1
|
Zhang Y, Shen B, Meng W, Gao B, Wang T, Geng Y. Correlation of internalized stigma with self-esteem, social support and coping styles in patients with rheumatoid arthritis: A cross-sectional study. Jpn J Nurs Sci 2024; 21:e12616. [PMID: 39136343 DOI: 10.1111/jjns.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 10/03/2024]
Abstract
AIM To understand the status of internalized stigma in patients with rheumatoid arthritis (RA) and explore its relationship with self-esteem, social support, and coping style. METHODS This cross-sectional study selected patients with RA who visited the Rheumatology and Immunology Department of a tertiary hospital from May 2022 to May 2023. The Chinese versions of the Internalized Stigma of Mental Illness Scale-Rheumatoid Arthritis (ISMI-RA), Social Support Rating Scale, Rosenberg Self-Esteem Scale, and Medical Coping Style Questionnaire were administered to assess the internalized stigma, social support, self-esteem, and coping styles, respectively. The Pearson correlation test or Spearman rank correlation was then used to analyze the correlation between these measures. RESULTS Overall, 69.5% participants reported high level of internalized stigma. The average age of the 174 participants was 52.67 ± 12.24 years, with 87.36 per cent female patients. The mean ISMI-RA score was 54.49 ± 9.62, and the ISMI-RA subscale with the highest average score was alienation. The Pearson's correlations show that internalized stigma was positively associated with the coping styles of avoidance (r = .212, p < .01) and acceptance (r = .560, p < .01), and that internalized stigma was negatively associated with the coping styles of confrontation (r = -.479, p < .01), social support (r = -.570, p < .01), and self-esteem(r = -.512, p < .05). CONCLUSION The high level of internalized stigma in RA patients suggests that we should develop interventions to improve patients' self-esteem, encourage them to adopt positive coping styles, and gain more social support for them, so as to alleviate their internalized stigma.
Collapse
Affiliation(s)
- Yi Zhang
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
- Department of Nursing, Nanjing Medical University, Nanjing, China
| | - Biyu Shen
- Department of Nursing, Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medcine, Shanghai, China
| | - Weifen Meng
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Bo Gao
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tiantian Wang
- Department of Pain Rehabilitation, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yaqin Geng
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
- Department of Nursing, Nanjing Medical University, Nanjing, China
| |
Collapse
|
2
|
Hernandez AL, Lingas EO, Juarez W, Villa A, Palefsky J. Using an anti-racist research framework to design studies of oral human papillomavirus and oropharyngeal cancer in San Francisco: rationale and protocol for the Health Equity and Oral Health in People living with HIV (HEOHP) qualitative study. BMJ Open 2024; 14:e091474. [PMID: 39317508 PMCID: PMC11423734 DOI: 10.1136/bmjopen-2024-091474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/14/2024] [Indexed: 09/26/2024] Open
Abstract
INTRODUCTION The goal of our research programme is to develop culturally appropriate patient-specific interventions for primary and secondary prevention of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) among people living with HIV (PLWH); PLWH are at a higher risk for OPC than the general population and, as with many cancers, there are disparities in OPC health outcomes by race and ethnicity. Our study incorporates an anti-racist research framework that proposes considering racism as a foundational sociocultural system that causes ill health. We expand the framework to include biases due to gender, sexual orientation, HIV status and membership in other non-dominant groups. Our research programme focuses on HPV-related OPC among people living with PLWH, and on how intersecting identities may impact an individual's experience with oral health, obtaining regular and appropriate oral healthcare, knowledge and perceptions of oral HPV infection, risk factors for OPC and HPV vaccination. METHODS AND ANALYSIS We will follow a grounded theory (GT) qualitative research methodology using focus group discussions (FGDs) to collect data. We will invite PLWH with intersecting identities to participate in one of 12-18 FGDs with 5-8 participants per group. Focus groups will be formed based on self-reported domains, including race, ethnicity, gender identity, sexual orientation and other identities that could impact oral health, such as smoking status, experience with homelessness or experience with drug use disorders. We do not know which aspects of intersecting identities are most salient to accessing oral healthcare. Using FGDs will allow us to gain this knowledge in a setting where participants can build on and reinforce shared understandings about oral healthcare. Following our GT methodology, analysis will occur concurrently with data collection, and emerging concepts or theories may result in changes to focus group guide questions. Initial focus group questions will be organised around our main objectives: (1) to identify individual, interpersonal and structural health equity factors that serve as barriers or facilitators to oral health status and care; (2) to explore knowledge and perceptions about causes, risk factors, prevention and screening for oral or OPC and (3) to elicit recommendations for improving access to regular and appropriate oral healthcare and suggestions on engaging PLWH from diverse identity groups in prevention interventions. ETHICS AND DISSEMINATION All methods and procedures were approved by the University of California, San Francisco, Institutional Review Board (approval number: 23-39307) and are in accordance with the Declaration of Helsinki of 1975, as revised in 2000. Participants are required to provide informed consent. The results of this study will be presented at scholarly meetings and published in peer-reviewed journals. In addition, a lay summary of results will be created and distributed to our participants and community through our website and social media. TRIAL REGISTRATION NUMBER NCT06055868.
Collapse
Affiliation(s)
- Alexandra L Hernandez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Public Health Program, Touro University California College of Education and Health Sciences, Vallejo, California, USA
| | | | - William Juarez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Alessandro Villa
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Joel Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
3
|
Acharya S, Parthasarathy MR, Karanjkar V, Katkar S, Setia MS. Barriers and facilitators for adherence to antiretroviral therapy, and strategies to address the barriers in key populations, Mumbai-A qualitative study. PLoS One 2024; 19:e0305390. [PMID: 38990894 PMCID: PMC11239046 DOI: 10.1371/journal.pone.0305390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/28/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Even though quantitative studies have described barriers to anti-retroviral therapy (ART), a more exploratory approach will provide in-depth information on these issues, and potential suggestions to address these issues at individual as well as structural level. We designed this qualitative study to examine the barriers and facilitators for antiretroviral therapy adherence in key population (KP) in Mumbai, India. We also wanted to understand the strategies adopted by these groups and get suggestions to improve adherence to ART. METHODS This is a qualitative analysis of seven focus group discussions (FGDs) conducted with four KP subgroups in Mumbai. We conducted two FGDs each with female sex workers (FSW), men who have sex with men (MSM), male-to-female transgendered people/Hijras (TGH) each, and one FGD with people who inject drugs (IDU). We transcribed the audio-recorded electronic records of these FGDs. We also added the notes of the observers on the group dynamics to the transcribed data. We used the Framework Approach to analyse these data. RESULTS Some experiences-such as side effects to ART medicines-were common across groups. However, incarceration as a reason for stopping ART was reported by FSWs but not by other KPs. Friends and family (including Guru) are important support systems for HIV infected individuals and adherence to ART. Stigma and discrimination by community members and general community prevent regular access of ART centres and other health care facilities. Additional factors which led to missed doses were mental health issues, alcohol use, and misplacing the ART tablets during police raids or during robbery attempts at the cruising sites. Since a common source of discrimination among peers and the community was the presence of 'Green book' (or their treatment book); the key population wanted the AIDS program to change it to digital cards so that labelling one as 'HIV positive' for being seen with the book can be avoided. CONCLUSIONS The qualitative study helped us explore the barriers to ART among key population and the community provided specific suggestions to address them. In addition to Key Population centric enhanced adherence counselling, some administrative guidelines and procedures may need to be altered to improve adherence to ART in these populations.
Collapse
Affiliation(s)
- Shrikala Acharya
- Mumbai Districts AIDS Control Society, Mumbai, India
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | | | | | | | | |
Collapse
|
4
|
Alcouffe L, Tareau MA, Oberlis M, Adenis A, Vignier N. Research in an intercultural context: mediator-investigators of epidemiological health studies, bridges between two worlds. Front Public Health 2024; 12:1342140. [PMID: 39022426 PMCID: PMC11251968 DOI: 10.3389/fpubh.2024.1342140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/03/2024] [Indexed: 07/20/2024] Open
Abstract
ContextFrench Guiana is a French overseas department where very different linguistic, cultural and societal populations live together in a small area. Health issues and their specific epidemiological profiles call for research projects crossing several cultures. In this context, health mediators have a role to play in research. The aim of this study was to describe the perceptions, attitudes and opinions on research of mediators and researchers collaborating on research projects, and to describe the strengths and difficulties encountered during this cooperation.MethodsThe Inter-med project was conducted in French Guiana between February 2022 and April 2023 on the base of semi-directive interviews with mediators, or researchers, all working in health research in the intercultural context of French Guiana. The socio-demographic characteristics of the participants were described. An inductive thematic analysis was carried out on all the interviews, and word occurrence analysis on certain themes. The information was triangulated with field coordination notebooks from two epidemiological surveys conducted in French Guiana between 2021 and 2022.ResultsA total of 26 semi-structured interviews were conducted and 1,328 notebook pages analyzed. Mediation was described as an indispensable interface between the world of research and that of the population targeted by a survey. Mediators have a role to play at different stages of projects, in respect of good clinical practice, ethics and legislation. They act as interfaces between languages, concepts and representations. Their profession remains under-defined and under-dimensioned. The jobs offered are often precarious. Mediation work is emotionally costly, calls on soft skills and requires a combination of rigor and flexibility. All these aspects are implemented in the specific world of research, where there are common concepts and divergent perceptions. Researchers and mediators converge on a common goal: improving health.ConclusionThis study covers several aspects of the development and implementation of research projects. Respect for good clinical practice and people, transparency and data quality are redundant concerns, and this study touches on ethnocentrism, stigmatization and cultural representations. This study points out that the integration and recognition of mediators could be beneficial in research conducted in a cross-cultural context.
