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1.
HAART has improved the well-being of many people living with HIV (PLWH). This study aimed at (i) comparing heterosexual practices between PLWH and the general population by gender, and (ii) identifying factors associated with sexual practices and at-risk behaviors in the two populations. Self-reported data were collected among PLWH attending hospitals (VESPA2 survey; n?=?3022) and the general population (CSF survey; n?=?10,280). Significant differences between the two samples were corrected for by implementing propensity score matching on both socio-demographic characteristics and sexual behavior in terms of number of partners. Men not reporting heterosexual intercourse were excluded. After matching, 61% of women (out of 707) and 68% of men (out of 709) were sexually active in both populations. PLWH practiced oral sex less than the general population and used condoms more consistently over the previous 12-month period, irrespective of having multiple sexual partners or not. For women living with HIV: those with several sexual partners and those consuming drugs over the previous 12 months were more likely to practice oral sex; those living in a couple for at least 6 years and migrants were less likely to practice anal intercourse. For men living with HIV: those reporting bisexual relationships and those with multiple sexual partners over the previous 12 months were more likely to practice anal heterosexual intercourse; migrants reported less oral sex, irrespective of HIV status. Error term correlations showed that anal intercourse was not linked to condom use for women or men from either population. Our results show that PLWH had a lower rate of heterosexual practices compared with the general population, and used condoms more often, irrespective of the number of sexual partners and strong cultural background (e.g., for Sub-Saharan African women). Further preventive information needs to be disseminated on the risk of infection transmission through heterosexual anal intercourse.  相似文献   

2.
Psychiatric comorbidities are common in people living with HIV (PLWH) and adversely affect life satisfaction, treatment adherence and disease progression. There are few data to inform the burden of psychiatric symptoms in older PLWH, a rapidly growing demographic in the U.S. We performed a cross-sectional analysis to understand the degree to which symptom burden was associated with cognitive disorders in PLWH over age 60. Participants completed a standardized neuropsychological battery and were assigned cognitive diagnoses using Frascati criteria. We captured psychiatric symptom burden using the Geriatric Depression Scale (GDS) and proxy-informed Neuropsychiatric Inventory-Questionnaire (NPI-Q). Those diagnosed with HIV-associated neurocognitive disorders (HAND, n?=?39) were similar to those without HAND (n?=?35) by age (median?=?67 years for each group, p?=?0.696), education (mean?=?16 years vs. 17 years, p?=?0.096), CD4+ T-lymphocyte counts (mean?=?520 vs. 579, p?=?0.240), duration of HIV (median?=?21 years for each group, p?=?0.911) and sex (92% male in HAND vs. 97% in non-HAND, p?=?0.617). Our findings showed similarities in HAND and non-HAND groups on both NPI-Q (items and clusters) and GDS scores. However, there was a greater overall symptom burden in HIV compared to healthy elder controls (n?=?236, p?p?相似文献   

3.
ABSTRACT

Older people living with HIV (PLWH) experience multimorbidity that can negatively impact quality of life (QoL). Exercise can improve physical function, but effects on QoL are not well understood. 32 PLWH and 37 controls aged 50–75 completed 12-weeks of moderate-intensity exercise, then were randomized to moderate or high-intensity for 12 additional weeks. Depressive symptoms (CES-D scores) were significantly greater and QOL (SF-36 mental and physical summary scores) significantly lower among PLWH at baseline (all p?<?0.05). PLWH had significantly greater worsening in CES-D scores compared to controls (3.4 [0.7, 6.0]; p?=?0.01) between 13and 24 weeks. Mental QoL changed minimally, with no significant difference in changes by serostatus between weeks 0 and 12 or weeks 13 and 24 (p?≤?0.22). Changes in physical function summary scores were similar by serostatus between 0 and 12 weeks (1.5 [?1.6, 4.6], p?=?0.35), but declined significantly more among PLWH between 13 and 24 weeks (?4.1 [?7.2,?1], p?=?0.01). Exercise intensity had no significant effect on changes in CES-D or SF-36 summary scores; high-intensity exercise was associated with greater improvements in vitality/fatigue (4.1 [0.8, 7.3], p?=?0.02), compared to moderate-intensity. Exercise initiation failed to improve depressive symptoms or QoL among PLWH. Additional interventions may be needed to maximize these patient-reported outcomes among older PLWH initiating an exercise program.  相似文献   

