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HIV disproportionately affects women in developing countries, especially in Southern Africa. Women thus stand to benefit most from a successful HIV vaccine and must participate in trials to test appropriate, gender-specific products. Several HIV vaccine efforts are currently underway in Africa. Participation in HIV vaccine trials requires that participants not only understand the complex nature of trial procedures, but that they also have autonomous decisional capacity to enroll. Given that the risk factors inherent in women's greater vulnerability constitute an intricate mix of biological. economic and social variables, will women's very vulnerability to HIV he an obstacle to ethical participation in vaccine development? This paper addresses some of the challenges underlying the successful recruitment of women into vaccine research and makes research and policy recommendations for the ethical inclusion of women in HIV vaccine trials in Africa. [ABSTRACT FROM AUTHOR]

Simple robust approaches are needed to monitor the prevalence and incidence of HIV in Africa. The aim of this study was to evaluate the use of dried blood spot (DBS) as an alternative to serum or plasma for sentinel surveillance. Paired DBS and blood samples were obtained from 200 patients attending a genito-urinary medicine clinic in West Africa. The gold standard of diagnosis was based on the combination of 3 enzyme-linked immunosorbent assays (ELISA) using serum. The presence of HIV antibodies in eluates of dried blood spots was detected by ELISA, Gelatin Particle Assay (GPA) and Pepti-Lav 1-2 in 5 different testing strategies. All 200 eluates were tested individually, and in addition pools of 5 eluates each were tested. The sensitivity of the testing strategies ranged from 95.0% (83.1 – 99.4%) to 100% and the specificity from 97.5% (93.7 – 99.3%) to 100%. Testing in pools of 5 did not affect sensitivity. Dried blood spots were easy to work with. Test kit and laboratory consumable costs varied between £492 and £1037 (unpooled strategies) and £163 and £421 (pooled). The monospecific ELISAs used in this study are no longer in production; currently available differentiating assays need to be tested. DBS are recommended for sentinel surveillance in Africa. [ABSTRACT FROM AUTHOR]

Presents a commentary on the studies which examined cases of psychoanalytic psychotherapy with people with HIV and AIDS by Ubaldo Leli and Robert Weinstein. Literature which confronted questions of working with people living with HIV/AIDS; Influence of the analyst's theoretical point of view on how matters concerning HIV/AIDS are handled.

In this paper, a compartmental model on the co-infection of pneumonia and HIV/AIDS with optimal control strategies was formulated using the system of ordinary differential equations. Using qualitative methods, we have analysed the mono-infection and HIV/AIDS and pneumonia co-infection models. We have computed effective reproduction numbers by applying the next-generation matrix method, applying Castillo Chavez criteria the models disease-free equilibrium points global stabilities were shown, while we have used the Centre manifold criteria to determine that the pneumonia infection and pneumonia and HIV/AIDS co-infection exhibit the phenomenon of backward bifurcation whenever the corresponding effective reproduction number is less than unity. We carried out the numerical simulations to investigate the behaviour of the co-infection model solutions. Furthermore,wehave investigated various optimal control strategies to predict the best control strategy to minimize and possibly to eradicate the HIV/AIDS and pneumonia co-infection from the community. [ABSTRACT FROM AUTHOR]

The success of a study hinges on its recruitment procedures, however there is a paucity of papers focused on innovative recruitment strategies, especially as it relates to the recruitment and retention of marginalized populations. This paper aims to outline how consent-to-contact databases can be used as an effective tool for recruitment. First, we begin by describing the consent-to-contact databases we used. Then, we offer insight into how a consent-to-contact database was utilized to recruit Latino older adults with HIV participants for an interdisciplinary behavioral and physical health promotion intervention. We outline barriers and challenges to recruitment and research participation with a specific emphasis on the unique hurdles associated with recruiting and retaining racial/ethnic minority older adults with HIV in behavioral health studies. Finally, we provide final recommendations for future researchers interested in how to best employ this type of recruitment tool in their own research. [ABSTRACT FROM AUTHOR]

This paper analyzes the implications of illness and queerness for the identity Gil de Biedma constructs through his personal diary of 1985. This is a unique case of a Spanish author providing a complex picture of the effect of HIV/AIDS on his own life and work. In addition, the author's diaries are a rare example of Spanish autobiographical writing on illness. Gil de Biedma kept several diaries throughout his life. The last diary, titled "Diario de 1985", is an account of his stay at a French hospital while undergoing treatment for Kaposi's sarcoma. This short diary offers crude yet insightful material on human illness, suffering and the stigma of HIV/AIDS in Spain during the 1980s. By close reading a selection of fragments of the author's diary, utilizing an approach that combines psychoanalysis and social history, this paper exposes the connections between illness, sexuality and identity in Gil de Biedma's autobiographical writing. This paper claims that Gil de Biedma (un)consciously represses naming the illness in his diaries while being very descriptive about the physical symptoms of AIDS and its treatment. This evidences the brutal social and familial pressure to conform to a certain identity, ultimately giving way to a very particular symbiosis between the author's literary persona and his bourgeois self. [ABSTRACT FROM AUTHOR]

Exposure to a multitude of risks, including food insecurity, poverty, and – perhaps most prominently – HIV can be damaging for early childhood survival, healthy growth and development. Yet, guidance regarding the implementation factors that contribute to early child development-focussed programme success is lacking in low- and middle-income countries broadly, and sub-Saharan Africa in particular. Having access to guidelines for practice and implementation could assist in improving the implementation of programmes to improve early childhood development. We conducted a narrative review of the literature with the goal of identifying how implementation features of these early interventions may influence the effectiveness of such work in the complex contexts which characterise this region. Our final review included 197 for final analysis. There were two primary cross-cutting findings. Firstly, the benefit for parents was less clear than they were for children, and secondly, while the benefits for children were clear, those most at risk benefited the most. Home visiting was found to be the predominant service delivery platform, and positive outcomes for children were reported when home visiting programmes were implemented by trained non-professionals, whereas positive parent outcomes were reported more frequently when delivered by professionals. In early childhood care and education programmes, positive outcomes for children and parents were reported when they were implemented by both trained non-professionals and professionals. Trained non-professionals facilitating parent groups produced similar benefits to groups run by professionals. Take-home lessons for successful programmes were that high levels of attendance, regular sessions of at least an hour duration, with the programme continuing for more than 6 months and closer to a year are key for effectiveness. [ABSTRACT FROM AUTHOR]