Collapse
Affiliation(s)
- Leslie Alcouffe
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
| | - Marc-Alexandre Tareau
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Association Mélisse, Cayenne, French Guiana
| | | | - Antoine Adenis
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
| | - Nicolas Vignier
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Centre Hospitalier de Cayenne, Inserm CIC1424, Cayenne, French Guiana
- Université de Guyane, Cayenne, French Guiana
- Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne and Jean Verdier, AP-HP, Bobigny, French Guiana
- IAME, Inserm UMR 1137, Université Sorbonne Paris Nord, UFR SMBH, Bobigny, France
- Institut Convergences et Migration, Aubervilliers, French Guiana
| |
Collapse
|
5
|
Leavitt VM, Bae C, Shinohara RT, Weinstein SM, Schmidt H, Aoun SM, Solari A, Solomon AJ. Diagnosis concealment behaviors and disclosure beliefs are associated with health and quality of life in people with multiple sclerosis. Mult Scler Relat Disord 2024; 87:105628. [PMID: 38759425 DOI: 10.1016/j.msard.2024.105628] [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] [Received: 11/08/2023] [Revised: 03/31/2024] [Accepted: 04/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND People with multiple sclerosis (pwMS) struggle with whether, how, and how much to disclose their diagnosis. They often expend resources to conceal their diagnosis, and hold beliefs that it may negatively affect their personal relationships and/or professional opportunities. To better understand these effects, we developed a measure to quantify concealment behaviors and disclosure beliefs. Our main objective is to evaluate relationships of DISCO-MS responses to health and quality of life in a multinational cohort. METHODS Survey responses were obtained for DISCO-MS and PROMIS-MS scales: global health, communication, social roles participation, anxiety, depression, emotional / behavioral dyscontrol, fatigue, lower extremity function, positive affect / well-being, social roles satisfaction, sleep, stigma, upper extremity function, cognitive function, bladder control, bowel control, visual function. Simple linear regression assessed associations. RESULTS 263 pwMS were include. Higher concealment was associated with higher anxiety (beta= 0.15 [0.07, 0.23]), depression (beta = 0.13 [0.05, 0.21]), emotional dyscontrol (beta = 0.12 [0.04, 0.20]), lower affect / well-being (beta = -0.13 [-0.21, - 0.05]). Higher anticipation of negative consequences of disclosure was associated with lower self-reported physical (beta = -0.15) and mental health (beta = -0.14), lower positive affect / well-being, social roles satisfaction, higher anxiety, depression, emotional dyscontrol, sleep disturbance, and higher perceived stigma. DISCUSSION These results reveal potential consequences of diagnosis concealment for physical and mental health and quality of life. Raising awareness and implementing interventions may mitigate negative repercussions of concealment.
Collapse
Affiliation(s)
- Victoria M Leavitt
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Caleb Bae
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah M Weinstein
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | | | - Samar M Aoun
- University of Western Australia, Perron Institute for Neurological and Translational Science, La Trobe University, Australia
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrew J Solomon
- Larner College of Medicine at the University of Vermont, Department of Neurological Sciences. University Health Center, Arnold 2, 1 South Prospect Street, Burlington, VT, USA
| |
Collapse
|
6
|
Groenewegen H, Vissink A, Spijkervet FKL, Bierman WFW, Delli K. Quality Assessment of Internet Information Regarding Periodontitis in Persons Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:857. [PMID: 39063434 PMCID: PMC11276730 DOI: 10.3390/ijerph21070857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
The Internet is the most used source of HIV information second to information received from healthcare professionals. The aim of this study was to assess the quality of Internet information about periodontitis in people living with HIV (PLWH). An Internet search was performed on 18 April 2024 using the search terms "Periodontitis", "Periodontal disease", and "Gum disease" in combination with "HIV" in the most popular search engines (Google™, Bing™, and YAHOO!®). The first 20 results from each search term engine were pooled for analysis. Quality was assessed by JAMA benchmarks. Readability was assessed using the Flesch reading ease score (FRES). Origin of the site, type of author, and information details were also recorded. The quality of Internet information about periodontitis in PLWH varied. The mean JAMA score was 2.81 (SD = 1.0). The websites were generally fairly difficult to read (mean FRES = 57.1, SD = 15.0). Most websites provided some advice about self-treatment of oral problems, accompanied by a strong recommendation to seek professional dental care. In conclusion, advanced reading skills on periodontitis in PLWH were required and quality features were mostly not provided. Therefore, healthcare professionals should be actively involved in developing high-quality information resources and direct patients to evidence-based materials on the Internet.
Collapse
Affiliation(s)
- Hester Groenewegen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (F.K.L.S.); (K.D.)
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (F.K.L.S.); (K.D.)
| | - Fred K. L. Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (F.K.L.S.); (K.D.)
| | - Wouter F. W. Bierman
- Department of Internal Medicine, Division of Infectious Diseases, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands;
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (F.K.L.S.); (K.D.)
| |
Collapse
|
7
|
Vance DE, Billings R, Lambert CC, Fazeli PL, Goodin BR, Kempf MC, Rubin LH, Turan B, Wise J, Hellemann G, Lee J. A Systematic Review and Meta-Analysis of Social Cognition Among People Living with HIV: Implications for Non-Social Cognition and Social Everyday Functioning. Neuropsychol Rev 2024:10.1007/s11065-024-09643-5. [PMID: 38869661 DOI: 10.1007/s11065-024-09643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/05/2024] [Indexed: 06/14/2024]
Abstract
Social cognition-the complex mental ability to perceive social stimuli and negotiate the social environment-has emerged as an important cognitive ability needed for social functioning, everyday functioning, and quality of life. Deficits in social cognition have been well documented in those with severe mental illness including schizophrenia and depression, those along the autism spectrum, and those with other brain disorders where such deficits profoundly impact everyday life. Moreover, subtle deficits in social cognition have been observed in other clinical populations, especially those that may have compromised non-social cognition (i.e., fluid intelligence such as memory). Among people living with HIV (PLHIV), 44% experience cognitive impairment; likewise, social cognitive deficits in theory of mind, prosody, empathy, and emotional face recognition/perception are gradually being recognized. This systematic review and meta-analysis aim to summarize the current knowledge of social cognitive ability among PLHIV, identified by 14 studies focused on social cognition among PLHIV, and provides an objective consensus of the findings. In general, the literature suggests that PLHIV may be at-risk of developing subtle social cognitive deficits that may impact their everyday social functioning and quality of life. The causes of such social cognitive deficits remain unclear, but perhaps develop due to (1) HIV-related sequelae that are damaging the same neurological systems in which social cognition and non-social cognition are processed; (2) stress related to coping with HIV disease itself that overwhelms one's social cognitive resources; or (3) may have been present pre-morbidly, possibly contributing to an HIV infection. From this, a theoretical framework is proposed highlighting the relationships between social cognition, non-social cognition, and social everyday functioning.
Collapse
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, MO, USA
| | | | - Leah H Rubin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Rumelifeneri Caddesi, Turkey
| | - Jenni Wise
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerhard Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
8
|
Muiruri C, Dombeck C, Swezey T, Gonzales S, Lima M, Gray S, Vicini J, Pettit AC, Longenecker CT, Meissner EG, Okeke NL, Bloomfield GS, Corneli A. Specialty Care Referral for Underrepresented Minorities Living with HIV in the United States: Experiences, Barriers, and Facilitators. AIDS Patient Care STDS 2024; 38:259-266. [PMID: 38868933 PMCID: PMC11301706 DOI: 10.1089/apc.2024.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
The increased incidence of chronic diseases among people with HIV (PWH) is poised to increase the need for specialty care outside of HIV treatment settings. To reduce outcome disparities for HIV-associated comorbidities in the United States, it is critical to optimize access to and the quality of specialty care for underrepresented racial and ethnic minority (URM) individuals with HIV. We explored the experiences of URM individuals with HIV and other comorbidities in the specialty care setting during their initial and follow-up appointments. We conducted qualitative interviews with participants at three large academic medical centers in the United States with comprehensive health care delivery systems between November 2019 and March 2020. The data were analyzed using applied thematic analysis. A total of 27 URM individuals with HIV were interviewed. The majority were Black or African American and were referred to cardiology specialty care. Most of the participants had positive experiences in the specialty care setting. Facilitators of the referral process included their motivation to stay healthy, referral assistance from HIV providers, access to reliable transportation, and proximity to the specialty care health center. Few participants faced individual, interpersonal, and structural barriers, including the perception of individual and facility stigma toward PWH, a lack of transportation, and a lack of rapport with providers. Future case studies are needed for those URM individuals with HIV who face barriers and negative experiences. Interventions that involve PWH and health care providers in specialty care settings with a focus on individual- and structural-level stigma can support the optimal use of specialty care.
