Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis

Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.

The Study of Feasibility and Acceptibility of Using HIV Self-Tests in High-Risk Iranian Populations(FSWs, MSM, and TG Populations): A Cross-Sectional Study

Background: This study aimed to evaluate the feasibility of using the HIV Self-Test in high-risk Iranian groups (MSM, FSWs, and TG people).Methods: This study was conducted in 2 main steps (the pre and post HIVST intervention and the qualitative method) between 1 October 2020 and 22 June 2021 in Tehran, Iran. The sample size needed for this study generally was 1000 people, including FSWs, MSM, and transgender individuals. The sampling method in this study was convenience sampling, while snowball sampling was used to complete the number of samples.Results: A total of 930 eligible respondents were enrolled in the study, of whom 456 (49%) were female, 49 (5.3%) were transgender (98% of TGs were male to female). The median age was 33.63 ±10.54 SD. The feasibility of the use of HIV self-tests in Iranian high-risk groups was significantly high. The majority of participants (97%) did not have any confidentiality problems while preparing or performing the test. In general, feasibility was assessed based on five questions. The overall feasibility score was 6.33 (0.824 SD). Taking tests, reading HIV test results, finding a safe place to do the test, and accessing HIV self-testing showed a high average. Conclusion: HIV self-testing was highly acceptable and feasible to permit routine HIV testing between high-risk populations efficiently.

Ranula as the First Symptom of HIV Infection in Young Patients

Introduction. Oral manifestations are often the earliest HIV signs. Salivary gland diseases are a common form of HIV expression. A ranula can occur in association with HIV. However, this manifestation is rarely considered as the disease sentinel sign. We present two cases of children consulting for a ranula, leading to the diagnosis of a previously unknown HIV infection. Case Reports. Two children, respectively, 5 and 13, were treated for a ranula by marsupialization. Relapse occurred in both cases, and thereafter, a ranula excision was performed. While the follow-up was uneventful, HIV infection was diagnosed during the patients’ care. The only sign or symptom observed was the ranula. A routine HIV testing of ranula patients would have allowed earlier care. Conclusion. Routine HIV testing of patients with a ranula is justified and may be recommended, especially for children. Ranula excision associated with the sublingual gland resection is suggested in order to avoid recurrence.

Stigma, Structural Vulnerability, and “What Matters Most” Among Women Living With HIV in Botswana, 2017

Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from “what matters most” in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners’. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner’s status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as “promiscuous” and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306274 )

Students’ Perception on Government Policy of Routine HIV Testing: A Case of University of Zambia Ridgeway Campus

Background HIV Routine testing to all hospital attendants offers testing to all patients irrespective of their presenting illness even if it has nothing to do with HIV. This approach differs from voluntary counselling and testing, which is client-initiated. Adolescents and young adults especially those in colleges are a sexually active group of people which makes them prone to HIV infection. Therefore, there was need to conduct this study to determine the perception of students on routine HIV testing at the University of Zambia (Ridgeway campus) to determine their attitude towards HIV testing. Design and Methods A cross sectional quantitative study was conducted at UNZARidgeway hostels using stratified random sampling to select study participants which included all males and females who were on campus. A semi-structured interview questionnaire was applied to collect data which was analyzed using SPSS version 23software. A Chi-square test was applied for descriptive analysis and results were presented in tables and charts. Results Majority indicated that routine HIV testing was a good policy and supported it; though surprisingly 94% of the students were knowledgeable about routine HIV testing and yet their knowledge did not affect their perception of the policy. However, their experiences, expectations and beliefs affected students’ perception on routine HIV testing. Conclusion Health practitioners should have positive attitude and good work culture in order to uphold students’ positive perception so as to encourage a culture of HIV testing and is free from stigma.

Evolution of late presentation to care and advanced HIV in newly HIV diagnosed subjects in the Republic of Panama: 2012–2017

Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1–1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8–2.9, p < 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6–2.7, p < 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.