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Medication adherence is linked to health outcomes among adults with HIV infection. Transgender women living with HIV (TWLWH) in the US report suboptimal adherence to medications and are found to have difficulty integrating HIV medication into their daily routine, but few studies explore the factors associated with medication adherence among transgender women. Thus, the purpose of this paper is to examine demographic and clinical factors related to self-reported medication adherence among transgender women. This secondary analysis is based on data collected from the Symptom and Genetic Study that included a convenience sample of 22 self-identified transgender women, 201 non-transgender men, and 72 non-transgender women recruited in northern California. Self-reported medication adherence was assessed using the AIDS Clinical Trials Group Adherence Questionnaire. Gender differences in demographic and clinical variables were assessed, as were differences between transgender women reporting high and low adherence. Transgender women had lower adherence to medications compared to non-transgender males and non-transgender females (p = .028) and were less likely to achieve viral suppression (p = .039). Within the transgender group, Black/African-Americans reported better adherence than participants who were Whites/Caucasian or other races (p = .009). Adherence among transgender women was unrelated to medication count and estrogen therapy, but consistent with other reports on the HIV population as a whole; transgender women with high adherence were more likely to achieve viral suppression compared to the transgender women with low adherence. Despite the high incidence of HIV infection in the transgender population, few studies focus on TWLWH, either in regard to their adherence to antiretroviral therapies or to their healthcare in general. To address ongoing health disparities, more studies are needed focusing on the transgender population's continuum of care in HIV therapies. [ABSTRACT FROM PUBLISHER]

This paper reports on Kganya Motsha Adolescent Centre, an adolescent program specifically established to provide voluntary counseling and testing as well as management of HIV-positive young people in Soweto, South Africa. A retrospective cross-sectional analysis, using clinic records of young people accessing services from 2008 to 2012, was conducted. Of the 11,522 who tested, 7689 (67%) were females. The total number of HIV infections was 410, with an HIV prevalence of 3.6% (95% CI 3.2–3.9%). More females (332, 4% vs. 72, 2%;p< 0.0001) were HIV-infected than males. Of those testing HIV positive, 109 (26.5%) had a median CD4 cell count of 491 (IQR 345–686) cells/mm3. Only 12/410 individuals (2.9%) were eligible for antiretroviral treatment and 10 (2.4%) of those successfully received treatment. The program observed that young people testing HIV positive would not return for follow up blood specimens or confirmatory results. Future programs should consider innovative ways of retaining adolescents in care to reduce potential HIV transmissions that could lead to deteriorating health. [ABSTRACT FROM AUTHOR]

Optimal adherence to antiretroviral therapy (ART) is essential for reducing mortality and morbidity in persons living with HIV/AIDS (PLWHA), as well as for reducing the risk of further HIV transmission. While studies have identified psychosocial factors such as lack of social support and poor mental health status as important barriers to optimal ART adherence, few studies have explored the potential of a mediation effect of psychosocial factors on the relationship between social support and optimal ART adherence. This paper assessed whether mental health status mediated the relationship between social support and optimal ART adherence among a cross-sectional sample of 202 persons living with HIV who were recruited from HIV clinical care sites and community-based organizations in Los Angeles County (LAC). Participants completed a survey that included social support items from the Medical Outcome Study: Social Support Survey (MOS-SSS) Instrument, mental health measures from the Medical Outcomes Study Short Form (SF-12), and ART adherence based on self-report. Among those currently taking ART, 61.7% reported having optimal adherence. Social support was significantly associated with a high score on the mental health status scale (AOR =2.90; 95% CI=1.14–5.78) and optimal ART adherence (AOR=1.81; 95% CI=1.81; 95% CI=1.18–2.79). When mental health status was introduced into the model, the association between social support and optimal ART adherence was no longer significant. Our findings suggest the HIV interventions targeting social support to improve ART adherence will likely be most successful if the support bolsters the mental health of the participants. Clearly, better understanding the relationships among social support, mental health, and ART adherence will be critical for development and implementation of future ART adherence interventions. [ABSTRACT FROM AUTHOR]

Poor adherence to antiretroviral therapies (ARTs) in human immunodeficiency virus (HIV)-infected patients increases the risk of incomplete viral suppression, development of viral resistance, progression to acquired immune deficiency syndrome and death. This study assesses the impact of specific treatment-related adverse events (AEs) on adherence to ART in the adult HIV patient population. A systematic review of studies involving adult HIV-infected patients aged ≥ 16 years that reported an odds ratio (OR) for factors affecting adherence to ART was conducted through a search of the EMBASE® and Medline® databases. Database searches were complemented with a search of titles in the bibliographies of review papers. Studies conducted in populations limited to a particular demographic characteristic or behavioural risk were excluded. To qualify for inclusion into a meta-analysis, treatment-related AEs had to be defined similarly across studies. Also, multiple ORs from the same study were included where study sub-groups were distinct. Random effects models were used to pool ORs. In total, 19 studies and 18 ART-related AEs were included in meta-analyses. Adherence to ART was significantly lower in patients with non-specific AEs than in patients who did not experience AEs [OR = 0.623; 95% confidence interval (CI): 0.465–0.834]. Patients with specific AEs such as fatigue (OR = 0.631; 95% CI: 0.433–0.918), confusion (OR = 0.349; 95% CI: 0.184–0.661), taste disturbances (OR = 0.485; 95% CI: 0.303–0.775) and nausea (OR = 0.574; 95% CI: 0.427–0.772) were significantly less likely to adhere to ART compared to patients without these AEs. Knowledge of specific treatment-related AEs may allow for targeted management of these events and a careful consideration of well-tolerated treatment regimens to improve ART adherence and clinical outcomes. [ABSTRACT FROM PUBLISHER]