Collapse
Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Carrie Dombeck
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Teresa Swezey
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Morgan Lima
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shamea Gray
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph Vicini
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - April C. Pettit
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chris T. Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Eric G. Meissner
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nwora Lance Okeke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gerald S. Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
9
|
Beschorner N, Künzle P, Voges M, Hauber I, Indenbirken D, Nakel J, Virdi S, Bradtke P, Lory NC, Rothe M, Paszkowski-Rogacz M, Buchholz F, Grundhoff A, Schambach A, Thirion C, Mittrücker HW, Schulze zur Wiesch J, Hauber J, Chemnitz J. Preclinical toxicity analyses of lentiviral vectors expressing the HIV-1 LTR-specific designer-recombinase Brec1. PLoS One 2024; 19:e0298542. [PMID: 38457474 PMCID: PMC10923487 DOI: 10.1371/journal.pone.0298542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/25/2024] [Indexed: 03/10/2024] Open
Abstract
Drug-based antiretroviral therapies (ART) efficiently suppress HIV replication in humans, but the virus persists as integrated proviral reservoirs in small numbers of cells. Importantly, ART cannot eliminate HIV from an infected individual, since it does not target the integrated provirus. Therefore, genome editing-based strategies that can inactivate or excise HIV genomes would provide the technology for novel curative therapies. In fact, the HIV-1 LTR-specific designer-recombinase Brec1 has been shown to remove integrated proviruses from infected cells and is highly efficacious on clinical HIV-1 isolates in vitro and in vivo, suggesting that Brec1 has the potential for clinical development of advanced HIV-1 eradication strategies in people living with HIV. In line with the preparation of a first-in-human advanced therapy medicinal product gene therapy trial, we here present an extensive preclinical evaluation of Brec1 and lentiviral vectors expressing the Brec1 transgene. This included detailed functional analysis of potential genomic off-target sites, assessing vector safety by investigating vector copy number (VCN) and the risk for potential vector-related insertional mutagenesis, as well as analyzing the potential of Brec1 to trigger an undesired strong T cell immune response. In conclusion, the antiviral designer-recombinase Brec1 is shown to lack any detectable cytopathic, genotoxic or T cell-related immunogenic effects, thereby meeting an important precondition for clinical application of the therapeutic lentiviral vector LV-Brec1 in novel HIV-1 curative strategies.
Collapse
Affiliation(s)
- Niklas Beschorner
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
- PROVIREX Genome Editing Therapies GmbH, Hamburg, Germany
| | - Paul Künzle
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
| | - Maike Voges
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- PROVIREX Genome Editing Therapies GmbH, Hamburg, Germany
| | - Ilona Hauber
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- PROVIREX Genome Editing Therapies GmbH, Hamburg, Germany
| | - Daniela Indenbirken
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
| | - Jacqueline Nakel
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
| | - Sanamjeet Virdi
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
| | - Peter Bradtke
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Christian Lory
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rothe
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | | | - Frank Buchholz
- PROVIREX Genome Editing Therapies GmbH, Hamburg, Germany
- Medical Systems Biology, UCC, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Adam Grundhoff
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
| | - Axel Schambach
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | | | - Hans-Willi Mittrücker
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze zur Wiesch
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
- Infectious Diseases Unit, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Hauber
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
- PROVIREX Genome Editing Therapies GmbH, Hamburg, Germany
| | - Jan Chemnitz
- Leibniz-Institute of Virology (LIV), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg–Lübeck–Borstel–Riems, Germany
- PROVIREX Genome Editing Therapies GmbH, Hamburg, Germany
| |
Collapse
|
10
|
Amura CR, Thorne J, Bean M, Avery LK, Sylla LN, Liss HK, Cook PF. Evolution of HIV Health Care Workforce Needs in the U.S. Mountain West During the COVID-19 Pandemic: A Mixed Method Study. J Assoc Nurses AIDS Care 2024; 35:78-90. [PMID: 38949905 PMCID: PMC11217585 DOI: 10.1097/jnc.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
ABSTRACT The COVID-19 pandemic drastically affected health care delivery for vulnerable populations. Many facilities shifted services to telemedicine, and people with HIV or at risk of acquiring HIV experienced interruptions in care. Simultaneously, traditional training approaches to help providers adapt were disrupted. Using a mixed method approach to examine changes over time, we integrated data on trainee needs collected by the Mountain West AIDS Education and Training Center (AETC): a 10-state needs assessment survey in 2020; feedback from a 2020 community of practice; aggregate training data from 2000 to 2022; and a second survey in 2022. HIV care providers' training needs evolved from wanting support on telemedicine and COVID-19 patient care issues, to a later focus on mental health and substance use, social determinants of health, and care coordination. This integrative analysis demonstrates the vital role that AETCs can play in addressing evolving and emergent public health challenges for the HIV workforce.
Collapse
Affiliation(s)
- Claudia R Amura
- Claudia R. Amura, PhD, MPH, is an Assistant Professor of Research, University of Colorado College of Nursing, and is a Director of the Latino Health Certificate, Latino Research of Policy Center, Colorado School of Public University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Julia Thorne, is an MPH Graduate, Colorado School of Public Health, Aurora, Colorado, USA. Meagan Bean, is a Latino Health Certificate and MPH Candidate, Colorado School of Public Health, Aurora, Colorado, USA. Lisa Krug Avery, MSW, is a Professional Research Assistant, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Laurie N. Sylla, MHSA, is the Director, Mountain West AIDS Training Education Center, Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA. Hillary K. Liss, MD, is a Clinical Associate Professor, Division of General Internal Medicine, University of Washington, Seattle, Washington, USA. Paul F. Cook, PhD, is a Professor and Chair, Department of Behavioral, Family and Population Health, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | | | | | | |
Collapse
|
11
|
Wadhwa S, Finn TR, Kister K, Matsumura S, Levit M, Cantos A, Shah J, Bohn B, Lalla E, Grbic JT, Demmer RT, Yin MT. Postmenopausal women with HIV have increased tooth loss. BMC Oral Health 2024; 24:52. [PMID: 38191383 PMCID: PMC10775528 DOI: 10.1186/s12903-023-03744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND With effective antiretroviral therapy, people with HIV (PWH) are living longer and aging; the majority of PWH in the United States are now over the age of 50 and in women have gone through the menopause transition. Menopause potentiates skeletal bone loss at the spine, hip, and radius in PWH. The alveolar bone which surronds the teeth is different than long bones because it is derived from the neural crest. However, few studies have assessed the oral health and alveolar bone in middle aged and older women with HIV. Therefore, the objective of this study was to evaluate periodontal disease and alveolar bone microarchitecture in postmenopausal women with HIV. METHODS 135 self-reported postmenopausal women were recruited (59 HIV-, 76 HIV + on combination antiretroviral therapy with virological suppression) from a single academic center. The following parameters were measured: cytokine levels (IFN-γ, TNF-α, IL-1β, IL-2, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, IL-17 A, OPG, and RANKL) in gingival crevicular fluid, bleeding on probing, probing depth, clinical attachment loss, number of teeth present, alveolar crestal height, and alveolar bone microarchitecture. RESULTS The mean age of participants was 57.04+/-6.25 years and a greater proportion of women with HIV were black/African American (HIV + 68.42%, HIV- 23.73%; p < 0.001). There was no significant difference in bleeding on probing (p = 0.17) and attachment loss (p = 0.39) between women who were HIV infected vs. HIV uninfected. Women with HIV had significantly higher RANKL expression in Gingival Crevicular Fluid (HIV + 3.80+/-3.19 pg/ul, HIV- 1.29+/-2.14 pg/ul ; p < 0.001), fewer teeth present (HIV + 17.75+/-7.62, HIV- 22.79+/-5.70; p < 0.001), ), lower trabecular number (HIV + 0.08+/-0.01, HIV- 0.09+/-0.02; p = 0.004) and greater trabecular separation (HIV + 9.23+/-3.11, HIV- 7.99+/-3.23; p = 0.04) compared to women without HIV that remained significant in multivariate logistic regression analysis in a sub-cohort after adjusting for age, race/ethnicity, smoking status, and diabetes. CONCLUSION Postmenopausal women with HIV have deterioration of the alveolar trabecular bone microarchitecture that may contribute to greater tooth loss.