This article considers the Bayes analysis of generalized gamma accelerated failure time model and its two components Weibull and gamma when the given observations are left truncated and right censored. In order to perform the analysis, the paper proposes the use of an improved version of the Metropolis-Hastings algorithm, namely, the Metropolis-adjusted Langevin algorithm. Besides, the paper also checks the model compatibility and compares the considered models with its components using the Bayes factor computed on the basis of a recent methodology. A numerical illustration is provided based on a simulated as well as a real dataset. The real dataset consists of individuals infected with human immunodeficiency virus who are at the risk of acquired immunodeficiency syndrome and subsequent deaths. The numerical illustration is further extended to check the effect of different therapies including the highly active antiretroviral therapy on the lifetime of individuals. [ABSTRACT FROM AUTHOR]

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Occupational groups at high-risk of HIV in sub-Saharan Africa (SSA) may be at increased risk of substance use because of occupation-related factors. We synthesised qualitative data on determinants and context of alcohol misuse and illicit drug use in these groups. We systematically searched five databases for qualitative studies reporting on alcohol misuse or illicit drug use in fisherfolk, uniformed personnel, miners, truckers, motorcycle taxi riders, and sex workers in SSA. Qualitative data and interpretations were extracted and synthesised using a systematic iterative process to capture themes and overarching concepts. We searched for papers published prior to January 2018. We identified 5692 papers, and included 21 papers in our review, published from 1993 to 2017. Most studies were conducted among fisherfolk (n = 4) or sex workers (n = 12). Ten papers reported on alcohol use alone, three on illicit drug use alone and eight on both. Substance use was commonly examined in the context of work and risky behaviour, key drivers identified included transactional sex, availability of disposable income, poverty, gender inequalities and work/living environments. Substance use was linked to risky behaviour and reduced perceived susceptibility to HIV. Our review underscores the importance of multilevel, integrated HIV prevention and harm reduction interventions in these settings. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa over 52 million children are living with the death of one or both parents. Drivers of this parental mortality include afflictions at levels endemic to the region, including: HIV; malaria and other parasites; lower respiratory infections; diarrhoeal illnesses; and road accidents, among others. This paper examines the impact of orphanhood on learning outcomes among girls and boys in sub-Saharan Africa, conditional on school enrolment. By analysing test scores for approximately 60,000 pupils in 12 countries, we estimate the effect on student test scores by comparing paternal, maternal, and double orphans to non-orphans in the sample, specifically for the subjects of reading, mathematics, and HIV-AIDS knowledge. No previous study has analysed how orphanhood might influence learning by using student test score data, making this paper's approach unique in the literature. This study employs two estimation techniques: Coarsened exact matching calculates the sample average treatment effect on the treated, while matching on students' family structure, household wealth, school resources, and geographic location; and double lasso (DL) regression applies applying machine-learning for variable selection with high-dimensional controls for regional and school identifiers, school location, and student age. Our results show both CEM and DL consistently report a significant negative impact of orphanhood on test scores among specific countries, especially those which faltered in addressing the HIV-AIDS crisis. [ABSTRACT FROM AUTHOR]

This paper draws on an autoethnographic 'digital diary' which the author began after testing positive for HIV in July 2016, until May 2021, to critically assess (mis)representations of both the AIDS and COVID-19 pandemics in the media. Drawing on insights from art, literature, queer theory and social anthropology, the paper focuses on dominant moral and political discourses to show how narratives of blame, shame and guilt about viral transmission contribute to the stigmatisation of 'at risk' groups. Concepts of biopower and normative judgement are used to reflect on discourses which construct those who 'test positive' for HIV or SARS-CoV-2 as 'reckless', 'risky' or 'irresponsible' subjects. The paper also analyses notes on recent media appearances made by the author to discuss their participation in the PARTNER study, which showed that HIV antiretroviral therapy eliminates the possibility of HIV transmission, including reports in The Guardian, on BBC News, on Sky News, on Channel 5 News, and in the Metro. As the former had reported that the 'Covid-19 crisis raises hopes of end to UK transmission of HIV', portrayals of the two pandemics are compared to explore tensions between public health and individual responsibility as normative priorities. [ABSTRACT FROM AUTHOR]

AbstractThis paper examines the influence of the COVID-19 pandemic on memories and metaphors associated with the earlier AIDS epidemic. It argues that while previous research has focused on how HIV informs COVID-19, the reverse relationship has received insufficient attention. The authors propose a more comprehensive understanding of the issues, using insights from the sociology of memory. Experiences during COVID-19 not only reshape perceptions of HIV in the present but also transform how we remember the AIDS crisis of the past. We discuss the impact of these pandemics particularly for gay and bisexual men and their connected communities. Doing so underscores the co-construction of collective memories in the present, suggesting that COVID-19 has not only redefined our experience of HIV, but it has also reframed our understanding of the earlier AIDS crisis. We conclude by highlighting the potential for these transformations to be leveraged for empowerment, political action and change. Revisiting and reframing our memories of AIDS in the light of COVID-19 can open up new avenues for optimism and positive engagement. [ABSTRACT FROM AUTHOR]

