Social change and HIV in Iran: reaching hidden populations

Prevalence of Late Presenters and Advanced HIV Disease in HIV Patients and Their Related Factors in Iran: Results from 19 Years of National Surveillance HIV Data

Late presenters (LP) and Advanced HIV Disease (AHD) represent important missed opportunities to reduce secondary transmission and undesirable HIV outcomes. Despite efforts, the diagnoses are still delayed for the majority of patients. This cross-sectional study was conducted using the Iranian national HIV surveillance database from 2001 to 2019, to determine the factors affecting AHD and LP in Iran. To determine LP (CD4 ≤ 350 cells/μL) and AHD (CD4 ≤ 200 cells/μL), the first patients' CD4 at baseline were used. To examine the relationship between the covariates and LP or AHD, a Logistic Regression was applied. The adjusted odds ratio (AOR) stated to report the relationship. Totally, 13,571 patients were included in the study. Of these, 4,060 (29.92%) were AHD and 7,161 (52.77%) LP. Female gender [AOR = 0.88, 95% confidence interval (CI): 0.80-0.97], higher education (AOR = 0.80, 95% CI: 0.69-0.93), and having a positive HIV spouse (AOR = 0.75, 95% CI = 0.66-0.85) significantly decreased odds of LP (p < .05). However, older age (AOR = 2.53, 95% CI: 2.20-2.91) was a risk factor for LP. For AHD, years of detection (AOR = 1.16, 95% CI: 1.06-1.27), older age (AOR = 2.49, 95% CI: 2.12-2.92), and having a spouse with high-risk behavior (AOR = 1.23, 95% CI: 1.02-1.49) led to higher odds. (p < .05). Also, female (AOR = 0.82, 95% CI: 0.73-0.92) and having a positive HIV spouse (AOR = 0.67, 95% CI: 0.58-0.78) were protective factors for ADH. The present study estimated that approximately two-thirds of HIV patients are LP and one-third are AHD in Iran. Older age, male gender, lower education, and having a spouse with high-risk behavior were the factors affecting LP and AHD. Thus, to reduce the percentage of patients with LP and AHD in Iran, improvements in knowledge and periodic screening programs are necessary for these groups.

HIV-Related Stigma Among People Living With HIV in Iran: A Cross-Sectional Study

ABSTRACT

HIV is perceived as a taboo topic in Iranian culture. This study examined HIV-related stigma among Iranian people living with HIV (PLWH). This cross-sectional study was conducted among 123 PLWH in 2019. HIV-related stigma was assessed by a standardized questionnaire adapted into Persian for this study. The range of the stigma scores for each of the subscales (personalized stigma, negative self-image, disclosure concerns, and concerns about public attitudes) was 3-12, whereas the range for the total stigma score was 12-48. The highest and lowest mean scores were observed in concerns about public attitudes (10.07) and negative self-image (7.39). The total mean stigma score was 37.03, indicating a high level of stigma. The most important factors determining HIV-related stigma were socioeconomic status, transmission method, duration of disease, and education level. This study suggests the need for more effective interventions to reduce HIV-related stigma among Iranian PLWH.

A Study on the Knowledge, Attitudes, and Behaviors of Pregnant Women Regarding HIV and Routine Rapid Testing: An Assessment in a High-Risk Marginal Area

Acquired immunodeficiency syndrome (AIDS) is one of the main obstacles to communities’ development. The disease mostly involves active and productive population groups. This study aimed to determine the knowledge, attitudes, and behaviors of pregnant women regarding HIV prevention and rapid HIV tests. Pregnant women who were referred to the local health centers and who were willing to participate in the study were interviewed. To collect data, a standard questionnaire was used among 200 pregnant women in eight local health centers of Kermanshah, Iran. The survey contained 50 questions on demographic characteristics and the knowledge, attitudes, and behaviors regarding HIV/AIDS prevention and rapid tests for pregnant women. Although the majority (82.5%) of the pregnant women knew that mother-to-child HIV transmission during pregnancy was possible, fewer than half (48.2%) of them knew that HIV can be transmitted from mother to child through breastfeeding. Only 22.5% of pregnant women knew that a Cesarean section for HIV-positive mothers is recommended. The mean attitudes of pregnant women toward HIV prevention and HIV rapid testing were 4.5 (SD = 0.4) and 4 (SD = 0.3), respectively. Of the women, 11.5% had participated in an HIV rapid test counseling class, and 25.5% had participated in HIV education and counseling classes. The low knowledge of mothers regarding HIV transmission highlights the need for education and counseling classes and campaigns to improve knowledge and behaviors related to HIV prevention, especially during pregnancy for women in marginal regions.

The Prevalence of Human Immunodeficiency Virus Infection in Patients with Sexually Transmitted Diseases

Background:

Human immunodeficiency virus (HIV) transmission pattern in Iran has been changed from injection drug to sexual contact. Lack of accurate assessment of HIV in people with sexually transmitted diseases (STDs) in Iran prompted us to conduct this study to determine the frequency of HIV infection in these patients.

Materials and Methods:

In this cross-sectional study which conducted in 2016–2017, overall, 190 patients with STDs referring to two hospitals of Hamadan were enrolled in the study. All of the patients were examined for HIV in the first visit by rapid test and then 1 and 4 months later by the 4^th generation ELISA. A questionnaire including demographic data, clinical manifestations, and high-risk behaviors was completed for all of the referring people. The collected data were analyzed using appropriate statistical tests.

Results:

Of 190 patients, 126 (66.3%) were female with a mean age of 34.1 ± 10.1 years and 64 (33.7%) were male with a mean age of 30.8 ± 7.8 years. One hundred twenty-eight (67.4%) got married, 73 (38.4%) and 76 (40%) had a diploma and postgraduate education, respectively, 32 (16.8%) mentioned the history of unsafe sex, and 23 (12.1%) had used condoms continuously during sexual contacts. The most common STDs were reported genital warts, 107 patients (56.3%), vaginal discharge (28, 14.7%), and genital ulcer (33, 17.4%). Two (1%) patients were positive for HIV at the first visit.

Conclusion:

Patients with STDs should be considered as an important source of HIV transmission, so clinicians should pay more attention to screening these patients for HIV infection.