Collapse
Affiliation(s)
- Sunil Wadhwa
- Division of Orthodontics, Columbia University College of Dental Medicine, New York, NY, USA.
| | - Taylor R Finn
- Division of Orthodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - Karolina Kister
- Division of Orthodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - Satoko Matsumura
- Division of Oral and Maxillofacial Radiology, Columbia University College of Dental Medicine, New York, NY, USA
| | - Michael Levit
- Division of Orthodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - Anyelina Cantos
- Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jayesh Shah
- Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Evanthia Lalla
- Division of Periodontics, Columbia University College of Dental Medicine, New York, NY, USA
| | - John T Grbic
- Division of Foundational Sciences, Columbia University College of Dental Medicine, New York, NY, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Michael T Yin
- Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
12
|
Nguyen TT, Huong DT, Nguyen LT, Nguyen BD, Giang LM, Lin C. Disclosure of HIV Status in Healthcare Settings: Practices and Considerations among Women Living with HIV/AIDS in Vietnam. J Int Assoc Provid AIDS Care 2024; 23:23259582241277655. [PMID: 39238476 PMCID: PMC11378245 DOI: 10.1177/23259582241277655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE This study investigated women living with HIV/AIDS (WLHA)'s practices and decision-making regarding disclosure of HIV status in healthcare settings in Vietnam. Introduction: Disclosure of HIV status in healthcare settings is under-studied. METHODS We conducted in-depth interviews with 30 WLHA in Hanoi, Vietnam. Thematic analysis was conducted to investigate the patterns, considerations, and consequences of HIV disclosure. Results: Most participants chose a selective disclosure strategy based on the type of procedure and healthcare setting. They considered several factors: concerns about stigma/discrimination, risks of confidentiality breach, relevance to healthcare provision, and altruism towards protecting providers and other patients. Selective disclosure or non-disclosure often prevented participants from accessing comprehensive care. Conclusion: The study underscores the need to prepare WLHA to make informed decisions regarding disclosure and provide them with service navigations and support. It also highlights the necessity of reducing stigma and enhancing confidentiality protection to ensure safe disclosure in healthcare settings.
Collapse
Affiliation(s)
- Thu Trang Nguyen
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Dang Thi Huong
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Lynn T Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Bich Diep Nguyen
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Le Minh Giang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Hanoi, Vietnam
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, USA
| |
Collapse
|
13
|
Siette J, Meka A, Antoniades J. Breaking the barriers: overcoming dementia-related stigma in minority communities. Front Psychiatry 2023; 14:1278944. [PMID: 38179250 PMCID: PMC10765564 DOI: 10.3389/fpsyt.2023.1278944] [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: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Dementia is a global health concern that affects individuals irrespective of their cultural or linguistic backgrounds. However, research has long recognized the pronounced stigma associated with dementia, particularly within Culturally and Linguistically Diverse (CALD) communities. This article seeks to summarize the underlying factors contributing to the heightened levels of dementia stigma within CALD communities, through a review of the literature. Our examination shows that cultural beliefs, language barriers, limited awareness, and the impact of migration on perceptions of aging and cognitive decline are contributing factors. Consequently, our analysis highlights the need for tailored, culturally appropriate interventions aimed at mitigating stigma and enhancing dementia care within CALD populations. Our proposed solutions, built on a social-ecological approach, highlights the critical role of collaborative efforts involving policymakers, healthcare providers, community organizations, and CALD community members in fostering a more dementia-inclusive society. This perspective piece aims to shed light on the distinct challenges faced by CALD communities, while advocating for a holistic approach to redefine perceptions and care strategies tailored to these populations.
Collapse
Affiliation(s)
- Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, Australia
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Anjani Meka
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, NSW, Australia
| | - Josefine Antoniades
- National Ageing Research Institute, Affiliate Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Royal Melbourne Hospital, Parkville, VIC, Australia
| |
Collapse
|
14
|
Jia DT, Carcamo PM, Diaz MM. Ongoing Healthcare Disparities in neuroHIV: Addressing Gaps in the Care Continuum. Curr HIV/AIDS Rep 2023; 20:368-378. [PMID: 37999827 DOI: 10.1007/s11904-023-00683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW We aim to review the neurological complications of HIV and the social, cultural, and economic inequalities that contribute to disparities in neuroHIV care. RECENT FINDINGS Disparities in diagnostics and care of patients with neurological infections and non-infectious conditions associated with HIV in both high-income and low-to-middle-income countries (LMIC) are common. The COVID-19 pandemic has exacerbated these disparities. Factors, such as HIV-related stigma, may deter people from accessing HIV treatment. First-line recommended treatments for neurological infections are not available in many LMICs, leading to inadequate treatment and exposure to agents with more harmful side effect profiles. Access-related factors, such as lack of transportation, lack of health insurance, and inadequate telehealth access, may increase the risk of HIV-related neurological complications. Further research is needed to increase awareness of neurological complications among providers and PWH, and regional guidelines should be considered to better address these complications.
Collapse
Affiliation(s)
- Dan Tong Jia
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Paloma M Carcamo
- Laboratory of Epidemiology and Public Health, Yale School of Public Health, New Haven, CT, USA
- Health Innovation Laboratory, Alexander Von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica M Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| |
Collapse
|
15
|
McIntyre AC, Cody SL, Ezemenaka CJ, Johnson K, Mugoya G, Foster P. HIV Knowledge, Risk Factors, and Utilization of Services in the US Rural Deep South. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01868-z. [PMID: 37985647 DOI: 10.1007/s40615-023-01868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND HIV prevalence in the rural South remains high among Black Americans due to limited access to prevention and treatment services and poverty. HIV care inequities for Black Americans living in the rural South are further intensified by high mortality rates, low HIV health literacy, stigma, and discrimination. Few studies have focused on HIV knowledge and risk factors within Black Americans in the rural South. METHODS This cross-sectional study examined the association between HIV risk factors, HIV knowledge, and utilization of HIV and/or sexually transmitted infection (STI) testing services among Black Americans (N = 200) living in the rural South. HIV knowledge, risk factors, and utilization of testing services were assessed via The HIV Knowledge Questionnaire, The HIV Risk Factor Questionnaire, and three investigator-generated questions, respectively. Linear regression was used to examine the relationship between demographic characteristics, HIV knowledge, utilization of testing services, and HIV risk factors. RESULTS Among 200 participants, a smaller percentage (37.7%, n = 75) reported using HIV/STI testing services compared to non-users. Controlling for demographic covariates in the model, HIV knowledge (p < .0001) and marital status (p = .010) were significantly associated with HIV risk factors. HIV risk factors decreased as HIV knowledge increased. Individuals who reported being single also reported having fewer risk factors. CONCLUSION Future research should examine the impact of HIV education tailored for individuals with greater HIV risk factors within rural Black Americans. Studies exploring barriers to the utilization of HIV/STI testing services within Black American rural communities are warranted.
Collapse
Affiliation(s)
- Alissa C McIntyre
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Tuscaloosa, AL, 35487-0348, USA.
| | - Shameka L Cody
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA
| | | | - Karen Johnson
- Department of Social Work, The University of Alabama, Tuscaloosa, AL, USA
| | - George Mugoya
- Department of Educational Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Pamela Foster
- Department of Community Medicine/Population Health, School of Medicine, The University of Alabama, Tuscaloosa Regional Campus, Tuscaloosa, AL, USA
| |
Collapse
|
16
|
Wang R, Zheng F, Cao G, Goldsamt LA, Shen Y, Zhang C, Yi M, Peng W, Li X. The relationship between social support and depression among HIV-positive men who have sex with men in China: the chain mediating role of psychological flexibility and hope. Front Public Health 2023; 11:1271915. [PMID: 38026353 PMCID: PMC10665023 DOI: 10.3389/fpubh.2023.1271915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction HIV and mental health problems are a global syndemic. One key issue is that the significant mental health problems among people vulnerable to acquiring or living with HIV have not been fully addressed. Access to social support has been one of the biggest challenges for HIV-positive men who have sex with men (HIV+ MSM). Lower social support has been linked to more severe depression symptoms. However, the mechanisms underlying the association between social support and depression in HIV+ MSM are unclear. Two possible mediators include hope and psychological flexibility. This study aimed to examine the relationship between social support and depression in HIV+ MSM and to explore the single mediating effects of hope and psychological flexibility and the chain mediating effect of these two variables on this relationship. Methods A convenience sample was used to recruit participants from the designated HIV/AIDS hospital in Changsha city, Hunan Province of China. A total of 290 HIV+ MSM completed questionnaires. Results Our findings showed that hope mediated the relationship between social support and depression in HIV+ MSM. Furthermore, the chain mediation model confirmed a direct negative association between social support and depression, but this relationship was largely mediated by the chain effects of hope and psychological flexibility. Conclusions Integrating hope and psychological flexibility into interventions may provide better mental health support for HIV+ MSM and improve their wellbeing and quality of life.
