HIV-related characteristics among female partners of injecting drug users in Kelantan,Malaysia: a descriptive study

Kelantan, a northeastern state in Peninsular Malaysia, is one of the states that has been acutely hit by injecting drug user (IDU)-driven HIV epidemic, in addition to having a high number of infected women in Malaysia. This cross-sectional study describes the socio-demographic characteristics, HIV risk factors, risk perception, and adoption of preventive behaviors among female partners of IDUs in Kelantan. Out of 101 women, the majority of them are from low socioeconomic background and have no other risk factors besides heterosexual HIV transmission from their male IDU partners. Although 45.5% have not been tested for HIV and more than half (53.5%) of them did not use condoms during sexual intercourse, only 44.6% of the women perceived themselves to be at risk of being infected with HIV. Most of the women (86.1%) were willing to undergo voluntary counseling and testing (VCT). Female partners of IDUs continue to be vulnerable to HIV due to having sexual contact with IDUs, and also due to their socioeconomic position in the community. To prevent HIV transmission among female partners of IDUs, consolidating HIV prevention efforts from multiple approaches is needed.     

If you don't ask moms about HIV, they won't be tested

The national efforts to reduce perinatal HIV transmission break down at the individual level when physicians fail to identify pregnant women who may be infected or are at high risk of being infected. The patients who are not identified are often white, middle-class women; the social stigma of the disease results in the failure of some doctors to discuss the possibility of HIV infection with these women. Marc Bulterys of the Centers for Disease Control and Prevention (CDC) believes HIV testing should be universal and treated the same way as syphilis testing in pregnant women. HIV experts suggest that doctors can help stop vertical transmission by identifying and counseling high-risk patients; providing state-of-the-art antiretroviral treatment to HIV-positive pregnant women; encouraging women in labor to be tested and treated for HIV; and counseling HIV-positive mothers not to breast-feed their babies.     

Correlates of antiretroviral adherence and viral load among transgender women living with HIV

Transgender women are 49 times more likely to become HIV infected than other groups, yet they are drastically underserved by current treatment efforts and report lower rates of treatment adherence then other groups. The objective of this study was to explore correlates of antiretroviral (ART) adherence and viral load among HIV-positive transgender women on ART utilizing a cross-sectional survey of a convenience sample of 59 transgender women. In multivariate models of ART adherence, correlates were age, stress appraisal of transphobic experiences, importance of gender affirmation, and adherence to hormone therapy. In multivariate models of self-reported viral load, correlates were stress appraisal of transphobic experiences and being in a relationship. This study provides preliminary evidence of transgender-relevant correlates of ART adherence and viral load.     

艾滋病治疗的研究进展

艾滋病抗病毒治疗(ART),现已取得很大成效。该病原为致死性疾病,现已成为一种可治可管理的传染病,全球艾滋病病毒感染者/艾滋病(HIV/AIDS)的病例虽仍多达3 800万,但有一半以上已经抗病毒治疗。除了药物治疗外,目前一些新技术新方法如基因组编辑等也已介入艾滋病的治疗,并且在人源化动物试验中业已取得很好的效果。不容置疑,艾滋病终究会被人类控制消除。但随着艾滋病抗病毒治疗的不断发展,最根本的问题也就是HIV潜伏库的问题日益突出,不论是分子治疗、组合治疗都存在这样的问题。因此,不断寻找新的潜伏病毒细胞的标记,缩小病毒潜伏库,是当前艾滋病治疗必须解决的课题。此外,尽管艾滋病的防治取得了很大成绩,但目前全球每天仍有近6 000例HIV/AIDS感染的病例发生。因此,安全有效疫苗的研发,不论在预防领域、还是在临床治疗方面,都有其积极的意义。     

HIV Voluntary Counseling and Testing Service Preferences in a Rural Malawi Population