Robust advancements in clinical treatment of people living with HIV (PLHIV) have resulted in the current “treatment as prevention” strategy: the inability to transmit the virus when it is undetectable. Nevertheless, disclosure within marital relationships remains important to adhere optimally to treatment and further limit transmission in the era of treat-all. Disclosure, however, can have serious social repercussions, particularly for women. This paper examines gendered disclosure decisions and their social consequences in marital relationships in Tanzania. Drawing from a 9-month ethnographic study in Shinyanga Region, we explore how Sukuma societal values shape disclosure decisions. In-depth interviews with 103 PLHIV and 19 FGDs inform our analysis. We found that societal values regarding gender and marriage significantly influence disclosure decisions in marital relationships. The HIV treat-all approach, with its focus on early treatment initiation preserved health and inability to transmit allowed men and women to carefully weigh the costs and benefits of disclosure to their marital aspirations. The benefits of antiretroviral treatment for social relations are often overlooked in medical interventions. We conclude that to reduce difficult disclosure decisions for PLHIV, emphasising community awareness of HIV treatment as prevention to mitigate the negative impacts of disclosure is needed. [ABSTRACT FROM AUTHOR]

AbstractThis paper is one of the few to examine how people who have lived through both COVID-19 and AIDS understand these pandemics in relation to each other. Data were collected in Uganda, and we found that the AIDS epidemic proved to be a key reference point for people in explaining why COVID-19 was perceived as so worrisome. In addition, AIDS-related stigma was a problematically common frame when discussing responsibility for HIV versus SARS-CoV-2 infection, and there was evidence of some forgetfulness regarding the toll AIDS had taken on the country. More positively, the legacy of AIDS made many people more attentive to social inequalities tied to health risks, and this at times prompted a more nuanced understanding of the socially varied effects of COVID-19. Overall, we argue that how individuals respond to a novel epidemic is shaped not only by their understandings of current threats but also by enduring perceptions of epidemics and pandemics that may have preceded it. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse (CSA) has been linked to substance use and substance use disorders in adulthood. However, there have been limited studies examining the relationship between CSA and opioid use among older adults living with HIV (OALH). Therefore, the aim of this study was to determine the association between CSA and opioid use among OALH (n = 91). Data were obtained from an HIV clinic population in South Carolina using paper-and-pen, and online questionnaires. CSA was operationalized using six questions from the Early Trauma Inventory-Self Report Form (Yes vs. No). Opioid use was self-report of the use of opioids including: heroin, fentanyl, Oxycontin, Vicodin, codeine, morphine (used vs. never used). Nested crude and multivariable logistic regression models adjusting for sociodemographic confounders were used to determine the association between CSA and opioid use. After adjusting for race, gender, age, and education, OALH who were CSA survivors were 21 times more likely to currently use opioids compared to OALH who were not exposed to CSA (adjusted OR: 21.1; 95% CI: 1.78–250.0). The association seen between CSA history and opioid use may be due to unresolved trauma among OALH. Trauma-informed interventions addressing CSA may help to reduce opioid use among OALH. [ABSTRACT FROM AUTHOR]

How should creative writers, including HIV-negative writers, think through HIV as a livable illness? What is the potential for writing gay fiction in an era of 'post-crisis'? This creative writing research draws links between literary modernism's roots in crisis and the roots of contemporary gay realist fiction in the AIDS crisis. It suggests these origins place similar demands on writers to re-conceive elements of fiction. This paper, primarily, outlines challenges of representing HIV in contemporary fiction, and then suggests that contemporary HIV's history of crisis provides ways to address these challenges, that the challenges may be productive. Because HIV in contemporary life is doubly invisible – viral loads may be undetectable, and the ongoing crisis can be understood as marginal or tactically historicised – aspects of creative writing after antiretrovirals exist in conversation with uncertainty, including elements that are otherwise put to representative use. By looking at some examples of post-crisis writing in contemporary gay realist fiction, the paper establishes the potential for HIV-positive representations to shift fiction-writing practice, bringing aspects of the novel such as time, metaphor and textual representation towards an aesthetics of post-crisis. [ABSTRACT FROM AUTHOR]

Background: The war in Ukraine has posed significant challenges to the healthcare system. This paper draws upon expert consultations, held between December 2022 and February 2023, focused on HIV/AIDS, addiction, and mental health service delivery during the first year of this war, and following the Global Mental Health Humanitarian Coalition panel discussion in May 2022. Objectives: This commentary presents the experiences of frontline healthcare workers in Ukraine, challenges, and local adaptations to meet the increased mental health needs of healthcare providers. We aimed to document the adaptations made in the addiction healthcare system and to acknowledge the changes in vulnerabilities and lessons learned. Results: Burnout among healthcare providers delivering addiction, HIV/AIDS and mental health services became more visible after the second half of 2022. Challenges included increased workload, contextual threats, lack of job relocation strategies, and money-follow-the-patient policies. Recommendations: The lessons from the first year of war in Ukraine hold significant generalizability to other contexts. These include enabling bottom-up approaches to tailoring services and allowing healthcare providers to respond to the dynamics of war in an effective and active manner. Other recommendations include departmental-specific resources and strategies, particularly as vulnerable groups and challenges are unstable in humanitarian contexts. Conclusions: Globally and in Ukraine, healthcare workers need more than applause. Along with monetary incentives, other strategies to prevent burnout, ensure sustainable capacity building, job relocation opportunities, and bespoke adaptations are imperative to protect healthcare providers' wellbeing and overall public health. [ABSTRACT FROM AUTHOR]

In Australia, the response to HIV, hepatitis C and hepatitis B has largely been through the constructed category of 'blood borne viruses' which treats these viruses as an interconnected set of conditions with respect to their mode of transmission. In this paper, we explore how people understand their viral infection, and compare the logics underpinning these different understandings. In-depth interviews were conducted with 61 participants who were either living with a blood borne virus or were the family members of people living with them. Our analysis reveals that the viral infection was often described as 'just a condition that needs to be managed', albeit in potentially exhausting ways. This understanding hinged upon a biomedical logic in which viral invasion was seen as causing illness and in turn necessitating biomedical intervention. In contrast, some participants with hepatitis B presented their infection as a condition unintelligible through Western biomedical logics, defined instead by symptomology – in terms of 'liver disease', and/or 'liver inflammation'. This focus on symptomology calls into question the soundness of prevention and management responses to hepatitis B based in biomedical logics and reveals the extent to which living with a virus involves multiple, sometimes incompatible, cultural logics. The different logics underpinning HIV, hepatitis C and hepatitis B reveal shortcomings of framing these viruses together as a coherent single construct. [ABSTRACT FROM AUTHOR]