Collapse
Affiliation(s)
- Run Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Fang Zheng
- Department of AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Guiying Cao
- Department of AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Lloyd A. Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Yan Shen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Mengyao Yi
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| |
Collapse
|
17
|
Rana BK, Sarfraz M, Reza TE, Emmanuel F. A Cross-Sectional Study to Assess HIV/AIDS-Related Stigma and Its Drivers Among Dental Healthcare Providers in Islamabad, Pakistan. Cureus 2023; 15:e46769. [PMID: 37954825 PMCID: PMC10632562 DOI: 10.7759/cureus.46769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction HIV-related stigma and discrimination among healthcare providers are some of the strongest obstacles to effectively responding to HIV and achieving health-related quality of life. In the Pakistani context, HIV-related discrimination has been explored mainly among people living with HIV (PLHIV), and no study has investigated HIV-related stigma from the perspective of dental healthcare providers. Aim This study aimed to investigate the HIV-related stigma among dental healthcare workers in Pakistan and understand the factors associated with it. Methodology This cross-sectional study was conducted for a period of three months (December 2021 to February 2022) among 601 consenting dental healthcare providers in all public and private dental healthcare facilities in Islamabad, Pakistan. Pretested questionnaires collected information on demographics, work-related characteristics, knowledge, attitudes, and practices regarding HIV/AIDS. HIV-related stigma was assessed through "the stigma index" developed by USAID and was measured as a continuous variable. Multivariate linear regression analysis evaluated the independent effect of different factors associated with HIV-related stigma. Results HIV-related stigma remains highly prevalent within both public and private dental healthcare facilities in ICT and among all cadres of dental healthcare providers. Among associated factors, misconceptions in HIV knowledge are highly significant (p < 0.001) and those with a higher score of incorrect HIV knowledge had higher levels of stigma. Healthcare providers who read any HIV-related manual or guidelines were found to be less stigmatized as compared to those who have not been exposed to any such literature (p=0.029). Dentists (p=0.04) showed higher levels of stigma as compared to dental assistants and dental hygienists, while employees of private hospitals (p=0.0) and private clinics (p=0.0) were far more stigmatized by HIV in comparison to dental healthcare providers in public hospitals. Conclusion This study provides the first-ever analysis of HIV-related stigma and its drivers in the dental healthcare settings in Pakistan and highlights multiple individual, clinical, and policy-level factors associated with it. In order to address this stigma, it is essential for healthcare institutions to create supportive and inclusive healthcare settings, by providing education and training to care providers in order to increase their understanding of the disease itself. In addition, healthcare institutions can take steps to ensure that their policies and practices are inclusive and non-discriminatory, such as implementing policies that prohibit discrimination based on HIV status and providing confidential care. On the other hand, care providers must work to recognize their own biases and strive to provide non-discriminatory and culturally sensitive care to all patients. The findings of this study could be used as a baseline and insight by organizations like the National AIDS Control Program into possible targets for future exploration and interventions to effectively reduce the stigma toward PLHIV in dental healthcare settings.
Collapse
Affiliation(s)
- Beenish K Rana
- Global Public Health, Health Services Academy, Islamabad, PAK
| | - Mariyam Sarfraz
- Global Public Health, Health Services Academy, Islamabad, PAK
| | - Tahira Ezra Reza
- Epidemiology and Public Health, Centre for Global Public Health, Islamabad, PAK
| | - Faran Emmanuel
- Epidemiology and Public Health, University of Manitoba, Winnipeg, CAN
| |
Collapse
|
18
|
Subramanian K, Alayo QA, Sedarous M, Nwaiwu O, Okafor PN. Healthcare Disparities Among Homeless Patients Hospitalized With Gastrointestinal Bleeding: A Propensity-Matched, State-Level Analysis. J Clin Gastroenterol 2023; 57:707-713. [PMID: 36730876 DOI: 10.1097/mcg.0000000000001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
GOALS Examine outcomes among homeless patients admitted with gastrointestinal (GI) bleeding, including all-cause mortality and endoscopic intervention rates. BACKGROUND Hospitalizations among homeless individuals have increased steadily since at least 2007 but little is known about GI outcomes in these patients. STUDY The 2010-2014 Healthcare Utilization Project (HCUP) State Inpatient Databases from New York and Florida were used to identify adults admitted with a primary diagnosis of acute upper or lower GI bleed. Homeless patients were 1:3 matched with nonhomeless patients using a propensity-score greedy-matched algorithm. The primary outcome (all-cause in-hospital mortality) and secondary outcomes (30-day readmission rates, endoscopy utilization, length of stay, and total hospitalization costs) were compared. RESULTS We matched 4074 homeless patients with 12,222 nonhomeless patients. Most hospitalizations for homeless individuals were concentrated in 113 (26.4%) of 428 hospitals. Homeless adults were more likely to be younger, male, African American or Hispanic, and on Medicaid. They experienced significantly higher odds of all-cause inpatient mortality compared with nonhomeless patients admitted with GI bleeding (OR 1.37, 95% CI 1.11-1.69). Endoscopy utilization rates were also lower for both upper (OR 0.62, 95% CI 0.55-0.71) and lower (OR 0.76, 95% CI 0.68-0.85) GI bleeding, though upper endoscopy rates within the first 24 hours were comparable (OR 1.11, 95% CI 1.00-1.23). Total hospitalization costs were lower ($9,715 vs. $12,173, P <0.001) while 30-day all-cause readmission rates were significantly higher in the homeless group (14.9% vs. 18.4%, P <0.001). CONCLUSIONS Homeless patients hospitalized for GI bleeding face disparities, including higher mortality rates and lower endoscopy utilization.
Collapse
Affiliation(s)
- Kavitha Subramanian
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Quazim A Alayo
- Division of Internal Medicine, St. Luke's Hospital, Chesterfield, MO, USA
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO
| | - Mary Sedarous
- Department of Medicine, McMaster University, Hamilton, ON L8S4L8
| | - Obioma Nwaiwu
- Department of Medicine, University of Arkansas School of Medical Sciences, Little Rock, AR
| | - Philip N Okafor
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
19
|
Bouabida K, Chaves BG, Anane E. Challenges and barriers to HIV care engagement and care cascade: viewpoint. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1201087. [PMID: 37547803 PMCID: PMC10398380 DOI: 10.3389/frph.2023.1201087] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Patients with human immunodeficiency virus (HIV) are subject to long-term management and a complex care process. Patients with HIV are clinically, socially, and emotionally vulnerable, face many challenges, and are often stigmatized. Healthcare providers should engage them with diligence in the HIV care cascade process. In this paper, we discuss from our viewpoint certain social and public health barriers and challenges that should be considered by healthcare providers to better engage patients in the HIV care cascade process and maximize its outcomes.
Collapse
Affiliation(s)
- Khayreddine Bouabida
- Research Center of the Hospital Center of the University of Montreal (CRCHUM), Montreal, MTL, Canada
- École de Santé Publique, Université de Montréal, Montreal, QC, Canada
- Department of Biomedical Research, St. George’s University School of Medicine, Great River, NY, United States
| | | | - Enoch Anane
- Department of Biomedical Research, St. George’s University School of Medicine, Great River, NY, United States
| |
Collapse
|
20
|
Skuban-Eiseler T, Orzechowski M, Steger F. Access to healthcare for people living with HIV: an analysis of judgments of the European Court of Human Rights from an ethical perspective. Front Public Health 2023; 11:1193236. [PMID: 37377554 PMCID: PMC10292927 DOI: 10.3389/fpubh.2023.1193236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Although HIV has been part of our reality for over 30 years, people living with HIV (PLHIV) still experience restrictions regarding their access to healthcare. This poses a significant ethical problem, especially as it endangers achieving the goal of ending the HIV epidemic worldwide. The aim of this paper is to analyze the rulings of the European Court of Human Rights (ECtHR) regarding cases where PLHIV experienced restrictions on their access to healthcare. Methods We conducted an analysis of the ECtHR database and were able to identify N = 28 cases dealing with restricted access to healthcare for PLHIV. A descriptive and thematic analysis was conducted to identify ways in which access to healthcare for PLHIV was restricted. Results We were able to identify a total of four main categories, with denial of adequate therapeutic support as the main category with N = 22 cases (78.57%). Most of the judgments examined were filed against Russia (N = 12, 42.86%) and Ukraine (N = 9, 32.14%). A large proportion of PLHIV in the cases studied (N = 57, 85.07%) were detainees. Discussion The analysis shows a clear condemnation of limited access to healthcare for PLHIV by the ECtHR. Ethical implications of the analyzed cases are discussed in detail.