Voluntary counseling and testing (VCT) services have become an integral component of HIV prevention efforts in sub-Saharan Africa. This study of a rural Malawi district population examined variation in past and desired use of VCT services among 868 women aged 15 to 34 and 648 men aged 20 to 44 aware of HIV/AIDS. Only 11% of men and 7% of women had been tested, but of those untested, 76% of men and 61% of women desired testing. Ninety percent of respondents willing to know their results preferred to hear them from a test site counselor and on the same day of the test. However, 27% of women wanting to be tested did not want to know their test results, a finding significantly associated with knowing someone affected by AIDS and perceiving oneself at HIV infection risk. Knowledge of the behaviors of HIV prevention, knowing someone with AIDS, knowing the locations of a test site, and perceived risk of HIV infection all had a consistently significant association with past and future VCT use for men and women.     

Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City

The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts.     

Pregnancy Decisions Among Women with HIV

Nearly 80% of women currently infected with HIV are of childbearing age. As women of childbearing age continue to be at risk of contracting HIV, there will be an increased need for choices about whether or not to have biological children. The purpose of this exploratory study was to investigate the influence of partners, physicians, and family members on pregnancy decisions, as well as the impact of HIV stigma on these decisions. Results indicated that most women chose not to become pregnant since learning their HIV diagnosis and the woman’s age at the time of diagnosis is significantly associated with this decision. Additional factors included fear of transmitting HIV to their child, personal health-related concerns, and desire to have children. Women with a procreative inclination were more likely to choose to become pregnant which outweighed social support and personal health concerns. Implications and suggestions for future research are noted.     

A gender-specific intervention for at-risk women in the USA

Women are the fastest growing group in the USA to become infected with HIV. Also, the mode of transmission is changing with heterosexual behaviour being the predominant source. As these changes occur, HIV infection becomes more common in women who have not typically been considered at high risk. This paper describes an intervention designed to decrease unsafe sexual encounters and to focus on a highly meaningful concern in the lives of these women: relationships with men. The sessions encouraged making decisions, choice, partner selection, sexual rights, refusal of any unwanted sex, female controlled methods and other elements of empowerment. An eight-session and a four-session curriculum were created to assess dose factors as well.     

Ethnicity,Sex Work,and Incident HIV/STI Among Transgender Women in New York City: A Three Year Prospective Study

In conjunction with a 3-year prospective study of 199 transgender women from the New York City Area, we attempted to better understand why non-Whites are much more likely than Whites to become HIV infected. We first assessed associations of ethnicity with sex work, sexual risk behavior for HIV, and biologically-determined HIV/STI, and then assessed the extent to which these ethnic differences are explained by socioeconomic factors, immigration status, and sexual orientation. Statistical techniques included generalized estimating equations and Cox proportional hazards. As expected, compared to Whites, Blacks and Hispanics were more involved in the sex trade, more likely to report unprotected receptive anal intercourse, and as a result, more likely to become HIV/STI infected. All of these associations were mediated by androphilia, and to a lesser extent androphilia/gynephilia. Sexual orientation is a significant but little recognized factors associated with new cases of HIV/STI among transgender women of color.     

HIV is spreading rapidly among U.S. youth

Cambodia's HIV infection rate is the highest in Asia. An estimated 20,000 people have died of AIDS in Cambodia and 180,000 people are infected with HIV. The epidemic has the potential to destabilize the entire region, which is already in turmoil. The country's commercial sex industry has worsened the epidemic, but other factors such as poverty and high migration patterns have also contributed to the outbreak. In Cambodia, HIV is transmitted mostly via heterosexual intercourse; few men will acknowledge sex with other men. Information on HIV transmission via IV drug use is almost nonexistent. Antiretroviral therapy for all HIV-infected residents is not affordable, and there are few resources to prevent perinatal transmission, even though 2.5 percent of pregnant Cambodian women are HIV-positive. The recent efforts by the Cambodian government to deal with the epidemic are not enough; the World Health Organization, UNICEF, and other international organizations are also working to control the problem.     

