Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle,Washington

African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas’ impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas’ influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.

     

Maternal obesity and rate of cesarean delivery in Djibouti

Objective

To calculate the prevalence of maternal obesity and to determine the relation between obesity and cesarean delivery in an urban hospital in Djibouti.

Methods

In an observational cohort study, all women who had a live birth or stillbirth between October 2012 and November 2013 were considered for inclusion. Body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was calculated throughout pregnancy, and women with a BMI of at least 30.0 were deemed to be obese. Multivariate logistic regression analyses were used to evaluate the relation between cesarean and obesity.

Results

Overall, 100 (24.8%) of 404 women were obese before 14 weeks of pregnancy, as were 112 (25.2%) of 445 before 22 weeks, and 200 (43.2%) of 463 at delivery. Obesity before 22 weeks was associated with a 127% excess risk of cesarean delivery (adjusted odds ratio 2.27; 95% CI 1.07–4.82; P = 0.032). Similar trends were found when the analyses were limited to the subgroup of women without a previous cesarean delivery or primiparae.

Conclusion

Prevalence of maternal obesity is high in Djibouti City and is related to an excess risk of cesarean delivery, even after controlling for a range of medical and socioeconomic variables.     

Knowledge and acceptability of HAART among TB patients in Durban, South Africa

From October 2002 to February 2003, we conducted semi-structured interviews on knowledge of HIV, antiretroviral treatment, and willingness to participate in voluntary counselling and testing and HAART with 54 consenting patients attending a tuberculosis (TB) clinic in Durban, South Africa. 74% of patients interviewed reported not knowing anything about antiretroviral treatment (HAART). Knowledge of antiretroviral drugs (ARVs) was restricted to use in preventing mother to child HIV transmission (MTCT). 57.4% of the patients reported having an HIV test in the past, but less than 10% were aware of their current HIV status. Patients who did not know their current HIV status expressed fear and hesitation about testing HIV positive. However, 91% of the patients expressed willingness to participate in HIV treatment given the opportunity. The findings from this study indicate that knowledge of HIV treatment is limited. As access to HAART is expanded, information about HIV treatment options will need to be disseminated. TB centres may present unique opportunities for disseminating HIV prevention, care, and treatment options.     

Opposite clear corneal incisions on the steep meridian in phacoemulsification: early effects on the cornea

PURPOSE: To evaluate the effect of on-axis opposite clear corneal incisions (OCCIs) in phacoemulsification on reducing preoperative corneal astigmatism and to predict the astigmatic outcome of the incisions. SETTING: Royal Eye Infirmary, Dorset County Hospital, and Winterbourne Hospital, Dorchester, Dorset, and the Department of Ophthalmology, East Somerset Hospital, Yeovil, Somerset, United Kingdom. METHODS: This prospective study included all patients (n = 103) who had on-axis OCCIs as a part of routine phacoemulsification with foldable intraocular lens (IOL) implantation performed by 1 surgeon during 2000. Keratometry was done 6 to 8 weeks postoperatively. The differences in the preoperative and postoperative corneal astigmatism and corneal spherical equivalent (SE) were recorded. Surgically induced astigmatism (SIA) was calculated using vector analysis. RESULTS: The mean reduction in corneal astigmatism was 0.50 diopter (D) (P<.001). The mean SIA was 1.57 D (95% confidence interval [CI], 1.42 to 1.71). There was a weak association between the SIA and the patient's age and axis of preoperative astigmatism. The mean change in SE was +0.02 D (95% CI, -0.08 to +0.12). CONCLUSIONS: Results indicate that on-axis OCCIs are a reliable and practical way of reducing preexisting corneal astigmatism. The change in SE was negligible and thus can be ignored during biometry.     

Estimating the impact of establishing family housing on the annual risk of HIV infection in South African mining communities

OBJECTIVE: The objective of this study was to determine the HIV-related epidemiologic impact of establishing family-style housing in mining communities in South Africa. METHODS: Modeling sex acts as independent Bernoulli trials, the estimated impact of converting to family housing arrangements on the annual risk of HIV infection is calculated and the differential effects on migrants and their partners is explored. RESULTS: Family housing could reduce HIV transmission among migrants and their partners in South Africa. Given baseline estimates, the predicted net reduction in the annual risk of HIV infection with family housing is 0.0254 and 0.0305 for short- and long-stay couples respectively. A reduction in the annual risk of HIV infection under family housing depends on the proportion of HIV negative concordance among couples. HIV-negative concordance among couples above 22% provides reductions in the annual risk of HIV infection under family housing. CONCLUSIONS: The results indicate that family housing could decrease HIV transmission among HIV-negative concordant couples, indicating that this policy alternative should be examined closely to assess its viability and use as a prevention method.     

