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Ribeiro A, Pinto DGA, Trevisol AP, Tardelli V, Arcadepani F, Bosso RA, Ribeiro M, Fidalgo TM. Can Contingency Management Solve the Problem of Adherence to Antiretroviral Therapy in Drug-Dependent Individuals? HEALTH EDUCATION & BEHAVIOR 2023; 50:738-747. [PMID: 36744756 DOI: 10.1177/10901981221148966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Drug misuse among people living with HIV (human immunodeficiency virus) is associated with higher mortality. It is a frequently observed reason for treatment abandonment, with people who misuse drugs showing a 10 to 25 times higher risk of HIV than the general population. The authors conducted a systematic review and meta-analysis to assess the efficacy of contingency management (CM) to improve adherence to antiretroviral therapy in people living with HIV and substance use disorder (SUD). The inclusion criteria consisted of studies written in English, Italian, Spanish, German, and French; studies conducted with humans; and clinical trials that combined SUD treatment with CM for people living with HIV. Two hundred twenty-two articles were identified, five met all inclusion criteria, and three provided enough data to perform the meta-analysis. We considered treatment adherence by measuring the increase in the CD4 count as our primary outcome. We found a significant increase in treatment adherence in the patient group compared with the control groups during the intervention phase. Positive findings did not persist after the cessation of the incentives. The meta-analysis showed that the intervention improved patient adherence by 2.69 (95% confidence interval: [0.08, 0.51]; p = .007) compared with the control group during the intervention period. All short-term CM studies converged on a positive result for adherence to antiretroviral therapy.
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Chirca N, Streinu-Cercel A, Stefan M, Aurelian J, Persu C. A Novel Risk Calculator to Predict Erectile Dysfunction in HIV-Positive Men. J Pers Med 2023; 13:jpm13040679. [PMID: 37109065 PMCID: PMC10140986 DOI: 10.3390/jpm13040679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
HIV infection is considered to be a lifelong medical condition, requiring follow-up and treatment for decades. HIV-positive men are reported to have erectile dysfunction more often than age-matched healthy controls, and improving sexuality is known to potentially improve overall health-related quality of life. The aim of this paper is to evaluate the presence of ED in HIV-positive men and the associated contributing factors and to create a statistical model to assess the risk to develop ED in this population. In a prospective study, we analyzed a group of HIV-positive men in a cross-sectional manner, looking at demographics, blood test results, and smoking habits. Data were statistically analyzed using the Kruskal-Wallis test. In our series, the overall incidence of ED was 48.5%, increasing with age. Our analysis showed no correlation with blood sugar level, but a very strong correlation with total serum lipids. We were able to develop and validate a risk calculator for ED in HIV-positive men.
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Affiliation(s)
- Narcis Chirca
- "Carol Davila" University of Medicine and Pharmacy, Str. Vasile Lascar, Nr. 37, Sector 3, 035648 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, Sos. Panduri Nr. 20, Sector 5, 05324 Bucharest, Romania
| | - Anca Streinu-Cercel
- "Carol Davila" University of Medicine and Pharmacy, Str. Vasile Lascar, Nr. 37, Sector 3, 035648 Bucharest, Romania
- National Institute of Infectious Diseases "Prof. Dr. Matei Bals", Str. Doctor Calistrat Grozovici, Sector 1, 021105 Bucharest, Romania
| | - Marius Stefan
- Faculty of Applied Sciences, Polytechnic University of Bucharest, Splaiul Independentei Nr. 313, Sala BN108, Sector 6, 060042 Bucharest, Romania
| | - Justin Aurelian
- "Carol Davila" University of Medicine and Pharmacy, Str. Vasile Lascar, Nr. 37, Sector 3, 035648 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, Sos. Panduri Nr. 20, Sector 5, 05324 Bucharest, Romania
| | - Cristian Persu
- "Carol Davila" University of Medicine and Pharmacy, Str. Vasile Lascar, Nr. 37, Sector 3, 035648 Bucharest, Romania
- Department of Urology, "Prof. Dr. Th. Burghele" Clinical Hospital, Sos. Panduri Nr. 20, Sector 5, 05324 Bucharest, Romania
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Lancaster KE, Endres-Dighe S, Sucaldito AD, Piscalko H, Madhu A, Kiriazova T, Batchelder AW. Measuring and Addressing Stigma Within HIV Interventions for People Who Use Drugs: a Scoping Review of Recent Research. Curr HIV/AIDS Rep 2022; 19:301-311. [PMID: 36048310 PMCID: PMC10546998 DOI: 10.1007/s11904-022-00619-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Persistent stigma remains a crucial barrier to HIV prevention and treatment services among people who use drugs (PWUD), particularly for those living with or at-risk for HIV. This scoping review examines the current state of science with regard to approaches for measuring and addressing stigma within HIV interventions among PWUD. RECENT FINDINGS Sixteen studies fit the inclusion criteria for this review. Half the studies originated within the USA, and the remaining represented four different regions. Within these studies, stigma was measured using various quantitative, qualitative, and mixed methods. The studies primarily focused on HIV stigma, including value-based judgments, anticipated stigma, and perceived stigma domains. Information-based and skills building approaches at the individual level were the most common for the stigma reduction interventions. Adoption of systematic evaluations is needed for measuring stigma, including intersectional stigma, within HIV interventions among PWUD. Future studies should focus on developing multilevel intersectional stigma reduction interventions for PWUD with and at-risk for HIV globally.