Family, cultural and gender role aspects in the context of HIV risk among African American women of unidentified HIV status: an exploratory qualitative study

This was an exploratory, qualitative study of contextual cultural and social realities of the sexual interactions of a representative sample of African American women of unidentified HIV status. The study expanded our understanding of family and gender role variables by exploring influences of family of origin and idealistic perceptions of roles on sexual relationships. Data was collected on 51 African American women who were recruited through probability sampling. Between 39% and 70% of study participants reported at least one of the following HIV risk factors: low condom use, substance use during sex, partner's incarceration and history of abuse. Nonetheless, all women in our study perceived their chances of HIV infection to be almost non-existent, despite a fairly good knowledge of HIV/AIDS modes of transmission including that anyone could become HIV infected, knowing somebody with HIV/AIDS and acknowledgment, among some, of their partner's infidelity and risk behaviors. Our analysis revealed that parental communications about sexuality in relationships focused largely on trust (being mistrustful of men) and women's control of their sexual impulses. Trust was also emphasized (desired) by women in the discussions of gender roles. Women reported a strong reliance on God and made frequent references to the role of the church in HIV prevention. Our findings offer suggestions for HIV prevention for the general population of African American women. HIV-prevention messages that consider their views of relationships, gender roles, sexual abuse history and the role of the church are suggested.     

Biologic approaches to the prevention of sexual transmission of human immunodeficiency virus

HIV prevention science has made progress, especially in Thailand and some sub-Saharan African countries. New cases of HIV in the United States, however, have not diminished and explosive epidemics in India and the People's Republic of China seem inevitable. Therefore, HIV prevention activities must move forward in parallel. Funding for biologic and behavioral research efforts must be balanced. Behavioral research must inform biologic strategies. In addition, HIV prevention efforts have been distorted by forces that require further consideration. First, the stigmatization associated with a diagnosis of HIV infection led to prevention efforts that virtually ignore the index case. Focusing entirely on the susceptible population puts intense and unrealistic pressure on behavior change and vaccine development. Although development of an HIV vaccine is desirable, there is no evidence that this goal can be achieved in the near future. Blind faith in vaccine technology detracts from pursuit of alternative aspects of prevention science. Vaccine development is but one of several key components to a broad-based prevention strategy. The history of control of infectious diseases has shown the need for targeting index cases. This certainly will prove important in HIV over the next few years. In developed countries, antiretroviral therapy for established HIV infection has become the standard of care. Increased knowledge of the biology of transmission of HIV suggests use of ART to prevent transmission. Such intervention must be accompanied by safer sex behavior in the index cases, and ultimately could lead to some form of monitoring and directly observed therapy. At this time, the latter approach seems unrealistic in developing countries, where the expense of drugs renders them unavailable. But there is every reason to believe that cheaper, more appropriate drugs will be developed before an effective vaccine. Furthermore, targeted use of ART might have disproportionate benefits in some countries. Women are the fastest growing HIV risk group. Several issues, both biologic and social, make this trend a concern. Increases in the number of HIV-infected women will lead to greater vertical transmission. Women possibly have different risk factors for acquisition and transmission than men. Information about the effects of vaginal ecology, specifically, the role of bacterial vaginosis, in the acquisition of HIV is essential because bacterial vaginosis can be reversed, at least transiently. To allow women to take an active role in HIV prevention methods, development of a topical microbicide is vital and may prove easier than a vaccine. Finally, HIV prevention efforts require knowledgeable, central leadership. All prevention efforts should be developed and implemented in parallel, to gain a synergistic result. Few vaccine experts are enthusiastic about microbicides, and HIV caregivers only rarely focus on the public health considerations of their patients. Stopping the spread of HIV requires a coordinated, concerted efforts using "all the tools in the toolbox."     

