990. The annual AIDS incidence increased initially and peaked in 1993 (4.6 per 100,000 inhabitants), then decreased to 1.2 per 100,000 inhabitants in 1998 and further to 0.9 in 2000. Most AIDS cases occur among men who have sex with men (MSM), representing 92% in 1980-1985 and 31% in 2000. Recently, AIDS incidence and mortality has decreased due to the new antiretroviral drugs. In 1995, 43 per million inhabitants died of AIDS, compared with 5 per million in 1998. HIV reporting in Denmark is anonymous. The annual number of new identified cases has been fairly stable at approximately 5.7 per 100,000 inhabitants. Immigrants represent 24% of identified HIV-infected persons and represent nearly 50% of all heterosexually acquired cases. Estimates show that HIV prevalence as of 2000 is 0.1% of the total population, distributed at 0.03% among heterosexuals and 4.8% among MSM. Estimated annual HIV incidence is around 5.6 per 100,000 inhabitants; three times higher among men than women, and as high as 220 per 100,000 among MSM. The spread of HIV is limited in Denmark but the prevalence is increasing due to the effect of antiretroviral therapy. This is a challenge to the existing HIV/AIDS surveillance and prevention strategy.     

HIV/AIDS behind bars: an avenue for culturally sensitive interventions.

The prevalence of HIV infection and the incidence of AIDS are higher among prison inmates compared to the general population. Although African Americans and Hispanics constitute approximately 13% and 12.5% of the population, respectively, they are over-represented among the prison population. The current trend in the adult/adolescent AIDS cases among African Americans and Hispanics outpaces that of the white population. The sociodemographic data of HIV/AIDS looks similar to the sociodemographics of U.S. prisons. This suggests that there may be a link between HIV transmission in prison and the current AIDS epidemic in the community. In addition, this high incidence is also a reflection of the high-risk lifestyle of the incarcerated population. High-risk behavior common among the incarcerated and inner city minority communities includes injection drug use, sharing of drugs and drug paraphernalia, and multiple sex partners. HIV transmission risk-reduction efforts such as mandatory screening of inmates, preventive HIV/AIDS education, and appropriate and adequate therapeutic management are essential to curtail the epidemic. However, any HIV/AIDS reduction program for minority communities must include culturally sensitive interventions.     

"Putting a face" on HIV infection/AIDS in older adults: a psychosocial context

Older HIV-1-seropositive individuals largely have not been investigated with respect to their psychosocial characteristics. In this article, the authors review research reported to date regarding the psychosocial context of this growing subgroup of HIV-1-infected individuals. Specifically, the authors consider the characteristics of mood state, life stressor burden, social support network, and coping strategies that individuals older than 50 years are more likely to adopt in adjusting to HIV-1 infection. The authors also separately consider issues of caregiving burden. Data supporting a theoretically based stressor-support-coping model are presented and related to targeting psychotherapeutic interventions for this age group.     

Perceived barriers to social support from family and friends among older adults with HIV/AIDS

Research has found that HIV-infected adults age 50 and older are more socially isolated than younger HIV-infected individuals. This study examines the perceived barriers to obtaining emotional and practical social support from friends and family among 63 older adults (age 50+) living with HIV/AIDS. Many reported they did not receive enough emotional support (42%) or practical assistance (27%). Barriers to obtaining support included: (1) nondisclosure of HIV status; (2) others' fear of HIV/AIDS; (3) desire to be self-reliant and independent; (4) not wanting to be a burden; (5) unavailability of family; (6) death of friends to AIDS; and (7) ageism. These barriers may explain the greater social isolation of HIV-infected older adults and inform interventions targeted at reducing these barriers.     

Complementary health approaches for health and wellness in midlife and older US adults

ObjectivesTo characterize the use of complementary health approaches (CHA) and examine the perceived benefits of using CHA by reason for use among midlife and older adults.Study designAnalysis of 2012 National Health Interview Survey data, a nationally representative US sample using cross-tabulations with design-based F-tests and multiple logistic regression. The analytic sample included adults aged over 50 years (N = 14,849).Main outcome measuresThe proposed benefits of using CHA included: (1) better control over health, (2) reduced stress/relaxation, (3) better sleep, (4) feeling better emotionally, (5) coping with health problems, (6) improved health/feeling better, and (7) improved relationships.ResultsOverall, 31% of this sample of midlife and older US adults had used CHA in the past year. Among users, 15% had used CHA for treatment only, 40% for wellness only, and 45% for combined wellness and treatment. Herbs (60%), chiropractic (28%), massage (22%), and yoga (19%) were the most common CHA. Wellness-only and combined users had significantly higher odds of reporting that CHA conferred benefit compared with treatment-only users.ConclusionsCHA are used by nearly a third of midlife and older adults and are perceived to provide substantial benefit. Integrating CHA as part of a healthy lifestyle has the potential to contribute to healthy aging among midlife and older adults.     

Key issues in sex work-related HIV / AIDS / STD prevention interventions

In the last 20 years prostitutes, or sex workers, have formed self-help and advocacy organizations in a number of countries that could have an effect on acquired immunodeficiency syndrome (AIDS) and sexually transmitted disease (STD) prevention efforts. It is essential when planning a sex work-related intervention to identify sex workers, clients, or third parties as well as any factors that affect the safety of existing sex and drug use practices. It is important to know where sex workers and clients contact each other, where they go to engage in sex, and the working conditions of sex work establishments. Other considerations include the accessibility of condoms and health care; the impact of laws, regulations, and enforcement practices; and the impact of migration of both sex workers and clients. Many projects have involved members of the target audiences in the assessment as interviewers as well as in the design and implementation of the project. All interventions should include current information, education, and communication consisting of media strategies as well as person-to-person strategies. A combination of sites can help to reach the maximum proportion of the population at risk. Several projects have provided bulk supplies in order to ensure access to condoms at no cost or inexpensively to hotels, bars, brothels and other sex work businesses. Projects have also promoted the use of sterile injection equipment where injecting drug use is common. Functioning outreach and education projects emphasize STD service, such as sensitivity training for health care providers to improve services and diagnostic procedures and to motivate sex workers to utilize the health care system. Voluntary utilization may the boosted by offering STD services in a stationary or mobile clinic in the sex work neighborhoods during the afternoon and early evening and combining them with family planning, primary health care, and child health care.     