Using population-based and family structural data from a high HIV-prevalence district of Southern India, this paper considers four suggested social scenarios used to explain the positive correlation between HIV prevalence and previously married status among Indian women: (1) infection from and then bereavement of an infected husband; (2) abandonment after husbands learn of their wives' HIV status; (3) economic instability after becoming previously married, leading women to seek financial support through male partners; and (4) the social status of being previously married exposing women to sexual harassment and predation. By also considering seroprevalence of two other common sexually transmitted infections (STIs), herpes and syphilis, in a combined variable with HIV, we limit the likelihood of the first two scenarios accounting for the greater part of this correlation. Through a nuanced analysis of household residences patterns (family structure), standard of living, and education, we also limit the probability that scenario three explains a greater portion of the correlation. Scenario four emerges as the most likely explanation for this correlation, recognizing that other scenarios are also possible. Further, the interdisciplinary literature on the social position of previously married women in India strongly supports the suggestion that, as a population, previously married women are sexually vulnerable in India. Previously married status as an STI risk factor requires further biosocial research and warrants concentrated public health attention. [ABSTRACT FROM AUTHOR]

Informal caregivers, most often older people, provide valuable care and support for people ill due to AIDS, especially in poor-resource settings with inadequate health care systems and limited access to antiretroviral therapy. The negative health consequences associated with care-giving may vary depending on various factors that act to mediate the extent of the effects on the caregiver. This paper investigates the association between care-giving and poor health among older carers to people living with AIDS, and examines potential within-gender differences in reporting poor health. Data from 1429 men and women aged 50 years or older living in two slum areas of Nairobi are used to compare AIDS-caregivers with other caregivers and non-caregivers based on self-reported health using the World Health Organization disability assessment (WHODAS) score and the presence of a severe health problem. Women AIDS-caregivers reported higher disability scores for mobility and the lowest scores in self-care and life activities domains while men AIDS-caregivers reported higher scores in all domains (except interpersonal interaction) compared with other caregivers and non-caregivers. Multiple regression analysis is used to examine the association of providing care with health outcomes while controlling for other confounders. Consistently across all the health measures, no significant differences were observed between female AIDS-caregivers and female non-caregivers. Male AIDS-caregivers were however significantly more likely to report disability and having a severe health problem compared with male non-caregivers. This finding highlights a gendered variation in outcome and is possibly an indication of the differences in care-giving gender-role expectations and coping strategies. This study highlights the relatively neglected role of older men as caregivers and recommends comprehensive interventions to mitigate the impact of HIV and AIDS on caregivers that embrace men as well as women. [ABSTRACT FROM AUTHOR]

In Vietnam, ARV access has been scaled up since 2005 in high HIV prevalence areas in order to meet increasing demands for HIV treatment. This paper aims to estimate ARV unmet need and its associated socio-demographic characteristics among HIV-positive women in Haiphong, Vietnam. A cross-sectional study using structured questionnaires and CD4 cell count was conducted with 353 HIV-positive women recruited from groups of people living with HIV/AIDS (PLWHA), by snowball technique through member of PLWHA groups and the local AIDS management system (Provincial AIDS Center (PAC)). The percentage of HIV-positive women having an unmet ARV need was estimated to be 40%, particularly high among women who were not registered at PAC. Having an unmet ARV need was associated with not participating in PLWHA groups (OR 6.5; 2.4-17.2) and being younger than 30 years old (OR 2.9; 1.1-7.3). [ABSTRACT FROM AUTHOR]

The occurrence of high rates of alcohol consumption in a context of high HIV prevalence in South Africa poses a significant health challenge for this country. This paper aims to answer three questions that could further our knowledge regarding the links between alcohol use and HIV infection: (a) 'Are problem drinkers more likely to have multiple concurrent partners than those who are not?'; (b) 'Are condoms applied less effectively and less consistently by problem drinkers compared to those who are not?'; (c) 'Are the female sexual partners of problem drinkers different from those who are not?' Two cross-sectional HIV bio-behavioural surveillance surveys using Respondent-Driven Sampling were conducted in two peri-urban settings on the outskirts of Cape Town, South Africa. Eight hundred and forty-eight men aged 25-55 years who have multiple, concurrent female sexual partners were recruited. Problem drinkers had a score of ≥3 on the CAGE questionnaire. Questions enquired about partner numbers, condom use and partner traits. Multivariate logistic regression models were developed to determine significant associations between outcome variables and problem drinking. Fifty-eight percent of men were problem drinkers. Compared to non-problem drinkers, problem drinkers were significantly more likely to report having any symptom of a STI; not using condoms due to drinking; inconsistent condom use with all partner types; that their most recent once-off partner was unemployed; having met their most recent partner at an alcohol-serving venue; and having had a once-off sexual relationship. Alcohol may fuel once-off sexual encounters, often characterised by transactional sex and women's limited authority to negotiate sex and condom use; factors that can facilitate transmission of HIV. HIV prevention interventions specifically targeting drinkers, the contexts in which problem drinking occurs and multiple sexual partnering are urgently needed. [ABSTRACT FROM AUTHOR]