This paper addresses the role emotions play in the social assemblage of medicines and technical processes in the response to the HIV called pre-exposure prophylaxis (PrEP) for HIV. We describe a series of stages and processes in the social construction of PrEP in Brazil from the run-up to the launch of the initiative by the Ministry of Health to the subsequent implementation of the strategy by public health services. To understand the meanings and symbolism assigned to this biomedical technology, we examined the hopes underpinning scientific, government and non-governmental narratives, clinical processes and health policy. The social trajectory of PrEP was influenced not only by these hopes but also by fears and concerns about the impact of this approach to HIV prevention on lifestyles and modes of sexual governance. The evidence used in this study comes from interviews with health professionals and AIDS activists, anthropological fieldwork, scientific articles and documentary analysis. Our findings provide important insights into how emotions have shaped the meanings assigned to PrEP and shed light on the complex game of negotiation involved in defining responses to the HIV epidemic. [ABSTRACT FROM AUTHOR]

The trajectory of effective biomedical management means HIV is now considered a manageable chronic, not terminal, illness. However, despite the biomedical advances, many people living with HIV (PLHIV) continue to experience psychosocial challenges which are associated with poorer quality of life (QoL). This review explores the literature concerning psychosocial factors contributing to poorer QoL among PLHIV. The findings suggest that stigma/discrimination, social disconnectedness, and mental health difficulties remain prevalent psychosocial issues for this population, and typically occur comorbidly. Psychosocial comorbidities have compounding deleterious effects on QoL and can impede the individual's capacity to engage in medical care, creating major barriers to sustained biomedical management. Consequently, HIV management has evolved towards a multidisciplinary model of long-term condition management, whereby psychosocial services play an integral role. This narrative review outlines the important role of mental health practitioners (and other psychosocial services) in HIV management, providing a point of intervention for clinical services. What is already known about this topic: Successful biomedical management of HIV has allowed PLHIV to live longer. However, the literature suggests several significant psychosocial issues remain. HIV is associated with a range of unique psychosocial factors that are related to a diminished QoL in this population. These include the deleterious effects of stigma/discrimination, social disconnectedness, and mental health issues on QoL among PLHIV. What this paper adds: This narrative review highlights the impact of multiple psychosocial comorbidities on QoL amongst PLHIV. The review highlights the important role of mental health practitioners (and other psychosocial services) in HIV management. The paper provides points of intervention for clinical services to improve QoL among PLHIV. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral adherence is vital to the successful long-term rollout of the antiretroviral therapy program in South Africa. At present, there are no studies that look at the effects of disability on antiretroviral adherence. Methods: Drawing on the baseline data from an existing cohort of 1042 people on antiretrovirals in a public healthcare setting in KwaZulu-Natal, the paper investigated a variety of existing covariates relating to antiretroviral adherence, together with functional limitations, depressive symptoms, and health symptoms. Disability was defined according to the International Classification of Functioning, Disability, and Health framework and measured using the World Health Organization Disability Assessment Schedule. Results: In a proportional odds logistic regression functional limitations, depressive symptoms, health symptoms and gender emerged as significant associated with decreased adherence to antiretrovirals (Odds ratio [95% confidence interval]: 1.86 [1.31, 2.66], 1.61 [1.02, 2.55], 2.33 [1.47, 3.69], and 1.65 [1.16, 2.35], respectively). This was found for both severe and milder forms of functional limitations/disability. Conclusion: The paper highlights the need to better understand the role of these limitations in achieving adequate adherence to antiretrovirals and viral suppression. It also calls for investigations into integrated mitigating services such as integrating rehabilitation into routine human immunodeficiency virus care. This study provides a starting point to understand the association between functional limitations and challenges in maintaining adherence to antiretroviral therapy. Addressing functional limitations is currently a neglected factor in efforts targeting HIV-treatment adherence and retention. Rehabilitation is a key intervention that could address this gap. Even mild forms of disability can have profound effects on adherence to antiretroviral therapy, which highlights the need for better screening, early identification, and referrals to rehabilitative support and treatment [ABSTRACT FROM AUTHOR]

Medication is closely involved in the subjective experience of chronic diseases, but also in the chronification process of illnesses which is described in this paper in the specific case of HIV. The development of antiretroviral drugs (ARVs) and the progressive recognition of their potential dual use as treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) reshape the experience of HIV and its transmission. Acknowledging the importance of a socioanthropological approach to drugs, this paper highlights how therapeutic strategies of treatment and prevention currently shape the process of HIV chronification and its experience for people concerned with ARVs in Switzerland, whether they are seropositive patients on lifelong treatment or seronegative people affected by the preventive properties of drugs. [ABSTRACT FROM AUTHOR]

With the growing number of older people living with HIV, "What is the most effective geriatric care and the research trend of existing literature?" is a compelling question after 30 years since the first paper related to aging and HIV/AIDS published. Our study aims to apply quantitative and qualitative analysis to explore the knowledge gaps and describes the research interest of gerontology research in the field of HIV. A bibliometric analysis was conducted based on the databased of the Web of Science from 1991 to 2019. The major domains of research areas were visualized by using VOSviewer software. Latent Dirichlet Allocation (LDA) was applied to classify the dataset into topics. There was a rising number of publications about this topic over time. Our findings indicated that antiretroviral treatment and evaluating quality of life and harm reduction were the major domains regarding care for OPLWH. In addition, the finding highlights the role of social competence in treatment outcomes. Further research needs to tailor multi-disciplinary programs and flexible interventions to reduce the burden and the mortality rate of HIV/AIDS. [ABSTRACT FROM AUTHOR]