Psychological interventions with AIDS and HIV: prevention and treatment.

In the decade since acquired immune deficiency syndrome (AIDS) was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with human immunodeficiency virus (HIV) conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and injection drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "second wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection.     

Hydroxyapatite-coated bioalloy surfaces: current status and future challenges

The present review contains salient features of the most widely used methods for depositing hydroxyapatite (HA) coatings on bioalloy substrates. These methods range from the ubiquitous plasma spraying in air to the recently introduced ion beam enhanced deposition technique. Special attention is paid to the residual stress in the coating that arises from various sources and whose magnitude impacts the adhesion of the coating to the substrate and, hence, the efficacy of the coated part (see, for example, the in vivo performance of HA-coated orthopaedic and dental implants). Thus, the plethora of methods for estimating residual stresses in HA-coated systems are critically examined. The review concludes with a detailed presentation of ten areas for future research work.     

The needs of older adults with schizophrenia: implications for psychological interventions

The paper assesses whether the needs of people with schizophrenia over 65 years differ from those of younger adults with the diagnosis. It reviews studies comparing older and younger adults and older adults with schizophrenia and non-clinical or clinical controls on measures of psychosocial functioning. It also considers how psychological interventions can be best designed to cater for the specific needs of older adults. There are relatively few studies assessing how the needs of people with schizophrenia change over the life course and studies comparing the needs of older and younger adults. However, compared to same age peers older adults with schizophrenia have needs in relation to symptoms, cognitive functioning, social functioning, psychological resilience factors, social support, quality of life, physical health and medication adherence. Psychosocial interventions for this group therefore need to target these areas and there is evidence from three groups of researchers in the USA to suggest that cognitive behavioural or social skills interventions can be successfully adapted for older people. The paper concludes by summarising recommendations for future research and treatment.     

A public health perspective on HIV/AIDS in Africa: Victories and unmet challenges

More than three decades after the first cases of HIV were recognized in the United States and worldwide, Africa remains a remarkable example of both public health successes and remaining challenges. Although many African countries initially lacked the resources and sociopolitical will to advance HIV treatment and prevention strategies, world governments, a committed scientific community, and activists have made tremendous advances. We present a public health perspective on the history of the HIV epidemic in Africa, combining summaries of the epidemiology of HIV infection rates and risk factors for horizontal and vertical HIV transmission, along with a historic perspective on programmatic and funding initiatives that have strongly reduced levels of HIV infection across the continent. In our preparation of this review two clear themes emerged: that (1) the HIV epidemic in Africa remains geographically and culturally heterogeneous, so that treatment and prevention strategies need to be thoughtfully tailored for maximal effectiveness; and (2) a lack of openness to recognize and discuss infection disparities in high risk groups, disseminate prevention information, and enact policies to partner with these highly stigmatized risk groups. This is especially true of female sex workers, people who inject drugs, and men who have sex with men, communities that are often not recognized or typically undercounted when HIV testing and prevention policies are developed by many African governments. Without changes to recognize and de-stigmatize these high-risk groups, a lack of sociopolitical will to alter public health perspectives will likely hinder advances to further curb the HIV epidemic.     

Effects of exercise interventions on the functional status of acutely hospitalised older adults: A systematic review and meta-analysis

BackgroundAcute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.MethodsRelevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19^th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.ResultsFifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19–1.08) and 1–3 months post-discharge (SMD = 0.29, 95%CI = 0.13–0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18–0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).ConclusionsIn-hospital supervised exercise interventions seem overall safe and effective for improving – or attenuating the decline of – functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.     

Information and communication technologies for adherence to antiretroviral treatment in adults with HIV/AIDS

IntroductionInformation and communication technologies support interventions directed at the prevention of HIV transmission and patient monitoring by promoting improved accessibility and quality of care.ObjectiveTo evaluate the efficacy of information and communication technologies in the adherence to antiretroviral treatment in adults with HIV/AIDS.MethodologySystematic review conducted from March to May of 2015 in three databases—the Cumulative Index to Nursing and Allied Health Literature (CINAHL); the Latin-American and Caribbean Literature in Health Sciences (LILACS/BIREME) and SCOPUS; and the Cochrane library and the Medical Literature Analysis and Retrieval System Online portal (MEDLINE/PubMed). The sample consisted of nine randomized clinical trials based on the use of information and communication technologies for adherence to antiretroviral treatment in adults with HIV/AIDS.ResultsThree studies analysed the use of a short message service – SMS – two phone calls, two alarm devices, one web-enabled Hand-held device and one web electronic intervention. Improvements in the levels of adherence in the group subjected to the intervention were identified in seven studies. The phone was the type of information and communication technology with proven efficacy with respect to adherence. It was used to make calls, as well as to send alert messages and reminders about taking medications. Pagers were not considered to be effective regarding adherence to antiretroviral therapy.ConclusionThe integrated use of information and communication technologies with standard care promotes increased access to care, strengthening the relationship between patients and health services, with the possibility of mitigating the difficulties experienced by people with HIV in achieving optimal levels of adherence to drug therapy.