4.
A random sample consisting of 88 sexually active people living with HIV (PLWH) and their HIV negative spouses in rural China were interviewed. Data of 68 couples (77.2 %) who gave identical responses to whether they had been using condoms consistently in the last 12 months (n = 136) were analyzed. The results showed that 27.9 % of the discordant couples used condom inconsistently in the last year. Condom non-availability was the most commonly given main reason for not using condoms. Free condoms should be made available to these low-income couples. Suicidal ideation of the PLWH and the spouse’s perception on ‘whether someone could contract HIV via unprotected sexual intercourse with a HIV positive person’ were significantly associated with inconsistent condom use in the last year. Education program should change the cognition about the risk for HIV transmission via unprotected sex. Integrated psychological services to reduce suicidal ideation are greatly warranted.  相似文献   

5.
Historically, children with perinatally-acquired HIV (PHIV) were viewed as the “innocent victims” as their HIV infection was not acquired through sexual/drug related means. Today, adolescents with PHIV are surviving into young adulthood and are engaging in developmentally expected behaviors such as establishing intimate, sexual relationships. Like other youth, those living with PHIV often need to access sexual and reproductive health (SRH) services. Previous research has documented stigma and discrimination experienced by adult women living with HIV as they try to access SRH care. However, little is known about the experiences of stigma and discrimination encountered by the maturing adolescents and young adults (AYA) with PHIV when accessing services. HIV health care providers (HHCPs) who frequently care for this population are in a unique position to learn about and understand the stigma and discrimination experienced by their patients in formal service settings. HHCPs (n?=?57, 28 medical and 29 social service providers) were recruited using snowball sampling, and completed an online survey based on patient-shared experiences of stigma and discrimination when accessing SRH-related health care and social services. Thirty-eight percent (22/57) of providers reported that their patients with PHIV had shared encounters of stigma or discrimination when accessing SRH services. Coded open-ended provider comments indicated that AYA patients experienced challenges with providers who were unfamiliar with PHIV and expressed surprise that someone with PHIV was still alive. Analyses also revealed prejudicial attitudes towards women with HIV. Patients reported being counseled to terminate their pregnancy and lectured about their “poor choices.” As AYA with PHIV transition out of pediatric and adolescent care, it is important for providers to simultaneously help them navigate care in other health settings, as well as educate adult health care providers about possible misconceptions of caring for individuals with PHIV.  相似文献   

6.
Physical activity (PA) interventions have been shown to improve the health of people living with HIV (PLWH), yet treatment dropout poses an important challenge. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in PA interventions in PLWH. Electronic databases were searched for records up to September 2016. Randomized control trials of PA interventions in PLWH reporting dropout rates were included. Random effects meta-analysis and meta-regression analyses were employed. In 36 studies involving 49 PA intervention arms, 1128 PLWH were included (mean age?=?41.6 years; 79.3% male; 39% White). The trim and fill adjusted treatment dropout rate was 29.3% (95% CI?=?24.5–34.7%). There was a significant lower dropout rate in resistance training interventions compared with aerobic (p?=?0.003) PA interventions, in studies utilizing supervised interventions throughout the study period (p?p?β?=?1.15, standard error (SE)?=?0.49, z?=?2.0, p?=?0.048), a lower body mass index(BMI) (β?=?0.14, SE?=?0.06, z?=?2.16, p?=?0.03), and a lower cardiorespiratory fitness (β?=?0.10, SE?=?0.04, z?=?2.7, p?=?0.006). The dropout from PA interventions is much higher in PLWH than in many other populations with chronic morbidities. Qualified professionals (i.e., exercise physiologists, physical educators, or physical therapists) should be incorporated as key care providers in the multidisciplinary care of HIV/AIDS and should prescribe supervised PA for PLWH in order to enhance adherence and reduce the burden of HIV/AIDS. Special attention should be given men, those with a higher BMI, and those with a lower cardiorespiratory fitness.  相似文献   