Infectious endophthalmitis: clinical features, management and visual outcomes

Aim: To identify the clinical features and outcomes of infectious endophthalmitis in New Zealand. Methods: A retrospective review was performed on all patients presenting at Auckland Public Hospital with presumed infectious endophthalmitis between 1996 and 2004. Results: One hundred and six patients were diagnosed with infectious endophthalmitis over the 9‐year study period. More than half the infections occurred in the perioperative setting (58.5%), with the next most common group being patients with a history of ocular trauma (18.9%). Endogenous endophthalmitis accounted for 16.0% of the cases while a small percentage arose from other causes. The mean interval between the onset of symptoms and presentation was 4.2 ± 7.9 days. There was no significant difference in outcomes between clinical settings (P = 0.616) or between gram‐positive, gram‐negative and fungal infections (P = 0.090). Evisceration/enucleation was more likely in Pacific peoples and those with poor presenting visual acuity. Conclusions: The most common clinical scenario for patients presenting with presumed infectious endophthalmitis in this series was in the perioperative setting. We did not find that the prognosis was influenced by the microbiological isolate or clinical setting. However, those patients presenting with poor acuities typically had the worst outcomes. Pacific ethnicity was also associated with increased rate of complications.     

Microstructural Deformations Within the Depth of the Lamina Cribrosa in Response to Acute In Vivo Intraocular Pressure Modulation

PurposeThe lamina cribrosa (LC) is a leading target for initial glaucomatous damage. We investigated the in vivo microstructural deformation within the LC volume in response to acute IOP modulation while maintaining fixed intracranial pressure (ICP).MethodsIn vivo optic nerve head (ONH) spectral-domain optical coherence tomography (OCT) scans (Leica, Chicago, IL, USA) were obtained from eight eyes of healthy adult rhesus macaques (7 animals; ages = 7.9–14.4 years) in different IOP settings and fixed ICP (8–12 mm Hg). IOP and ICP were controlled by cannulation of the anterior chamber and the lateral ventricle of the brain, respectively, connected to a gravity-controlled reservoir. ONH images were acquired at baseline IOP, 30 mm Hg (H1-IOP), and 40 to 50 mm Hg (H2-IOP). Scans were registered in 3D, and LC microstructure measurements were obtained from shared regions and depths.ResultsOnly half of the eyes exhibited LC beam-to-pore ratio (BPR) and microstructure deformations. The maximal BPR change location within the LC volume varied between eyes. BPR deformer eyes had a significantly higher baseline connective tissue volume fraction (CTVF) and lower pore aspect ratio (P = 0.03 and P = 0.04, respectively) compared to BPR non-deformer. In all eyes, the magnitude of BPR changes in the anterior surface was significantly different (either larger or smaller) from the maximal change within the LC (H1-IOP: P = 0.02 and H2-IOP: P = 0.004).ConclusionsThe LC deforms unevenly throughout its depth in response to IOP modulation at fixed ICP. Therefore, analysis of merely the anterior LC surface microstructure will not fully capture the microstructure deformations within the LC. BPR deformer eyes have higher CTVF than BPR non-deformer eyes.     

Risky Sexual Practice among Street Dwelling People in Southern Ethiopia: A mixed-Method Study

BackgroundThe number of street dwellers in major cities in Ethiopia is rapidly increasing. However, their sexual health needs are not that much studied. Hence, this study assessed risky sexual practice and associated factors among street dwelling people in southern Ethiopia.MethodsA cross-sectional study employing a mixed method was conducted. For the quantitative part, a snowball sampling technique was made to conduct face-to-face interviews among 842 respondents. In-depth interviews among street dwellers and key informant interviews among stakeholders were conducted to collect qualitative data.A pre-tested and structured interviewer-administered questionnaire was used to collect data. The collected data were entered using Epidata and exported to SPSS for analysis, and qualitative data analyzed by thematic analysis approach.ResultsAbout one third, 266(31.6%), of the participants had risky sexual practices within the last year of the study period. Sexual violence such as gang rape and same-sex practice were reported qualitatively. Male respondents (AOR: 3.24, 95%CI: 2.09–5.02) had a more likelihood of risky sexual practice than females. Living in Dilla (AOR: 9.62, 95%CI: 4.49–20.58) and Wolaita Soddo towns (AOR: 14.35, 95%CI: 6.29–32.69) had also a more likelihood of risky sexual practice than living in Hawassa. Moreover, the daily average income of 21–50 Birr (AOR: 0.52, 95%CI: 0.29–0.92) had a less likelihood of risky sexual practice compared to those with a daily average income of 5–20 Birr.ConclusionRisky sexual practice among street dwelling people is found high. The Federal Ministry of Health and other stakeholders should work to cut risky sexual practices among street dwelling people.