Undetected anogenital sexually transmitted infections among young adults living with HIV and receiving antiretroviral therapy: Implications for HIV treatment as prevention

2021 ◽  
pp. 095646242110465
Author(s):  
Seth C Kalichman ◽  
Lisa A Eaton ◽  
Moira O Kalichman
Keyword(s):  
Antiretroviral Therapy ◽  
Sexually Transmitted Infections ◽  
Sexual Behaviors ◽  
Hiv Transmission ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sexually Transmitted ◽  
Condomless Anal Intercourse ◽  
Living With Hiv

Undetected sexually transmitted infections (STIs) pose health threats to people living with HIV and when combined with uncontrolled HIV can amplify HIV transmission. The current study screened 174 self-identified men under age 36 living with HIV and receiving antiretroviral therapy (ART) for urethral and rectal incident chlamydia and gonorrhea infections. Participants were also screened for biomarkers indicating alcohol and other drug use, subclinical genital inflammation, and HIV viral load. ART adherence and sexual behaviors were also assessed prospectively over 1 month. Results detected an undiagnosed STI in 32 (18%) individuals. Participants with a previously undetected STI had significantly greater HIV viremia than those who did not have an STI after controlling for several confounding variables. Participants with an undetected STI also engaged in greater condomless anal intercourse with HIV negative and unknown status partners, including partners to whom they had not disclosed their HIV status. These findings show that undetected STI are associated with incomplete ART adherence and unsuppressed HIV, all of which are important for preventing HIV transmission.

The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 233-253
Author(s):  
Eli Manning
Keyword(s):  
Hiv Transmission ◽  
Ethical Dilemmas ◽  
Hiv Treatment ◽  
First Century ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Hiv Positive Women ◽  
Aids Clinical Trials ◽  
Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

scholarly journals Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049824
Author(s):  
Andreas D Haas ◽  
Cordelia Kunzekwenyika ◽  
Stefanie Hossmann ◽  
Josphat Manzero ◽  
Janneke van Dijk ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Suicidal Ideation ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Living With Hiv

ObjectivesTo examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART).SettingSixteen government-funded health facilities in the rural Bikita district of Zimbabwe.DesignCross-sectional study.ParticipantsHIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months.Outcome measuresThe primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence.ResultsOut of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40–49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50–59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70).ConclusionsA substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe.Trial registration numberNCT03704805.

A model to predict adherence to antiretroviral therapy among people living with HIV

2021 ◽  
pp. sextrans-2021-055222
Author(s):  
Hui Chen ◽  
Rusi Long ◽  
Tian Hu ◽  
Yaqi Chen ◽  
Rongxi Wang ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Treatment ◽  
Poor Adherence ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Snowball Sampling ◽  
Hiv Viral Load ◽  
Temporal Validation ◽  
Suboptimal Adherence ◽  
Living With Hiv

ObjectivesSuboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.MethodsA cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.ResultsThe average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).ConclusionsOur model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.

scholarly journals The Achilles’ Heel of HIV Treatment for Prevention

2011 ◽  
Vol 10 (6) ◽  
pp. 365-372 ◽  
Author(s):  
Seth C. Kalichman ◽  
Chauncey Cherry ◽  
Denise White ◽  
Mich'l Jones ◽  
Moira Kalichman
Keyword(s):  
Sexual Behaviors ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Sexually Transmitted ◽  
The Past ◽  
Younger Age ◽  
Transgender Persons ◽  
History Of ◽  
Living With Hiv

Background: Antiretroviral therapies (ARTs) offer promising new avenues for HIV prevention. Unfortunately, people infected with HIV who have co-occurring sexually transmitted infections (STIs) are more infectious than suggested by the amount of virus in their peripheral blood. We examined the history of sexually transmitted coinfections in people living with HIV. Methods: People living with HIV/AIDS completed confidential computerized interviews that assessed history of STI, sexual behaviors, and STI knowledge. Results: Among 414 men and 156 women currently receiving ART, 53% had been diagnosed with at least 1 STI since testing HIV positive; 24% women, 19% men, and 11% transgender persons had been diagnosed with an STI in the past year. History of STI was associated with younger age, greater STI knowledge, substance use, and ART nonadherence. Conclusions: Aggressive strategies for detecting and treating STI in people receiving ART will be necessary to achieve protective benefits.

scholarly journals Symptoms of common mental disorders and adherence to antiretroviral therapy among adults living with HIV in rural Zimbabwe: a cross-sectional study