AbstractThere has been growing recognition of the need to address the sexual and reproductive health (SRH) needs of men and boys, including a need for more explicit guidance in domestic health policy and plans. This paper reports on a policy analysis, covering five East and Southern African countries, and discusses the extent and ways in which male clinical and non-clinical needs, and their roles in SRH are currently being reflected. It draws attention to the policy discourse, trends, and gaps in including men in the region as clients, partners and change agents to inform a way forward. [ABSTRACT FROM AUTHOR]

Over two-thirds of the population living with HIV were concentrated in Eastern, Southern, Western, and Central Africa in 2021. This paper employs data from the Demographic and Health Survey to assess the relationship between HIV prevalence and its socio-economic and demographic drivers at the neighborhood (macro-cluster) level. Additionally, the study examines the existence of differences in such relationships among countries. The results of the fractional logistic regression models highlight that highly educated neighborhoods are less likely to be affected by HIV. A greater average number of children, potentially due to programs that promote access to preventive antenatal care and prevention, is associated with a lower likelihood of residents living with HIV. Notably, HIV testing coverage is prevalent in neighborhoods with a high prevalence of HIV. It is also evident that there are notable differences between countries, which demonstrate national context plays a crucial role in the association between education, number of children, testing coverage, and HIV prevalences. [ABSTRACT FROM AUTHOR]

In Australia, surveillance data establish that there are higher rates of late HIV diagnoses among heterosexual migrants from Sub-Saharan Africa and new HIV diagnoses among gay and bisexual men (GBM) from Southeast and Northeast Asia and Latin America. Together, these groups are identified as priority migrant communities in current efforts to eliminate HIV transmissions. HIV health literacy is recognised as a key means of improving access to services and health outcomes. This qualitative paper explores critical HIV health literacy among priority migrant communities in Queensland, Australia. To foreground community voices, peer researchers from priority migrant communities participated in the project design, data collection and analysis, with 20 interviews completed. The findings demonstrate how participants' engagement with HIV health information and services is highly relational and situated within the framework of sexual health and wellbeing. Participants strategically selected where to seek information and who they trusted to help them appraise this information. They further demonstrated reflective capacities in identifying the contextual barriers that inhibit the development of their HIV health literacy. The findings highlight the need for HIV health promotion strategies that embrace a sex positive approach, promote cultural change, and involve collaboration with general practitioners (GPs). [ABSTRACT FROM AUTHOR]

Adolescents and men are two populations that perform poorly within the HIV cascade of care, having worse AIDS-related health outcomes, and experiencing higher levels of HIV-related stigma. This paper explores institutional health system discrimination as experienced by adolescent boys with perinatally-acquired HIV, situating them within the social and gendered contexts of the Eastern Cape Province, South Africa. Life history narratives (n = 36) and in-depth semi-structured interviews (n = 32) with adolescent boys living with HIV aged 13–22 were conducted in 2017-2018. In-depth semi-structured interviews with biomedical and traditional health practitioners (n = 14), analysis of health facility files (n = 41) and clinic observations were also conducted. Together, triangulated sources point to an incongruence between the complex needs of adoelscent boys and young men living with HIV and their experiences within the health system. Two institutional discrimination-related deterrents to retention in care were identified: (1) lack of confidentiality due to health facility layouts and practices that visibilised people living with HIV; and (2) mistreatment in the form of shouting. This article contributes to the limited literature on the experiences of young men within the HIV continuum of care, focusing on how stigma influences how young men experience and engage with the health sector. [ABSTRACT FROM AUTHOR]

This paper discusses Gilbert Cole's book, "Infecting the Treatment: Being an HIV-Positive Analyst." The author provides some personal reflections on the outbreak of AIDS and the impact it had upon his work as a psychotherapist. The paper addresses the importance of the cognitive schemata Cole provides to psychotherapists working with seropositive patients. This paper then addresses a powerful technique, a therapist's self disclosure to a patient, upon which Cole's work focuses. Using the example of psychoanalytic strictures regarding self-disclosure, the author argues that self-disclosure is more likely to be adhered to in theory than it is in practice. The author agrees with Cole that non-disclosure is often a technique used by analysts to hide, rather than provide a therapeutic field of action. The specific case of therapists hiding their antihomosexuality when working with lesbians and gay men is used to illustrate the author's perspective. A specific case presented by Cole in his book is then used to both compare and contrast Cole and this paper's author's use of self-disclosure. The paper commends Cole's study for opening a debate on how to use countertransference and self-disclosure as tools which widen and enrich the therapeutic relationship. [ABSTRACT FROM AUTHOR]

This paper explores how HIV-positive abakhwetha (young male initiates) undergoing ulwaluko (traditional Xhosa initiation and circumcision) engage with HIV-related biomedical care and treatment. Health-focused life history narratives (n = 36), semi-structured interviews (n = 32) and analysis of health facility files (n = 41) with adolescent boys and young men (ages 13–24) living with HIV, and semi-structured interviews with traditional and biomedical health practitioners (n = 14) were conducted in 2017 and 2018. This research was part of the Mzantsi Wakho study, a longitudinal, mixed methods study of adolescents living with HIV (n = 1060). Findings demonstrate that ulwaluko rules of not engaging with biomedical care and treatment pose a challenge for initiates who are taking chronic medicine. Fears of inadvertent disclosure of their HIV-positive status collide with the pressure to successfully complete ulwaluko in order to be legitimised as men. In response to this dilemma, they engage a variety of strategies – including taking medicine in secret by hiding them, having a trusted person deliver them discretely, and stopping medicine-taking altogether. The three months following ulwaluko also pose a challenge in accessing biomedical treatment and care. In this time of high surveillance, amakrwala (new men) do not present at health facilities for fear of being thought to have had a botched circumcision or to have contravened 'manhood rules' and left ulwaluko before having healed properly. To get around this, those who continued taking medicine engaged caregiver pick-ups. Beyond suggesting that ulwaluko is a high-risk time for disengagement from biomedical treatment and care, this paper builds on a robust scholarship on the importance of locality and context in gender and health research. It documents the creativity, agency and resilience of initiates and their families as they subvert and re-signify health-related masculine norms. [ABSTRACT FROM AUTHOR]