The influence of hiv coinfection on the natural history of hcv infection

In the United States, it is estimated that more than 4 million people are infected with the hepatitis C virus (HCV) and over 1.25 million are infected with HIV. With common routes of transmission, approximately 30% of HIV-infected individuals are coinfected with HCV. Deaths due to opportunistic infections from HIV declined with the advent of highly active antiretroviral therapy, whereas manifestations of end-stage liver disease have become more apparent with the increased longevity. Current efforts are directed toward understanding whether HIV/HCV coinfection affects the natural history of each virus. Early outcomes in treating coinfected patients for their HCV were below expectations, whereas recent treatment trials with highly selected patients and newer therapeutic agents have shown greater success. The aim of this paper is to review the epidemiology, natural history, and treatment outcomes, as well as unique challenges in the management of HIV/HCVcoinfected patients.     

Standing up for yourself, good communication will help you get your partner to use a condom

African-American females are ten times more likely to be infected with HIV than white females. Half of the HIV-positive African-American women became infected through drugs; more than one-third had sexual relations with someone who was infected. Women are urged to insist on the use of a condom each time they engage in sexual intercourse. Developing good communication skills and being assertive will help African-American women successfully negotiate safe sex. Six safer sex tips identified by researchers at the University of Alabama are understanding the difference between aggressive and assertive behavior, refraining from apologizing about being assertive, making eye contact with one's partner, and practicing skills through role play. Women can protect themselves from HIV by using a female condom, diaphragm, and/or spermicidal cream. However, the best strategy is the consistent use of a latex condom.     

Sex partner support,drug use and sex risk among HIV-negative non-injecting heroin users

HIV prevention efforts among drug users have incorporated social support to reinforce risk reduction. We examine the extent to which sex partner characteristics, including partner support, influence HIV sex risk practices among a little studied population of non-injecting heroin users, 257 of whom were recruited in New York City between 1996 and 2001. The sample was racially/ethnically diverse (26% African American, 43% Latino, 31% white or other ethnicity) and 65% male. Three-quarters reported having unprotected intercourse within 30 days; 27% had sex with partners at known risk of being HIV infected. There were no gender differences in terms of sex or drug use practices; however, gender differences in sex partner characteristics were apparent. Men were significantly less likely than women to have partners who used drugs (OR = 0.5, 95% CI = 0.3, 0.9), receive support from their partners (OR = 0.5, 95% CI = 0.3, 0.8), use heroin with their partners (OR = 0.5, 95% CI = 0.3, 0.8) and have partners at known risk of being HIV infected (OR = 0.4, 95% CI = 0.2, 0.7). For men, increased sex risk was independently associated with sex partner support, and for women, increased sex risk was independently associated with having used heroin with sex partners. Social support may have detrimental, as well as beneficial, consequences on HIV risk.     

Human immunodeficiency virus infection, AIDS, and smoking cessation: the time is now.

Treatments for persons who are infected with human immunodeficiency virus (HIV) or who have developed AIDS have advanced to the point where death is no longer the inevitable outcome of diagnosis. Combination antiretroviral therapy has made HIV infection less of a terminal condition and more of a medically manageable chronic disease. Thus, efforts to improve the health status and quality of life of HIV-infected persons have become one of the highest treatment priorities for the next decade. Cigarette smoking is highly prevalent among HIV-infected persons, and quitting smoking would greatly improve the health status of these individuals. However, to date, no studies have evaluated the efficacy of a smoking-cessation intervention specifically tailored to this population. This article reviews the evidence and rationale for advancing smoking-cessation treatments specifically tailored to the needs of HIV-infected persons and provides recommendations for future treatment studies.     

HIV testing and the role of individual- and structural-level barriers and facilitators

This study determined the overall prevalence of HIV testing within a community sample of heterosexual men and women at high risk for HIV infection, and analysed the gender-specific individual- and structural-level barriers and facilitators to testing. Data were collected through 1,643 personal interviews conducted in Philadelphia between 1999 and 2000. Overall, 79.4% of participants had ever taken an HIV test; women were significantly more likely to have tested than were men. Among the individual-level factors we examined, very few, including sexual and drug-using risk behaviours, were significantly associated with an increased likelihood of ever being tested for HIV. Structural-level factors were important correlates of HIV testing for both women and men. Results of this study indicate that there are gender-based similarities and differences in the correlates of testing, and that efforts to increase HIV testing must consider how structural factors, including access to health care, may deter or facilitate opportunities for HIV testing. In particular, efforts to improve the uptake of HIV testing by heterosexual men at high risk should focus on improving men's access to, and utilization of, routine health care.     