2021 ◽  
Author(s):  
Andreas D Haas ◽  
Cordelia Kunzekwenyika ◽  
Stefanie Hossmann ◽  
Josphat Manzero ◽  
Janneke H van Dijk ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Suicidal Ideation ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Living With Hiv

Objectives: To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). Setting: Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. Design: Cross-sectional study. Participants: HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least six months. Outcome measures: The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire (SSQ-14) score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms, and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms, and suboptimal ART adherence. Results: Out of 3,480 adults, 18.8% (95% confidence interval [CI] 14.8-23.7) screened positive for CMD, 2.7% (95% CI 1.5-4.7) reported suicidal ideations, and 1.5% (95% 0.9-2.6) reported perceptual symptoms. Positive CMD screens were more common in women (adjusted prevalence ratio [aPR] 1.67, 95% CI 1.19-2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47 95% CI 1.16-1.85) or aged 50-59 years (20.3%; aPR 1.51 95% CI 1.05-2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37-1.70). Conclusions: A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programs in rural Zimbabwe.

Human intestinal spirochetosis, a sexually transmissible infection? Review of six cases from two sexually transmitted infection centres in Barcelona

2020 ◽  
pp. 095646242095835
Author(s):  
David Garcia-Hernandez ◽  
Marti Vall-Mayans ◽  
Susanna Coll-Estrada ◽  
Lola Naranjo-Hans ◽  
Pere Armengol ◽  
...  
Keyword(s):  
Penicillin G ◽  
Chronic Diarrhoea ◽  
People Living With Hiv ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Condomless Anal Intercourse ◽  
Intestinal Spirochetosis ◽  
Colon Biopsy ◽  
Human Intestinal Spirochetosis ◽  
Living With Hiv

Human intestinal spirochetosis (HIS) is a possible cause of chronic diarrhoea and affects mainly men who have sex with men (MSM) and people living with HIV. Diagnosis is based on colon biopsy, where spirochetes can be observed on the luminal surface, especially with the Warthin-Starry stain or similar silver stains. We conducted a retrospective descriptive study of all HIS cases diagnosed in two sexually transmitted infections (STI) centres in Barcelona from 2009 until 2018. The medical histories were reviewed to gather epidemiological, clinical, and diagnostic variables. Six patients were diagnosed with HIS. All the individuals were MSM, with a median age of 31.5 years (interquartile range [IQR] 29.5;49.25) and half of them were living with HIV. Five patients reported condomless anal intercourse and 4 patients had practised oro-anal sex previously. Concomitantly, two of them had rectal gonorrhoea, one had rectal Chlamydia trachomatis and none of them had syphilis. The predominant clinical symptom was diarrhoea (5 patients). All cases were diagnosed by a Warthin-Starry stain on a colon biopsy specimen, and mild inflammatory changes were found in 5 cases. Five patients were treated with metronidazole and one with benzathine penicillin G. Treatment was successful in all the patients. HIS should be considered in patients with chronic diarrhoea who report risky sexual practices and/or concomitant STI. HIS may also be sexually transmitted according to the context.

Self-esteem and motivation with adherence of people living with HIV/AIDS (PLWHA) in Indonesia with antiretroviral therapy: a cross-sectional study

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Purwaningsih Purwaningsih ◽  
Candra Panji Asmoro ◽  
Yenis Anggi Prastiwi
Keyword(s):  
Antiretroviral Therapy ◽  
Self Esteem ◽  
Cross Sectional Study ◽  
The Body ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Sectional Study ◽  
Cross Sectional ◽  
Living With Hiv ◽  
Hiv Aids

Abstract Introduction Antiretroviral therapy (ART) helps reduce the amount of human immunodeficiency virus (HIV) that enters the body in order to avoid acquired immune deficiency syndrome (AIDS) and prevents the occurrence of opportunistic infections and complications. This study aims to describe the correlation between self-esteem and motivation with adherence of people living with HIV/AIDS (PLWHA) in ART. Methods This cross-sectional study involved 91 PLWHA who joined a non-government organization (NGO) support group, determined through a purposive sampling technique. The demography, and questionnaires about self-esteem, motivation and adherence to ART were employed to collect the raw data. The data were then analyzed using Spearman’s rho test with the degree of significance at p < 0.05. Results The result showed that self-esteem (p = 0.000, r = 0.445) and motivation (p = 0.019, r = 0.246) had correlation with adherence of PLWHA with ART. Conclusion PLWHA can increase self-esteem and motivation so that they can improve ART adherence. Further research is expected to use an instrument more objectively as a measurement tool for ART adherence in addition to a questionnaire so as to obtain more accurate and specific results.

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