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Affiliation(s)
| | | | - Ana D Sucaldito
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Hannah Piscalko
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Aarti Madhu
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Eng CW, Tuot S, Chann N, Chhoun P, Mun P, Yi S. Recent HIV testing and associated factors among people who use drugs in Cambodia: a national cross-sectional study. BMJ Open 2021; 11:e045282. [PMID: 33653761 PMCID: PMC7929833 DOI: 10.1136/bmjopen-2020-045282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of HIV testing and examine factors associated with recent HIV testing among people who use drugs (PWUD) in Cambodia. DESIGN Cross-sectional study. SETTING Twelve major provinces with a high burden of HIV and drug use in Cambodia. PARTICIPANTS This study included 1677 PWUD recruited using a peer-based social network recruitment method. Participants' selection criteria included being at least 18 years old and using any illicit drugs via any administration routes in the past 12 months. PRIMARY OUTCOME MEASURE Recent HIV testing, defined as having an HIV test in the past 6 months. RESULTS The median age of the participants was 28 (IQR 22-34) years, and 56.6% were men. The prevalence of lifetime and recent HIV testing was 70.7% and 42.9%, respectively. After adjustment in multivariable logistic regression analysis, recent HIV testing remained positively associated with being female (adjusted OR (AOR) 1.55, 95% CI 1.18 to 2.04) or third gender identity (AOR 2.06, 95% CI 1.11 to 3.80), having ever been to a drug rehabilitation centre (AOR 1.60, 95% CI 1.13 to 2.29), having used any HIV services in the past 6 months (AOR 7.37, 95% CI 5.61 to 9.69), having received HIV education in the past 3 months (AOR 3.40, 95% CI 2.63 to 4.40) and having self-perception of higher HIV risk (AOR 1.81, 95% CI 1.19 to 2.73). CONCLUSIONS Recent HIV test uptake among PWUD in Cambodia was suboptimal. This study highlights the roles of outreach HIV education and services in promoting regular HIV testing among PWUD. Strengthening the coordinated effort of government agencies and local civil society organisations to prioritise expanding community-based peer-driven interventions to reach out to this hidden population is warranted.
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Affiliation(s)
- Chee Wen Eng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- Surveillance Unit, National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Phalkun Mun
- Surveillance Unit, National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
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Ribeiro A, Trevizol A, Oluwoye O, McPherson S, McDonell MG, Briese V, Miguel AC, Fratzinger RC, Laranjeira RR, Alonso AL, Karasin AL, Ribeiro M, Madruga CS. HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo's "Cracolândia". TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 42:1-6. [PMID: 32215539 DOI: 10.1590/2237-6089-2018-0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/28/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with - or at risk of - infections. METHODS During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). RESULTS HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. CONCLUSION The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.