Collapse
Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
- kbo-Isar-Amper-Klinikum Region München, Munich, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| |
Collapse
|
21
|
Semler M, Pax L, McNamara KF, Joyce C, Shore J, Morey C, Gawne E, Clark NM. Reported HIV-related stigma according to race and ethnicity. AIDS Care 2023:1-8. [PMID: 37128634 DOI: 10.1080/09540121.2023.2206097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
People living with HIV/AIDS (PLWHA) have long experienced structural, community, and personal stigma. We explored differences in experienced HIV-related stigma according to race/ethnicity using quantitative and qualitative measures. Sixty-four patients were enrolled in this study (22 White and 42 people of color [POC]). POC scored higher than White PLWHA on all 12 survey statements, with statistically significant differences in disclosure concerns and with one of the statements on public attitudes towards PLWHA. Common themes in the qualitative interview were HIV disclosure concerns and fear of rejection. These data demonstrate that stigma continues to be a significant concern for PLWHA, particularly POC, meaningfully impacting their lives. By acknowledging and working to reduce negative perceptions about PLWHA, physicians may improve care for their patients by developing more trusting relationships.
Collapse
Affiliation(s)
- Matthew Semler
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Laura Pax
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Cara Joyce
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
- Center for Health Outcomes and Informatics Research, Loyola University Chicago, Maywood, IL, USA
| | | | - Craig Morey
- Loyola University Medical Center, Maywood, IL, USA
| | | | - Nina M Clark
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
- Loyola University Medical Center, Maywood, IL, USA
- Infectious Disease & Immunology Research Institute, Loyola University Chicago, Maywood, IL, USA
| |
Collapse
|
22
|
SeyedAlinaghi S, Mirzapour P, Pashaei Z, Afzalian A, Tantuoyir MM, Salmani R, Maroufi SF, Paranjkhoo P, Maroufi SP, Badri H, Varshochi S, Vahedi F, Mehraeen E, Dadras O. The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review. AIDS Res Ther 2023; 20:4. [PMID: 36609313 PMCID: PMC9821373 DOI: 10.1186/s12981-022-00496-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The COVID-19 epidemic and various control and mitigation measures to combat the widespread outbreak of the disease may affect other parts of health care systems. There is a concern that the COVID-19 pandemic could disrupt HIV services. Therefore, this study aimed to systematically evaluate the effect of the COVID-19 pandemic on service delivery and treatment outcomes in people with HIV. METHODS In this study, a systematic search was conducted using the keywords in the online databases including Scopus, PubMed, Web of Science, and Cochrane databases. The retrieved articles underwent a two-step title/abstract and full-text review process, and the eligible papers were selected and included in the qualitative synthesis. RESULT We selected 16 studies out of 529 retrieved records that met the inclusion criteria for this review. Study populations of the selected studies were either HIV-positive patients or HIV clinics and healthcare providers. Most studies were focused on adhering to and obtaining medication and attending clinical appointments and their decrement during the pandemic. Other aspects of HIV care (alternative healthcare settings, viral suppression, psychological care, etc.) were discussed to a lesser extent by the included studies. CONCLUSION Interruption in in-person visits and medical follow-up services, loss of adherence to treatment, and subsequent increase in mortality due to the COVID-19 pandemic complications in PLHIV have led to growing concerns. Other challenges were psychological disorders such as anxiety and depression, an increase in substance abuse, and a rise in experienced stigma and discrimination. However, the use of telemedicine in some countries helps to alleviate the situation to some extent and is recommended in similar settings in the future.
Collapse
Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Mirzapour
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Pashaei
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Arian Afzalian
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Marcarious M. Tantuoyir
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,grid.8652.90000 0004 1937 1485Biomedical Engineering Unit, University of Ghana Medical Center (UGMC), Accra, Ghana
| | - Roghayeh Salmani
- Department of Midwifery, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Seyed Farzad Maroufi
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Paranjkhoo
- grid.78780.300000 0004 0613 1044Turpanjian College of Health Sciences, American University of Armenia, 0019 Yerevan, Armenia
| | - Seyede Parmis Maroufi
- grid.486769.20000 0004 0384 8779Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hajar Badri
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, 5681761351 Iran
| | - Sanaz Varshochi
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Vahedi
- grid.411705.60000 0001 0166 0922School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, 5681761351 Iran
| | - Omid Dadras
- grid.411705.60000 0001 0166 0922Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran ,grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
23
|
Pereira LL, Veiga Siqueira Amorim D, Brito Sampaio W, Almeida Cruz Azevêdo T, Bispo Pereira Cardoso V, Barreto Lemos F, Silva Chang A, Machado F, Pereira Lima F, Sampaio Neves F, Leal Figueiredo AC. Factors Associated with Periodontitis in Patients with and without HIV. Int J Dent 2023; 2023:9929835. [PMID: 37159593 PMCID: PMC10163962 DOI: 10.1155/2023/9929835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose The aim of this study was to compare clinical periodontal conditions in HIV-positive people on HAART with an HIV-negative group, in addition to investigating factors associated with periodontitis in the entire sample. Methods This was a cross-sectional study. Data were collected by oral clinical examination for the diagnosis of periodontitis, review of medical records, and application of a questionnaire containing personal data, deleterious habits, and oral hygiene habits for the other variables. The results were analyzed by Pearson's χ 2 test and Student's t-test. A logistic regression model was constructed for the multivariate analysis and periodontitis was defined as a dependent variable. The analysis was performed on the entire sample (HIV+ and HIV-) and also on the group consisting of only people living with HIV. Results Individuals older than 43 years old and with HIV were more likely to develop moderate and severe periodontitis (47.80 and 4.84 times, respectively). When analyzing only HIV+, in addition to age (OR = 2.795; CI = 1.080-7.233), the use of nonnucleoside reverse transcriptase inhibitors (NNRTIs) (OR = 2.841; CI = 1.135-7.112) was also associated with moderate and severe periodontitis. Conclusion It was possible to observe a higher prevalence of periodontitis among individuals with HIV, showing an association between the virus, advanced age, and moderate or severe periodontitis.
Collapse
Affiliation(s)
- Luanderson Lopes Pereira
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | - Willian Brito Sampaio
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | | | - Felipe Barreto Lemos
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Andressa Silva Chang
- Postgraduate Program in Dentistry and Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | | | | | | |
Collapse
|
24
|
Health Related Quality of Life and Psychopathological Symptoms in People with Hemophilia, Bloodborne Co-Infections and Comorbidities: An Italian Multicenter Observational Study. Mediterr J Hematol Infect Dis 2023; 15:e2023005. [PMID: 36660351 PMCID: PMC9833307 DOI: 10.4084/mjhid.2023.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
Background The health-related quality of life (HRQoL) of people with hemophilia (PWH) is an important issue, especially considering people suffering from chronic diseases beyond hemophilia. The principal aim of this study was to investigate the presence and relevance of psychological symptoms, both internalizing and externalizing, lifestyle, and HRQoL in a group of Italian PWH with chronic bloodborne co-infections and comorbidities. Furthermore, the research describes the association between psychological aspects and the impact of disease-related characteristics (type of hemophilia, presence of co-infections, and comorbidities) on them. Methods Seventy patients (mean age 46.77±11.3), 64 with severe hemophilia A (Factor VIII: C < 1 IU/dL) and 6 with severe hemophilia B (Factor IX <1 IU/dL), were consecutively recruited from seven Hemophilia Centers in Italy of Italian Association of Hemophilia Centers (AICE). In order to assess psychological symptoms, HRQoL, and lifestyle, three psychological questionnaires were administered (the SCL-90-R, SF-36, and PSQ, respectively). Results A general decline in the quality of life and an increase in the tendency to adopt a lifestyle characterized by hyperactivity emerged. Inverse correlations were found between HRQoL and psychological distress. Although the SCL-90-R did not reveal symptoms above the clinical cut-off, co-infections significantly increased anxiety, depression, somatizations, paranoia, and social withdrawal. Lastly, HRQoL is impaired by co-infections as well as comorbidities. Conclusion Our preliminary results must be confirmed to deepen the findings between mental health and hemophilia.