7.
ABSTRACT

One in five transgender women (TW) are living with HIV, yet little has been published about their health outcomes. We analyzed data from TW (n?=?37), cisgender women (CW, n?=?165), and cisgender men who have sex with men (MSM, n?=?151) in Thailand and Brazil. We hypothesized: (1) TW will have higher odds of depressive symptoms, lower odds of condom use and greater odds of a detectable viral load compared to MSM and CW; and (2) TW will have lower odds of condom use and higher odds of detectable viral load. We found that TW had higher odds of depression (OR 2.2, 95%CI: 1.0, 4.8, p?=?0.04) and were less likely than MSM (22% v. 42%, p?=?0.01) to use condoms with partners of unknown serostatus. In multivariable models, TW had lower odds than MSM of using condoms with partners with unknown serostatus (OR 0.38, 95%CI: 0.15, 0.90) and CW had lower odds than MSM of using condoms with HIV-negative partners (0.60 [0.38, 0.95], p?=?0.029). We found no significant differences in detectable viral load. Disaggregating data by gender is important to understand factors that contribute to viral suppression and HIV transmission risk among people living with HIV.  相似文献   

8.
Risky sexual behaviour in PLWHA on antiretroviral therapy threatens both prevention and treatment efforts, but disclosure promises to support safer sexual practices. This paper investigates the association between HIV self-disclosure and consistent condom use in a cohort of public sector patients on antiretroviral (ARV) treatment. Using data from the FEATS cohort study, logistic regression analysis shows that knowledge of your partner’s HIV status is positively associated with consistent condom use (OR 2.73, 95% CI 1.37–5.43, p?=?0.004) and so too mutual HIV disclosure (OR 3.38, 95% CI 1.60–7.18, p?=?0.001). Prevention and treatment programmes, through couple HIV counselling and testing (CHCT) and other assistance programmes, should focus on supporting the mutual disclosure of HIV status among PLWHA on ARV treatment.  相似文献   

9.
Essential HIV cure-related clinical trials (HCRCT) have a potentially high-risk profile in terms of participants’ health, which could hinder enrollment by people living with HIV (PLWH) and healthcare professionals (HP). The ANRS-APSEC survey is part of the IAS “Towards an HIV cure” initiative, which promotes multidisciplinary research for a safe, affordable and scalable cure. The study objectives were to understand the psychosocial mechanisms underlying PLWH and HP viewpoints about future HCRCT. Six focus group discussions (three with PLWH (n?=?21) and three with HP (n?=?30)) were held in three French infectious disease units. From these, three perspectives on HCRCT were identified. The first involved beliefs and knowledge associating HCRCT with poorer health and quality of life for PLWH. The second concerned perceptions of HCRCT as a biological and epidemiological flashback to a situation when HIV infection was left uncontrolled. The third was characterized by aspects of historical HIV culture that embrace innovation.  相似文献   