Drawing on qualitative research in Dar es Salaam, Tanzania, this article explores how men who engage in sex with other men perceive their interactions with healthcare providers, and how they would prefer healthcare services to be organised and delivered. The paper describes the strengths and weaknesses men associate with private and public healthcare; the advantages and disadvantages they associate with dedicated clinics for sexual minority persons; what they conceive of as good healthcare services; and how they would characterise a good healthcare worker. The paper also presents recommendations made by study participants. These include the view that health services for same-sex attracted men should be developed and delivered in collaboration with such men themselves; that health workers should receive training on the medical needs as well as the overall circumstances of same-sex attracted men; and that there should be mechanisms that make healthcare available to poorer community members. We analyse men's views and recommendations in the light of theoretical work on trust and discuss the ways in which same sex attracted men look for signs that healthcare workers and healthcare services are trustworthy. [ABSTRACT FROM AUTHOR]

Objectives: Despite billions of dollars in funding spent each year on sexual and reproductive health and rights (SRHR) and HIV programming, sexual pleasure is insufficiently addressed. This paper therefore has three key aims: (1) to introduce the concept of sexual pleasure in SRHR programming, while providing context regarding investment and research, (2) to introduce and situate an upcoming systematic review and meta-analysis to quantify whether and to what extent incorporating sexual pleasure into SRHR interventions can improve health outcomes, and (3) to examine the key practical, methodological, and theoretical challenges in carrying out such a review. Methods: We undertook a literature review and analysis of conference abstract publications to highlight the 'pleasure gap' in evidence in sexual and reproductive health and rights programming and research. We detailed the scope, search strategy and challenges for our subsequent systematic review. Results: This paper and the subsequent review highlights the need to equip the SRHR and HIV fields to better meet the needs of communities by considering key reasons people have sex, and understand the challenges of undertaking a review of this nature. Conclusions: We conclude that this a focus on pleasure is particularly pertinent in the context of the Sustainable Development Goals and the ratification of the declaration on sexual pleasure at the 2021 World Congress of the World Association for Sexual Health. [ABSTRACT FROM AUTHOR]

This paper presents the cost-effectiveness of a WHO-recommended harm-reduction programme implemented among a cohort of persons who inject drugs in Delhi, India. We estimate the number of infections averted using Bernoulli process model and calculate cost-effectiveness ratio as the total programme cost per infection averted. The intervention averted 996 HIV infections over 36 months, with a cost-effectiveness ratio of INR 24,763 (US$ 476) per infection averted per year. The first phase, when HIV testing and counselling were initiated, was more cost-effective than the second phase when full intervention package, including needle-syringe exchange, condom distribution, harm-reduction education, etc., was implemented. [ABSTRACT FROM AUTHOR]

Aim: Despite the clear morbidity, mortality and vertical transmission rates in women infected with HIV, there is still controversy surrounding the relationship between maternal infection and adverse neonatal outcomes. Antiretroviral therapy during pregnancy is considered the main and most effective method for reducing the vertical transmission of infection. However, there is no consensus over potential associations between antiretroviral therapy and adverse pregnancy outcomes. This systematic review focuses on the effects of antiretroviral drugs on pregnancy outcomes in HIV-positive women. Methods: After searching MEDLINE, the Cochrane Database of Systematic Reviews, the ISI Web of Sciences and EMBASE, 570 potentially eligible papers were identified. Only 32 papers were selected based on the inclusion criteria. Results: The most prevalent adverse pregnancy outcomes were low birth weight, preterm birth and stillbirth. Conclusion: Considering the higher prevalence of adverse pregnancy outcomes in HIV-infected women, HIV screening methods should be administered in all pregnant women. Appropriate treatment modalities should also be selected to minimize adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

This paper mobilizes the findings generated from in depth, in person interviews conducted with ten Black, HIV+ transgender women who had previously served time in local jails and prisons in the Atlanta region of the state of Georgia, USA. The paper explores how intersectional stigma emerges in the carceral environment in relation to the women's multiple identity locations and the ways that HIV and transgender stigma in particular are linked to two harmful correctional practices. First, participants revealed that the 'layering' of these different forms of stigma resulted in institutional coercion to suppress their gender identity and to the inappropriate use of solitary confinement, both of which led to increased mental and emotional distress during their period of incarceration as well as after they were released from jail or prison. Second, participants were also frequently denied access to or had irregular access to their HIV medication and hormone replacement therapies (HRT), which can have significant mental and physical side effects. In carceral environments, the manifestation of intersectional stigma influences how individuals are treated by staff, where they were housed and how their institutional time is managed; in other words, it contributes to mapping their carceral experience. [ABSTRACT FROM AUTHOR]

This paper examines how, in the midst of changing political times, some characteristics of HIV activism are changing, and suggests the relevance of these shifts for other fields of health activism. Despite the UK achieving UNAIDS's '90–90-90ʹ testing and treatment goals, many in the UK lack up-to-date HIV knowledge and retain stigmatising attitudes, and some areas of testing failure remain. In response, people with HIV and HIV organisations are generating imaginative, collaborative projects that indicate effective contemporary forms of health activism may, as other critical health research suggests, be decentred, participatory, multimodal, affective, and implicit. The paper describes a 2016 HIV NGO-run comedy event directed at HIV awareness which was researched via qualitative pre- and post-measures, and two-month follow-up interviews. Findings pointed to strong effects of comedy, as enjoyment and 'break' in HIV thinking, feeling, and action; of a one-off event's emotionality and particularity; and of performance in generating collectivity and HIV citizenship. The paper discusses the potential transferability of these findings to other health activisms, particularly around stigmatised conditions. It argues that such strategies of emotionality, multi-modality, and solidarity in a performance event can work as implicit activism for changing times, generating social change via a doubled politics of resistance and alterity. [ABSTRACT FROM AUTHOR]