Collapse
|
25
|
Chakrapani V, Kershaw T, Kaur J, Shunmugam M, Nelson R, Vijin PP, Rajan M, Subramanian T. Associations between sexual stigma, enacted HIV stigma, internalized HIV stigma and homonegativity, and depression: testing an extended minority stress model among men who have sex with men living with HIV in India. AIDS Care 2022; 34:1586-1594. [PMID: 36062378 DOI: 10.1080/09540121.2022.2119467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Limited data is available on the associations between intersectional stigmas and mental health outcomes among men who have sex with men living with HIV (MSMLH) in India. The minority stress model postulates that sexual stigma contributes to depression through proximal stressors like internalized homonegativity (IHN). Using cross-sectional survey data from 119 MSMLH in 2015/16, we tested whether: (1) sexual stigma and enacted HIV stigma (EHS) are associated with depression; (2) their effects on depression are mediated through IHN and internalized HIV stigma (IHS); and (3) their effects on IHN are mediated through IHS. Significant direct associations were observed between scores on sexual stigma and IHS (β = .49, 95% CI .27, .70), EHS and IHN (β = .19, 95% CI .03, .36), and IHS and IHN (β = .07, 95% CI .03, .12). IHS scores mediated the associations of sexual stigma with depression (β = .17, 95% CI .07, .27) and IHN scores (β = .04, 95% CI .004, .07). EHS was not found to be significantly associated with depression or IHN. The findings partially support the minority stress model among MSMLH and highlight the importance of addressing both sexual and HIV-related stigmas to improve mental health of MSMLH, especially by screening for and reducing IHS, IHN and depression.
Collapse
Affiliation(s)
| | - Trace Kershaw
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Jasvir Kaur
- Department of Nursing, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Ruban Nelson
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | | | - Magesh Rajan
- ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, India
| | | |
Collapse
|
26
|
Wu X, Hu Y, Hu A. Stigma and illness uncertainty among patients with visible burn scars: A cross-sectional study. Burns 2022; 48:1190-1197. [PMID: 34635366 DOI: 10.1016/j.burns.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/06/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022]
Abstract
The purpose of this research was to understand the current status of stigma and illness uncertainty in patients with visible burns and explore the correlation between them. Measures to help patients alleviate shame and uncertainty in illness are also discussed. A cross-sectional study was conducted in a tertiary hospital from November 2020 to March 2021 for patients with burns on exposed parts of the face, neck, or limbs. The scales used in this study include demographic data questionnaires, the Social Impact Scale (SIS), and the Mishel Uncertainty in Illness Scale for Adults (MUIS-A). A two-tailed independent t-test was used to evaluate the differences in the respondents' sociodemographic characteristics, stigma, and illness uncertainty. The total stigma and illness uncertainty scores of 146 patients were 57.03 ± 6.762 and 68.59 ± 12.901, respectively. Spearman correlation analysis showed that stigma was positively correlated with illness uncertainty (r = 0.398, p < 0.01). Multiple regression analysis showed a relationship between stigma and uncertainty of illness (B = 0.215, p = 0.000), itching (B = 2.555, p = 0.01), residence (B = 2.545, p = 0.029), and age (B = 0.074, p = 0.037). The stigma level of patients with visible burns increased with increasing uncertainty regarding illness. Therefore, reducing the patients' uncertainty in illness is a way to intervene in stigma.
Collapse
Affiliation(s)
- Xiaoxue Wu
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yueyun Hu
- The Third Affiliated Hospital, Sun Yat-sen University, No. 2693 Kaichuang Street, Huangpu District, Guangzhou, China
| | - Ailing Hu
- The Third Affiliated Hospital, Sun Yat-sen University, No. 2693 Kaichuang Street, Huangpu District, Guangzhou, China.
| |
Collapse
|
27
|
Wilson NL, Hoffman TJ, Heath SL, Saag MS, Miaskowski C. HIV Symptom Clusters are Similar Using the Dimensions of Symptom Occurrence and Distress. J Pain Symptom Manage 2022; 63:943-952. [PMID: 35235857 PMCID: PMC10408902 DOI: 10.1016/j.jpainsymman.2022.02.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
CONTEXT People living with HIV infection (PLWH) in the United States continue to experience a high symptom burden despite improvements in antiretroviral therapy. OBJECTIVES The purpose of this study was to determine if the number and types of symptom clusters differed based on whether symptom occurrence rates or distress ratings were used to create the clusters. METHODS Data from 2,000 patients with complete symptom occurrence rates and distress scores on the 20-item HIV Symptom Index from their first ambulatory clinic visit at one of six national HIV centers of excellence in the Center for AIDS Research Network of Integrated Clinical Systems were used in these analyses. Exploratory factor analysis was used to create the symptom clusters. RESULTS The same four symptom clusters (i.e., gastrointestinal, psychological, pain, body image) were identified using occurrence rates and distress ratings. For both dimensions of the symptom experience, the psychological, pain, and body image clusters each had the same symptoms. For the gastrointestinal cluster, four symptoms loaded on the occurrence dimension and six symptoms loaded on the distress dimension. CONCLUSION The number and types of symptom clusters were relatively similar across the occurrence and distress dimensions of the symptom experience. Symptom clusters in PLWH may provide insights into the development of targeted interventions for multiple co-occurring symptoms.
Collapse
Affiliation(s)
- Natalie L Wilson
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, USA.
| | - Thomas J Hoffman
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Sonya L Heath
- Division of Infectious Diseases, School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Michael S Saag
- Division of Infectious Diseases, School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| |
Collapse
|
28
|
Divergent Perspectives of Filipino PLWH, Their Partners, and Care Providers on Sexuality After an HIV Diagnosis: A Q-Methodological Analysis. J Assoc Nurses AIDS Care 2022; 33:478-491. [PMID: 35363625 DOI: 10.1097/jnc.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study explores the perspectives that Filipinos with professional and personal experience with people living with HIV hold about sexuality after an HIV diagnosis. Twenty people living with HIV (PLWH), 11 partners of PLWH, and 10 HIV care professionals in the Philippines were asked to rank-order 54 statements about sexuality post-HIV diagnosis. They shared the reasoning behind their rankings on an online survey platform. By-person factor analysis was done, with factors extracted based on principal component analysis followed by varimax rotation. The analysis yielded six factors with 22 males' and 3 females' Q-sorts exemplifying the views regarding sexuality post-HIV diagnosis: to be human, is to be sexual; information is power; fear of being othered; partnership for enhanced sexuality; disclosure and trust; and communication is foundational. This study revealed diverse viewpoints about sexuality after an HIV diagnosis. HIV care professionals play a decisive role in addressing concerns relating to the sexual health and well-being of newly diagnosed PLWH.
Collapse
|
29
|
The Mediating Role of Social Support and Resilience Between HIV-Related Stigmas and Patient Activation Among Young Black Women Living With HIV in the Southern United States: A Cross-sectional Study. J Assoc Nurses AIDS Care 2021; 33:78-88. [PMID: 34939990 DOI: 10.1097/jnc.0000000000000312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Little is known about the construct of patient activation for engaging in favorable self-management behaviors in people with HIV. We conducted a cross-sectional study among young Black women with HIV (n = 84) to examine the association between stigma and patient activation and the mediating role of social support and resilience. Social support mediated the relationship between the following dimensions of stigma and patient activation: internalized (β = -0.20, SE = 0.08, CI [-0.369 to -0.071]) and anticipated in health care settings (β = -0.06, SE = 0.04, CI [-0.177 to -0.001]). Resilience mediated the relationship between the following dimensions of stigma and patient activation: anticipated in health care (β = -0.20, SE = 0.08, CI [-0.387 to -0.057]) and community settings (β = -0.15, SE = 0.08, CI [-0.318 to -0.017]), and enacted in community settings (β = -0.14, SE = 0.09, CI [-0.332 to -0.001]). Our findings suggest intrapersonal and interpersonal mechanisms by which various dimensions of stigma contribute to patient activation, thus identifying social support, resilience, and patient activation as potential intervention targets.
Collapse
|
30
|
Mohammadifirouzeh M, Oh KM, Tanner S. HIV stigma reduction interventions among health care providers and students in different countries: a systematic review. Curr HIV Res 2021; 20:20-31. [PMID: 34872477 DOI: 10.2174/1570162x19666211206094709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/21/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health care providers' stigmatizing attitudes are obstacles to patients' well-being and quality of life. Dealing with HIV-related stigma and understanding the impact of feasible interventions on reducing stigmatizing attitudes among health care providers are considered important strategies to improve the quality of HIV care, patient-provider relationships, and provide supportive and safe care services. OBJECTIVES The aim of this study was to systematically review interventions to reduce HIV-related stigma among health care providers. METHODS This systematic review was performed using Medline, CINAHL, ERIC, and APA PsycInfo, Health Source: Nursing/Academic Edition to search for quasi-experimental studies and randomized controlled trials (RCTs) designed to reduce HIV stigma among health care providers. The quality of eligible research studies was independently appraised by two reviewers. RESULTS A total of 774 studies were screened, 100 articles were assessed for the eligibility, and 10 studies met the inclusion criteria. All interventions effectively reduced HIV-related stigma. Elements of successful interventions including knowledge modules, peer education, patients' testimonials, Photovoice-informed stigma reduction training, stigma-free space intervention, and popular opinion leaders. Interventions were assessed and compared in terms of contents, delivery modes, HIV stigma measurements, follow-up, and limitations. CONCLUSIONS This systematic review supports the effectiveness of in-person educational interventions at reducing HIV-related stigma among health care providers across countries. Comparisons of delivery modes of interventions indicated that educational interventions delivered by patients' testimonials and peer education strategies are more promising than lecture-based teaching methods. Further studies are needed to assess long-term effects of interventions on clinical behaviors and practices.