Implementing family‐focused HIV care and treatment: the first 2 years’ experience of the mother‐to‐child transmission ‐plus program in Abidjan,Côte d’Ivoire

Objectives To describe a family‐focused approach to HIV care and treatment and report on the first 2 years experience of implementing the mother‐to‐child transmission (MTCT)‐plus program in Abidjan, Côte d’Ivoire. Program The MTCT‐plus initiative aims to enrol HIV‐infected pregnant and postpartum women in comprehensive HIV care and treatment for themselves and their families. Main outcomes Between August 2003 and August 2005, 605 HIV‐infected pregnant or postpartum women and 582 HIV‐exposed infants enrolled. Of their 568 male partners reported alive, 52% were aware of their wife’s HIV status and 30% were tested for HIV; 53% of these tested partners were found to be HIV‐infected and 78% enrolled into the program. Overall only 10% of the women enrolled together with their infected partner. On the other hand, the program involved half of the seronegative men who came for voluntary counselling and testing (VCT) in the care of their families. Of 1624 children <15 years reported alive by their mothers (excluding the last newborn infants of the most recent pregnancy systematically screened for HIV), only 10.8% were brought in for HIV testing, of whom 12.3% were found to be HIV‐infected. Lessons learned and challenges The family‐focused model of HIV care pays attention to the needs of families and household members. The program was successful in enrolling HIV women, their partners and infants in continuous follow‐up. However engaging partners and family members of newly enrolled women into care involves numerous challenges such as disclosure of HIV status by women to their partners and family members. Further efforts are required to understand barriers for families accessing HIV services as strategies to improve partner involvement and provide access to care for other children in the households are needed in this West African urban setting.     

A review of the epidemiology, prevention and treatment of human immunodeficiency virus infection in Nigeria.

In order to amalgamate research findings on HIV/AIDS in Nigeria as well as the trend of the infection in a concise manner, we reviewed published articles on the HIV/AIDS situation in Nigeria. We categorized this review into several subheadings. The HIV prevalence rate has continued to rise steadily from less than 0.1% in 1987, to 5.8% in 2001, with a slight decrease in 2003 to 5.0%. Although the knowledge about HIV and its mode of transmission is widespread, it is however disheartening to note that this did not result into appreciable attitudinal change and behavior modification among Nigerians. Both HIV-1 and HIV-2 have been identified in Nigeria, with HIV-1 being the predominant type. Furthermore, several subtypes like subtypes A, B, C, G and J have been identified in Nigeria, with several recombinant forms like the CRF02_AG; the major ones being A, G and CRF02_AG. HIV-infected patients in Nigeria are also co-infected with other viral and bacterial infections, the commonly reported ones being co infections with hepatitis B and C. Although treatment of infected patients has increased recently, more effort is needed, especially in the area of patients monitoring, to maximize the benefits of ART in Nigeria. Finally, Nigeria has made appreciable efforts in vaccine development and candidate HIV DNA vaccines have been developed utilizing the sequences from predominant subtypes, and these candidates have been shown to be immunogenic in animal models. It is therefore clear that only the integration of prevention and antiretroviral research programmes into a coherent programme that is needed to address the public health needs that HIV/AIDS crisis represents for Nigeria.     

Sexual Attitudes,Beliefs, Practices,and HIV Risk During Pregnancy and Post-delivery: A Qualitative Study in Malawi,South Africa,Uganda, and Zimbabwe

AIDS and Behavior - Women who acquire HIV during the pregnancy and breastfeeding periods have a higher risk of transmitting the virus to their child than women who become infected with HIV before...