10.
The purpose of this study is to evaluate the association between utilization of HIV testing and condom use amongst Cameroonian youths/adolescents who are not known to be HIV-infected. Worldwide, HIV is spreading most quickly amongst youths/adolescents. Between 44% and 82% of sexually active youths in Cameroon report inconsistent condom use. Data regarding utilization of HIV testing and condom use are lacking. A cross-sectional survey was administered to 431 youths ages 12–26 years in Cameroon from September 2011 to December 2011. Data on sociodemographics, sexual risk behaviors, self-reported HIV status, and condom use were collected. We compared rates of inconsistent condom use between those with known HIV negative status who utilized testing (HIV-N) and those with unknown status due to unutilized testing (HIV-U). Inconsistent condom use was defined as responding “never,” “sometimes,” or “usually,” while consistent condom use was defined as responding “always” to questions regarding frequency of condom use. Generalized estimating equations were applied to assess the association between HIV testing and inconsistent condom use, adjusting for other confounders. Of 414 eligible respondents, 205 were HIV-U and 209 were HIV-N. HIV-U subjects were younger (mean age = 16.4 vs. 17.9, p < 0.001) and more likely to report living in an urban area (p = 0.002) than HIV-N subjects. Seventy-two percent (137/191) of sexually active youths reported inconsistent condom use. After adjusting for potential confounders, HIV-U status (odds ratio [OR] = 3.97, 95% confidence interval [CI] = 1.68–6.01) was associated with inconsistent condom use. Similarly, female gender (OR = 3.2, 95% CI = 1.29–7.89) was associated with inconsistent condom use, while older age at sexual debut was associated with a decreased risk for inconsistent condom use (OR = 0.67, 95% CI = 0.56–0.81). Cameroonian adolescents report high rates of inconsistent condom use which we found to be associated with self-reported unknown HIV status due to unutilized HIV testing. Successful HIV prevention programs among African youths/adolescents may benefit from expanded HIV testing programs.  相似文献   

11.
For persons living with HIV, health-related quality of life (HRQOL) may be threatened by physical and mental conditions but may be protected by positive psychological traits. We performed an exploratory look at the risk and protective factors for HRQOL in older adults living with HIV. Cross-sectional analyses of baseline data from the Rush Center of Excellence on Disparities in HIV and Aging (CEDHA), a community-based cohort of persons ages ≥50 living with HIV (n?=?176) were performed. Analyses examined the relationship between risk/protective factors and two outcomes (i.e., self-reported health status [SRHS] and the healthy days index [HDI]). Having good/excellent health was associated with being a non-smoker (p?=?0.002), greater purpose in life (p?=?0.006), higher education (p?=?0.007), fewer depressive symptoms (p?=?0.004), fewer disabilities (p?=?0.000), and less loneliness (p?=?0.002) in bivariate analyses. Males (p?=?0.03) and African Americans/Blacks (p?=?0.03) reported higher HDI. Fewer depressive symptoms (p?=?0.000), disabilities (p?=?0.002), adverse life events (p?=?0.0103), and loneliness (p?=?0.000) were associated with higher HDI in bivariate analyses. In a logistic regression model, greater purpose in life, fewer disabilities, and being a non-smoker were associated with better SRHS after adjusting for covariates. For African Americans/Blacks, having fewer depressive symptoms and disabilities were associated with higher HDI after adjusting for covariates. Disabilities, depression, smoking status, race/ethnicity, and purpose in life were significantly associated with HRQOL. Findings support the need for research to examine the influence of cultural interpretations of life quality and focus on promoting physical function, smoking cessation, and psychological wellness in persons aging with HIV.  相似文献   

12.
ABSTRACT

We conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24–32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p?=?0.029) and higher median percentage of condom use for anal intercourse (p?=?0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p?=?0.001), popper usage (p?=?0.002), median number of sexual partners (p?=?0.003), and increased median condom use percentage (p?=?0.006). Our study highlights that “Vialogues” intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.  相似文献   

13.
14.
Global targets aim to increase the number of people living with HIV (PLWH) who know their status. Using data from Mozambican facility-based HIV testing and counseling (HTC) and a population-based survey, we compared characteristics of PLWH diagnosed in HTC to the general population of PLWH to identify subgroups that are missing from the health system and may be undiagnosed. Male and female PLWH aged 50+ (PPR?=?0.47, p?=?.0001) and with higher HIV knowledge (PPR?=?0.52, p?=?.004) were underrepresented in HTC. A higher proportion of patients diagnosed in health facilities were aged 25–39 (PPR?=?1.23, p?=?.02). Female PLWH with lower economic (PPR?=?0.70, p?=?.04) and educational status (PPR?=?0.86, p?=?.02) and male PLWH aged 18–24 (PPR?=?0.47, p?=?.03) were underrepresented in HTC. Comparing HTC data to population-based data can inform efforts to increase HIV diagnoses and to ensure that all PLWH know their status.  相似文献   