Collapse
Affiliation(s)
- Mona Mohammadifirouzeh
- George Mason University, School of Nursing 4400 University Dr, Fairfax,VA 22030. United States
| | - Kyeung Mi Oh
- George Mason University, School of Nursing 4400 University Dr, Fairfax,VA 22030. United States
| | - Susan Tanner
- George Mason University, School of Nursing 4400 University Dr, Fairfax,VA 22030. United States
| |
Collapse
|
31
|
Lazarus JV, Safreed-Harmon K, Kamarulzaman A, Anderson J, Leite RB, Behrens G, Bekker LG, Bhagani S, Brown D, Brown G, Buchbinder S, Caceres C, Cahn PE, Carrieri P, Caswell G, Cooke GS, Monforte AD, Dedes N, Del Amo J, Elliott R, El-Sadr WM, Fuster-Ruiz de Apodaca MJ, Guaraldi G, Hallett T, Harding R, Hellard M, Jaffar S, Kall M, Klein M, Lewin SR, Mayer K, Pérez-Molina JA, Moraa D, Naniche D, Nash D, Noori T, Pozniak A, Rajasuriar R, Reiss P, Rizk N, Rockstroh J, Romero D, Sabin C, Serwadda D, Waters L. Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV. Nat Commun 2021; 12:4450. [PMID: 34272399 PMCID: PMC8285468 DOI: 10.1038/s41467-021-24673-w] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field's longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.
Collapse
Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Adeeba Kamarulzaman
- University of Malaya, Kuala Lumpur, Malaysia
- International AIDS Society (IAS), Geneva, Switzerland
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Georg Behrens
- Medizinische Hochschule Hannover (MHH), Hannover, Germany
| | | | - Sanjay Bhagani
- Royal Free London NHS Trust and University College London, London, United Kingdom
| | - Darren Brown
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, United States
| | - Carlos Caceres
- Center for Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseilles, France
| | - Georgina Caswell
- Global Network of People Living with HIV (GNP+), Cape Town, South Africa
| | | | | | | | - Julia Del Amo
- National Plan on AIDS, Ministry of Health, Madrid, Spain
| | | | | | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Università degli studi di Modena e Reggio Emilia, Modena, Italy
| | - Tim Hallett
- Imperial College London, London, United Kingdom
| | | | | | - Shabbar Jaffar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Marina Klein
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Ken Mayer
- Fenway Health and Harvard Medical School, Boston, United States
| | - Jose A Pérez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Denis Nash
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | - Teymur Noori
- European Centre for Disease Control and Prevention, Solna, Sweden
| | - Anton Pozniak
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Laura Waters
- Central and North West London NHS Trust, London, United Kingdom
| |
Collapse
|
32
|
Khoury ZH, Meeks V. The influence of antiretroviral therapy on HIV-related oral manifestations. J Natl Med Assoc 2021; 113:449-456. [PMID: 33762122 DOI: 10.1016/j.jnma.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This review aims to provide primary medical and dental healthcare professionals with the current state of information on the oral manifestations of HIV infection in the era of antiretroviral therapy (ART) advancements. RESULTS Infection with the human immunodeficiency virus (HIV) is associated with an increased risk of infectious, neoplastic, and immune-mediated oral complications that are regarded as a major constituent of this global epidemic. HIV-related oral manifestations have been subject to changes in their prevalence with the employment of ART, particularly in this period of enhanced patient accessibility to ART. Available antiretroviral medications (ARVs), the clinical presentation of common HIV-related oral manifestations, and patients and healthcare providers' perceptions are also discussed. CONCLUSIONS Screening, diagnosing, and treating patients with HIV/Acquired immunodeficiency syndrome (AIDS) has improved drastically since the isolation and characterization of HIV. Oral manifestations have been acknowledged to correlate with treatment responses and disease progression. Healthcare providers should be familiar with HIV-related oral manifestations and comfortable in managing and referring patients with HIV/AIDS, they are also key stakeholders in facilitating the elimination of the stigma associated with the infection.
Collapse
Affiliation(s)
- Zaid H Khoury
- Department of Oncology & Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650W Baltimore St, 7th Floor North, Baltimore, MD 21201, United States.
| | - Valli Meeks
- Department of Oncology & Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650W Baltimore St, 7th Floor North, Baltimore, MD 21201, United States
| |
Collapse
|
33
|
Sahoo SS, Khanna P, Verma R, Verma M, Mahapatra S, Parija PP, Panda UK. Social stigma and its determinants among people living with HIV/AIDS: A cross-sectional study at ART center in North India. J Family Med Prim Care 2021; 9:5646-5651. [PMID: 33532408 PMCID: PMC7842445 DOI: 10.4103/jfmpc.jfmpc_981_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: HIV/AIDS-related stigma and discrimination together have long been recognized as one of the main obstacles in the prevention, care, and treatment of HIV and AIDS. Yet, little has been done on a large scale to combat them. Stigma still precludes many in need of treatment and care for people living with HIV/AIDS (PLHIV). The purpose of this study was to assess the social stigma among PLHIV and the factors influencing it. Material and Methods: This hospital-based cross-sectional study was conducted among four hundred PLHIV attending the antiretroviral therapy (ART) center of a tertiary care institute of Haryana, India, using a semi-structured questionnaire and Berger Stigma Scale. Data analysis was performed using SPSS version 20.0 software to explore the relationship between a dependent (social stigma score) and other independent variables. Results: The overall mean stigma score in our study was found to be 110.96 ± 17.05. The stigma score in the male PLHIV was higher than in females. Male gender, younger age group (18–25 years), nuclear family, and rural residents PLHIV experienced more stigma as showed by the logistic regression analysis. Conclusion: Stigma and discrimination are a continuous deterrent for program implementation or successful outcomes. Education, behavior change strategies, and building supportive environments to the targeted population (young, single, and rural residents) can provide a roadmap in ending stigma and discrimination.
Collapse
Affiliation(s)
- Soumya S Sahoo
- Department of Community and Family Medicine, AIIMS, Bathinda, Punjab, India
| | - Pardeep Khanna
- Department of Community Medicine, Post Graduate Institute of Medical Studies (PGIMS), Rohtak, Haryana, India
| | - Ramesh Verma
- Department of Community Medicine, Post Graduate Institute of Medical Studies (PGIMS), Rohtak, Haryana, India
| | - Madhur Verma
- Department of Community and Family Medicine, AIIMS, Bathinda, Punjab, India
| | - Sandeep Mahapatra
- Associate Epidemiologist, Decision Resources Group (DRG), Bengaluru, Karnataka, India
| | - Pragyan P Parija
- Department of Community and Family Medicine, AIIMS, Raipur, Chhattisgarh, India
| | - Udit K Panda
- Post Doctoral Fellow, Addiction Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| |
Collapse
|
34
|
Riono P, Challacombe SJ. HIV in Indonesia and in neighbouring countries and its social impact. Oral Dis 2020; 26 Suppl 1:28-33. [PMID: 32862533 DOI: 10.1111/odi.13560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV incidence is still increasing in parts of Indonesia and in several Asian Countries. New cases of HIV in Indonesia have risen from 7,000 per year in 2006 to 48,000 per year in 2017. In spite of this increase, the number of newly diagnosed cases of AIDS has decreased from a peak of over 12,000 in 2013 to a little over 9,000 in 2017. The mean prevalence of HIV in Indonesia is 0.41% but there is a ten-fold difference in the prevalence in different regions with the highest in Papua (5%). Women represent over 35% of new infections per year and of the total (640,000) in Indonesia. Over 50% of HIV diagnoses are made when patients already have AIDS. Stigma and discrimination are still strong barriers in prevention and treatment but also there are considerable challenges in access to appropriate anti-retroviral therapy. There is a need for further investment in HIV Programs in Indonesia so that prevention can be enhanced, and diagnosis made at an earlier stage. Health Professionals including dentists should be readily willing to provide joint prevention efforts and care to people at risk and with HIV and other infectious diseases to help meet the WHO aims of 2030. Public health programmes are needed to make certain that the general public is aware of HIV testing and the role of dental healthcare workers in facilitating this, thereby further normalising attitudes to people living with HIV.
Collapse
Affiliation(s)
- Pandu Riono
- Faculty of Public Health, Universitas Indonesia, Kampus UI, Depok, Indonesia
| | | |
Collapse
|