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Affiliation(s)
- Ariadne Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Centro de Referência em Álcool Tabaco e Outras Drogas (CRATOD), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Alisson Trevizol
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University Health Sciences, Washington State University, Spokane, WA, USA
| | - Sterling McPherson
- Department of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane WA, USA
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University Health Sciences, Washington State University, Spokane, WA, USA
| | - Viviane Briese
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Centro de Referência em Álcool Tabaco e Outras Drogas (CRATOD), São Paulo, SP, Brazil
| | - André C Miguel
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Rosana C Fratzinger
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Ronaldo R Laranjeira
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Ana L Alonso
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Ana L Karasin
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Marcelo Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Centro de Referência em Álcool Tabaco e Outras Drogas (CRATOD), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Clarice S Madruga
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
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Optimizing HIV prevention and treatment outcomes for persons with substance use in Central Asia: what will it take? Curr Opin HIV AIDS 2020; 14:374-380. [PMID: 31219889 PMCID: PMC6688715 DOI: 10.1097/coh.0000000000000565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose of review To summarize the status of HIV and substance use in Central Asia and discuss potential ways to move forward to effective epidemic control among people who inject drugs (PWID) in the region and beyond. Recent findings PWID and their partners remain the population most affected by HIV in Central Asia. Lack of effective substance use prevention and treatment options and limited involvement of PWID-led community-based organizations in HIV programs, combined with the requirement for official registration, stigma and discrimination of PWID, and criminalization of drug use remain key barriers to effective HIV prevention and treatment. Summary Sustainable HIV epidemic control among PWID will not be feasible without decriminalization of drug use, addressing stigma and discrimination and policy changes to enhance uptake of HIV-related prevention, treatment and support services by PWID. It is also critical to ensure adoption of innovations, particularly those that combine evidence-based biomedical, behavioral and structural interventions tailored to the needs of the PWID.
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Des Jarlais DC, McKnight C, Arasteh K, Feelemyer J, Ross Z, Cooper HLF. Geographic distribution of risk ("Hotspots") for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history. Harm Reduct J 2019; 16:53. [PMID: 31477150 PMCID: PMC6721211 DOI: 10.1186/s12954-019-0326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
AIMS To identify geographic "hotspots" for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. METHODS A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. RESULTS Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. DISCUSSION Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.
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Affiliation(s)
- D C Des Jarlais
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA.
| | - C McKnight
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - K Arasteh
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - J Feelemyer
- College of Global Public Health, New York University, 665 Broadway, 8th Floor, New York, NY, 10003, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, 14850, USA
| | - H L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Knudsen HK, Cook J, Lofwall MR, Walsh SL, Studts JL, Havens JR. A mixed methods study of HIV-related services in buprenorphine treatment. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:37. [PMID: 28814313 PMCID: PMC5559779 DOI: 10.1186/s13011-017-0122-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers' medical specialty and across practice settings. METHODS Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients receive HIV testing, and availability of on-site HIV testing. Prescribers' medical specialty, practice settings, caseload demographics, and physician demographics were measured. Multivariate models of HIV services were estimated, while accounting for the nesting of physicians within states. RESULTS Qualitative interviews revealed that physicians often use injection behaviors as the primary indicator for whether a patient should be tested for HIV. Interviews revealed that HIV-related services were often viewed as beyond the scope of practice among general psychiatrists. Surveys indicated that prescribers screened for an average of 3.2 of 5 HIV risk behaviors (SD = 1.6) at intake. About 62.0% of prescribers delivered HIV education to patients and 53.2% recommended HIV testing to all new patients, but only 32.3% offered on-site HIV testing. Addiction specialists and psychiatrists screened for significantly more HIV risk behaviors than physicians in other specialties. Addiction specialists and psychiatrists were significantly less likely than other physicians to offer on-site testing. Physicians in individual medical practice were significantly less likely to recommend HIV testing and to offer onsite testing than physicians in other settings. CONCLUSIONS Buprenorphine treatment providers have not uniformly integrated HIV-related screening, education, and testing services for patients. Differences by medical specialty and practice setting suggest an opportunity for targeting efforts to increase implementation.
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 204, Lexington, KY, 40508, USA.
| | - Jennifer Cook
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 214, Lexington, KY, 40508, USA
| | - Michelle R Lofwall
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 203, Lexington, KY, 40508, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 202, Lexington, KY, 40508, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building, Room 127, Lexington, KY, 40536-0086, USA
| | - Jennifer R Havens
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 201, Lexington, KY, 40508, USA
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WHITEHEAD NICOLEENNIS. Commentary on Des Jarlais et al. (2017): Robust public health policies as a way forward in the HIV epidemic. Addiction 2017; 112:299-300. [PMID: 28078705 PMCID: PMC5820764 DOI: 10.1111/add.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022]
Abstract
Effective public health policies in the context of the HIV epidemic are complex, because HIV affects many subgroups that may or may not overlap. However, there is a good case for examining how robust public health policies can positively influence disease trends and the potential lessons that can be applied to high epidemic locales.
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Affiliation(s)
- NICOLE ENNIS WHITEHEAD
- University of Florida, Department of Clinical and Health Psychology, Gainesville, Florida, USA
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