15.
The focus of HIV interventions in Botswana, a country with the second highest prevalence of HIV in the world, remains targeted at those aged 15–49 years despite a growing cohort of older people living with the disease — driven largely by the successful roll-out of antiretroviral therapy (ART). Primarily utilising the Botswana AIDS Impact Survey IV, we set out to examine HIV related characteristics and behaviours of this often ignored older cohort (50–64 years) relative to younger (25–49 years) adults. Analysis revealed that more than 80% of older people living with HIV were on ART. HIV prevalence among this older cohort was 24.6% in 2013 compared to 35.1% among the younger cohort, p < 0.0001. Prevalence in older adults was higher among older males (27.8%) than females (21.9%), p = 0.02. Furthermore, 58.9% of older adults acknowledged being sexually active, with 59.0% of these admitting to inconsistent condom use during sexual intercourse. In addition to this low condom usage, older men (6.0%) were significantly more likely to be unaware of their HIV-positive status than older women (3.0%), p = 0.002. While HIV prevalence showed a dramatic increase among older men over time (17.2% in 2004, to 23.4% in 2008, to 27.8% in 2013), the trend was flatter among older women (16.3% in 2004, to 22.4% in 2008, to 21.9% in 2013). These trends are likely attributable to a large increase in ART coverage and uptake. Going forward, more targeted interventions acknowledging the ageing epidemic are important to consider.  相似文献   

16.
This study investigated correlates of quality of life (QOL) among people living with HIV/AIDS (PLWH) at An Hoa Clinic, Ho Chi Minh City, Vietnam. Inclusive criteria were PLWH ≥18 years old, under antiretroviral therapy (ART) for ≥3 months, and consent to participate. PLWH who were illiterate, too ill, or at the final stage of AIDS were excluded. QOL was assessed using WHOQOL-BREF-HIV. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. For every point increased in depression score, QOL decreased 0.13 points in Physical (p?<?.001), 0.12 points in Psychological and Social Relationships (p?<?.001), 0.07 points in Level of Independence (p?<?.001), 0.09 points in Environment (p?<?.001), and 0.15 points in Personal Beliefs domain (p?<?.001). PLWH from an economically disadvantaged household had lower QOL scores for all QOL domains but Personal Beliefs with differences ranging from 0.81 points for Social Relationships to 1.77 points for Environment domain. PLWH with a co-morbidity had lower scores whereas those living with a spouse and adhering to ART medication had higher scores in at least one QOL domain. In conclusion, depressive symptoms, household economy, living with a spouse, having a co-morbidity and ART medication adherence were important factors associated with PLWH’s QOL.  相似文献   

17.
More than 30% of perinatally HIV-infected children in Thailand are 12 years and older. As these youth become sexually active, there is a risk that they will transmit HIV to their partners. Data on the knowledge, attitudes, and practices (KAP) of HIV-infected youth in Thailand are limited. Therefore, we assessed the KAP of perinatally HIV-infected youth and youth reporting sexual risk behaviors receiving care at two tertiary care hospitals in Bangkok, Thailand and living in an orphanage in Lopburi, Thailand. From October 2010 to July 2011, 197 HIV-infected youth completed an audio computer-assisted self-interview to assess their KAP regarding antiretroviral (ARV) management, reproductive health, sexual risk behaviors, and sexually transmitted infections (STIs). A majority of youth in this study correctly answered questions about HIV transmission and prevention and the importance of taking ARVs regularly. More than half of the youth in this study demonstrated a lack of family planning, reproductive health, and STI knowledge. Girls had more appropriate attitudes toward safe sex and risk behaviors than boys. Although only 5% of the youth reported that they had engaged in sexual intercourse, about a third reported sexual risk behaviors (e.g., having or kissing boy/girlfriend or consuming an alcoholic beverage). We found low condom use and other family planning practices, increasing the risk of HIV and/or STI transmission to sexual partners. Additional resources are needed to improve reproductive health knowledge and reduce risk behavior among HIV-infected youth in Thailand.  相似文献   