Patterns of HIV prevalence in Kenya suggest that areas where various cultural practices are prevalent bear a disproportionate burden of HIV. This paper examines (i) the contextual effects of cultural practices (polygyny, male circumcision) and related sexual behaviour factors on HIV prevalence and (ii) the extent to which specific cultural practices in a community/county might explain existing ethnic variations in HIV prevalence in Kenya. The analysis applies multilevel logistic regression to data from the 2012/13 Kenya AIDS Indicator Survey. The results reveal striking ethnic variations in HIV prevalence in Kenya. The prevalence of polygyny in a community is positively associated with HIV prevalence, while a higher level of male circumcision in a county is protective for both men and women. The effects of these factors are stronger for men than women at both individual and contextual (community/county) levels. These cultural practices and associated risk factors partly explain existing ethnic differences in HIV prevalence in Kenya, but there remain significant ethnic variations that are not explained by these cultural practices or related sexual behaviour factors. These call for stronger empirical evidence to offer stronger theoretical explanations and inform effective policy and practice to address HIV epidemic in adversely affected communities in Kenya and similar settings in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

We document the extent to which economic shocks through economic incentives explain HIV transmission through risky sexual behaviours in LMICs. We include 35 papers containing 31 unique negative and 11 unique positive economic shocks combined with over 320 health and risky sex outcomes. We find a diverse literature with varying empirical approaches showing increases in risky sexual behaviours are more sensitive to negative shocks than decreases are to positive shocks. Those already at risk of engaging in transactional sex are particularly vulnerable to increasing risky behaviours. Protecting against negative shocks is likely to most effective in preventing HIV transmission. [ABSTRACT FROM AUTHOR]

In 2014 methadone as part of Medically Assisted Therapy (MAT) was introduced in Kenyan public health facilities as part of a comprehensive approach to HIV prevention and treatment. This paper explores the transition experiences for people moving from the use of heroin to MAT. The paper reports on a qualitative study conducted in an urban setting in Kenya in 2015. Findings show that transitioning from the use of heroin to methadone can both be a liberating and disempowering experience. While study participants were reportedly pleased with the life changes brought about by methadone, they struggled with negotiating the transition from an 'old life' of heroin use to methadone. Tensions were navigating the 'new life' on methadone and the 'old life' on heroin. These tensions generate new forms of social exclusion, as well as feelings of uncertainty and ambivalence. A particular effect of this challenging transition is how new forms of risk and vulnerability for HIV are created even whilst others are attended to. MAT programs need to attend to the dynamics described to address the risk of HIV posed by a 'new life' and the broader tensions involved in transitioning from the use of heroin to methadone. [ABSTRACT FROM AUTHOR]

Although HIV incidence and mortality rates have declined over the past 20 years, HIV health disparities continue to persist among patients living in urban communities. Barriers to proficient health outcomes for persons with HIV (PWH) in urban communities include lack of access to care, resulting from limited transportation or clinic availability. While healthcare systems in rural communities provide telemedicine (TM) services to PWH to eliminate transportation and accessibility barriers, few examples exist regarding TM use for PWH in urban communities. This project's goal was to increase the provision of healthcare services in an urban setting to PWH, using TM. As guided by "Integration of Healthcare Delivery Service" theories and key principles, we created an integration framework comprised of several simultaneous, overlapping activities to include: (1) capacity building (2) clinical standardization (3) community and patient engagement and (4) evaluation performance and measurements. This paper describes major activities involved with developing, implementing and evaluating a TM program for PWH. We discuss results, challenges, and lessons learned from integrating this program into our existing healthcare system. [ABSTRACT FROM AUTHOR]

AbstractCure rate models are mostly used to study data arising from cancer clinical trials. Its use in the context of infectious diseases has not been explored well. In 2008, Tournoud and Ecochard first proposed a mechanistic formulation of cure rate model in the context of infectious diseases with multiple exposures to infection. However, they assumed a simple Poisson distribution to capture the unobserved pathogens at each exposure time. In this paper, we propose a new cure rate model to study infectious diseases with discrete multiple exposures to infection. Our formulation captures both over-dispersion and under-dispersion with respect to the count on pathogens at each time of exposure. We also propose a new estimation method based on the expectation maximization algorithm to calculate the maximum likelihood estimates of the model parameters. We carry out a detailed Monte Carlo simulation study to demonstrate the performance of the proposed model and estimation algorithm. The flexibility of our proposed model also allows us to carry out a model discrimination. For this purpose, we use both likelihood ratio test and information-based criteria. Finally, we illustrate our proposed model using a recently collected data on COVID-19. [ABSTRACT FROM AUTHOR]

Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical. [ABSTRACT FROM AUTHOR]

Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses the change over time in Years Lived with Disability (YLD) for South Africa and how this compares to regional and global trends. This secondary analysis of the Global Burden of Disease Study 2017 dataset describes the observed contribution of YLD to Disability-Adjusted Life Years (DALYs) per 100 000 people over the period 1990–2016, and forecast to 2030 using simple linear prediction. South African trends are compared to global and sub-Saharan African (SSA) trends to highlight the effect of HIV and policy implications. Globally, the contribution of YLD to DALYs has increased from ±21.7% in 1990 to ±34% by 2016, with high socio-demographic index countries having a higher contribution (49%). HIV, mental health, musculoskeletal, neurological, and sense organ disorders are the five main contributors to YLD in South Africa (54%). Removing the effects of HIV/AIDS and sexually transmitted infections on YLD, South Africa's trend appears similar to the global trend, yet opposite to the SSA trend. Our analysis shows there is a growing burden of disability in South Africa. Differences in trends with the regional and global patterns can be attributed to the high burden of HIV and non-communicable diseases in South Africa. Therefore, strategies are urgently needed to increase integration of disability and rehabilitation services into chronic HIV and non-communicable disease management. This calls for disability screening to identify functional limitations in routine data collection and case management. South Africa has experienced an increase in disability prevalence over time. This requires strengthening of services such as mental health interventions, physiotherapy, optometry, and audiology, and linking major disease clusters, such as HIV and the NCDs, to rehabilitation services. The greatest contributors towards disability adjusted life years in South Africa are currently mental disorders (13.8%), HIV and sexually transmitted infections (11.8%), musculoskeletal disorders (10.4%), neurological disorders (8.2%), and sense organ diseases (7.5%). Routine data collection and case management needs to include disability screening to identify developing functional limitations. [ABSTRACT FROM AUTHOR]

Latently infected CD 4 + T cells represent one of the major obstacles to HIV eradication even after receiving prolonged highly active anti-retroviral therapy (HAART). Long-term use of HAART causes the emergence of drug-resistant virus which is then involved in HIV transmission. In this paper, we develop mathematical HIV models with staged disease progression by incorporating entry inhibitor and latently infected cells. We find that entry inhibitor has the same effect as protease inhibitor on the model dynamics and therefore would benefit HIV patients who developed resistance to many of current anti-HIV medications. Numerical simulations illustrate the theoretical results and show that the virus and latently infected cells reach an infected steady state in the absence of treatment and are eliminated under treatment whereas the model including homeostatic proliferation of latently infected cells maintains the virus at low level during suppressive treatment. Therefore, complete cure of HIV needs complete eradication of latent reservoirs. [ABSTRACT FROM AUTHOR]

HIV is a virus that weakens a person's immune system. HIV has three stages, and AIDS is the most severe stage of HIV (Stage 3). People with HIV should take medicine (called ART) recommended by WHO as soon as possible to reduce the amount of virus in the body. In this paper, we formulate a mathematical model for HIV/AIDS with a new approach by focusing on two groups of infectious individuals, HIV and AIDS. We also introduce a controlled class (treated patients and being monitored), and people in this class can spread the disease. We further investigate the essential dynamics of the model through an equilibrium analysis. Optimal control theory is applied to explore effective treatment strategies by combining two control measures: standard antiretroviral therapy and AIDS treatments. Numerical simulation results show the effects of the two time-dependent controls, and they can be used as guidelines for public health interventions. [ABSTRACT FROM AUTHOR]

This paper aims to analyse stability and Hopf bifurcation of the HIV-1 model with immune delay under the functional response of the Holling II type. The global stability analysis has been considered by Lyapunov–LaSalle theorem. And stability and the sufficient condition for the existence of Hopf Bifurcation of the infected equilibrium of the HIV-1 model with immune response are also studied. Some numerical simulations verify the above results. Finally, we propose a novel three dimension system to the future study. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To discuss studies conducted in Brazil relating to PrEP, from 2012 to 2022, based on a narrative review. METHODOLOGY: The databases of the Virtual Health Library/PAHO, portals from Scielo, Scopus, and PubMed, and the descriptors in English and Portuguese 'Pre-exposure to HIV' and 'Brazil' were used, as well as a list of planned/in-progress demonstrative studies. Inclusion criteria consists of articles with fieldwork in Brazil coupled with PrEP in the Brazilian scenario; and articles in English or Portuguese. Articles in which PrEP was not the central theme and the participating Brazilian population did not reside in Brazil were excluded. RESULTS: 107 papers have been reviewed, 80 articles met the inclusion criteria. The majority participating population was men who have sex with men. 61 studies preceded the implementation of PrEP in Brazil. Studies carried out after implementation (n = 19) deal primarily with the impact of the COVID-19 pandemic. CONCLUSIONS: There was an incipient number of studies on the injectable form of PrEP. Fewer studies included segments with greater difficulties in access, use, and adherence. Despite the issues that circumscribe this prevention technology, literature is consensual on the importance of Brazilian leadership for implementing PrEP. [ABSTRACT FROM AUTHOR]

Drawing on testimonies from oral history interviews with HIV/AIDS community activists and PrEP users, this paper analyses new forms of collective action in relation to the efforts to implement PrEP in England. The analysis of this PrEP response, delivered by an assemblage of independent actors and public health-related agents exposes three important aspects in relation to the lived experiences of first-wave PrEP users and HIV activists: (i) the negotiation of PrEP as a medical commodity, (ii) the use of gay dating apps as enabling technologies in regard to peer support, and (iii) the fact that access to PrEP was not equally distributed and differed between gay communities. This paper concludes that although this response was effective in decreasing HIV infection, it was only partially transformative in terms of social/health justice. However, the response featured forms of collective action that contrasted with the individualistic paradigm of the biomedicalisation of HIV prevention, pointing to a shift in future HIV prevention interventions. [ABSTRACT FROM AUTHOR]

The HIV epidemic is strongly gendered. Women and girls are more likely to contract HIV for biological and social reasons in Sub-Saharan Africa and men living with HIV are more likely to be lost to follow-up and die on antiretroviral therapy (ART) than women. Care work is also gendered, with women shouldering the burden of HIV care-related work. This paper considers the potential of male delivered community health work to improve men's HIV-related health outcomes and shift gendered norms related to care work. It describes the experiences and perspectives of eight HIV community health workers and their clients from the Cape Town area, and reviews current evidence on male-focused HIV and sexual and reproductive health services, gender transformation and men and care. Findings suggest that meaningfully involving more men in HIV care work may be a way to shift damaging hegemonic masculine norms related to care and health, and that South Africa's roll-out of National Health Insurance could be an opportunity to do so. Barriers to engaging men in this feminised profession are also explored. [ABSTRACT FROM AUTHOR]