18.
Human immunodeficiency virus (HIV) serodiscordant couples are at risk of sexual transmission of HIV between the infected and uninfected partner. We assessed New York area care providers for people living with HIV regarding attitudes, knowledge, and practice patterns toward fertility and conception in serodiscordant couples. Data were collected via a survey distributed in October 2013. Seventeen percent of respondents reported prescribing antiretroviral preexposure prophylaxis (PrEP) for a woman in a serodiscordant couple, and 38% percent of respondents reported having counseled serodiscordant couples on timed, unprotected intercourse without PrEP. Respondents who reported being “very” familiar with the data on HIV transmission in serodiscordant couples were more likely to report counseling their patients in timed, unprotected intercourse compared with those who reported less familiarity with the data (41% vs. 8%, p = 0.001). Although only 20% reported being “very” or “somewhat” familiar with the data on the safety of sperm washing with intrauterine insemination, those who did were more likely to have reported referring a patient for assisted reproductive technology (61% vs. 32%, p = 0.006). Effective patient counseling and referral for appropriate reproductive options were associated with knowledge of the literature pertaining to these options. This emphasizes the need for further provider education on reproductive options and appropriate counseling for serodiscordant couples.  相似文献   

19.
Understanding the sexual activities and partnerships of women living with human immunodeficiency virus (HIV) remains important to promote healthy sexuality and to reduce the transmission of HIV and other sexually transmitted infections. We described sexual behaviors of women living with HIV enrolled in an ongoing study in Ontario, Canada. Data were available from 582 women who self-completed a sexual behavior questionnaire between 2010 and 2012. Nearly half (46.1%) of women reported a sexual partner in the preceding three months; women less likely to be sexually active were older, Black/African, separated, divorced, widowed, single, and unemployed. Most sexually active women had one partner (76.4%), a regular partner (75.9%), male (96.2%) partner(s), and partners who were HIV-negative or unknown HIV status (75.2%). Women were more likely to use a condom with HIV-negative/status unknown partners (81.3%) than with HIV-positive partners (58.6%; p ?=?.008). Only 8.0% of sexually active women reported condomless sex with a discordant HIV-negative/status unknown partner when their viral load was detectable. Overall, most women living with HIV were sexually inactive or engaged in sexual activities that were low risk for HIV transmission.  相似文献   

20.
Pre-exposure prophylaxis (PrEP) has proven to be effective in reducing the risk of HIV transmission in uninfected individuals who engaged in sexual activity with HIV-infected partners. Serodiscordant couples are the key targets of PrEP implementation. The study aimed to compare awareness of and willingness to use PrEP and anticipated condom use among 112 HIV-serodiscordant couples: 32 heterosexuals couples, 70 men who have sex with men (MSM) couples, and 10 people who inject drugs (PWID) couples. A cross-sectional study was conducted in an AIDS designated hospital in Taiwan. The PrEP survey for discordant couples included questions on awareness of non-occupational post-exposure prophylaxis (nPEP) and PrEP, attitudes toward PrEP, anticipated condom use if using PrEP, and sexual behaviors. Overall, 46.2% were aware of PrEP, only 33% were willing to take PrEP, and 44.6% would continue condom use if they were taking PrEP. Among the three key populations, MSM couples had the highest awareness of and willingness to use PrEP. Awareness of and willingness to use PrEP did not differ by HIV status, with moderate agreement (Cohen’s Kappa coefficient: 0.56) between HIV-serodiscordant partners. Both HIV-serodiscordant partners’ willingness to use PrEP was significantly associated with being MSM (adjusted odds ratio (AOR), 4.28 [1.28–14.30], p?=?0.018), previous receipt of nPEP (AOR, 6.98 [1.23–39.65], p?=?0.028), anticipated condom use (AOR, 0.14 [0.05–0.41], p?p?=?0.05). Policy makers need to consider the differences among key populations to scale up PrEP implementation. More efforts should be focused on improving awareness of and willingness to use PrEP among heterosexual and PWID serodiscordant couples to scale up PrEP implementation in Taiwan.  相似文献   

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