Relationships among COVID-19 phobia, health anxiety, and social relations in women living with HIV in Iran: A path analysis

Introduction

The COVID-19 pandemic and its consequences have caused fear and anxiety worldwide and imposed a significant physical and psychological burden on people, especially women living with HIV (WLHIV). However, WLHIV were not studied as well as others during the pandemic. Hence, this study aimed to determine the relationships between COVID-19 phobia, health anxiety, and social relations in WLHIV.

Materials and methods

This cross-sectional study enrolled 300 WLHIV who had records at the Iranian Research Center for HIV/AIDS of Tehran University of Medical Sciences. Data were collected using sociodemographic questionnaire, the fear of COVID-19 scale, the social relations questionnaire, the socioeconomic status scale and the health anxiety inventory. Path-analysis was used to assess the direct and indirct associations between variables.

Results

Based on the path analysis, among variables that had significant causal relationships with social relations, socioeconomic status (β = -0.14) showed the greatest negative relationship, and health anxiety (β = 0.11) had the strongest positive relationship on the direct path. On the indirect path, fear of COVID-19 (β = 0.049) displayed the greatest positive relationship. The level of education (β = 0.29) was the only variable showing a significant positive relationship with social relations on both direct and indirect paths.

Conclusion

Our result showed that increased fear and health anxiety related to a higher social relations score in WLHIV. Hence, due to their vulnerability, these people require more support and education to adhere to health protocols in future pandemics and similar situations.

The effects of an educational program based on the health belief model on information-motivation-skill-behavioral skills among women living with human immunodeficiency virus

BACKGROUND

Human immunodeficiency virus (HIV) is a kind of behavioral disease in that adopting behavioral changes is the only way to control and stop the epidemic. The aim of this study is to investigate the effect of education base on the health belief model (HBM) on health-seeking behavior among HIV-positive women.

MATERIALS AND METHODS

This study is a paralleled, randomized controlled clinical trial done with control group among HIV-positive women who were registered at the voluntary and counseling testing center of Imam Khomeini hospital in Tehran. Data were gathered by using information obtained from the Motivation-Skill-Behavior questionnaire and demographic data. The women were divided by permuted block and were randomized into two groups. Interventional group participated in six HBM educational classes and used routine counseling guidelines, but the control group used only routine counseling protocol. Data were collected before, immediately after, and 3 weeks after interference among all participants. Data were analyzed by using SPSS software version 16.

RESULTS

According to the results and statistical test, before intervention, the mean score of knowledge was not significantly different in the two groups, but after intervention in the interventional group, test result and follow-up increased statistically significantly (P = 0.000). Both groups had increased mean score of knowledge, and there is significant trend in level of knowledge (interventional group 20.79 ± 1.88, control group: 17.36 ±2.44) and there was a significant increase in mean attitude follow-up score (P < 0.001).

CONCLUSION

According to the result of the present study, counseling base on HBM by trained educator can increase information-motivation-skill-behavior among women living with HIV.

Woman's Sexual Health Knowledge and Needs Assessment in Behavioral Clinics and Shelters in Tehran

Objective: The aim of this study was to assess the sexual health knowledge among females seeking consultation in behavioral clinics or shelters with emphasis on sexual routs of HIV transmission. Materials and methods: In this study 250 women who have attended behavioral clinics or shelters in Tehran were recruited and a standardized questionnaire which asked about demographics, sexual partner and knowledge about HIV/STDs was used. Results: The median age of our cases was 40.82% and among them 16% were married but lived alone. Among the total 250 cases, 56% (140) were sexually active in the last 30 days, 19.2% (48) had a history of a one-night stand and 2.4% had more than 1 sexual partner. 212 cases answered questions about condom use, 60% (127) of them did not use condoms at all. For knowledge about signs and symptoms related to STDs, 63% believed that abdominal pain has no relation to STDs. Also 44%, 43%, 37%,and 40% believed that dyspareunia, dysuria, malodorous vaginal discharge and change in color of vaginal discharge, respectively had no relation to STDs and 13%  of whom presented with these symptoms in the past 30 days had not seek medical evaluation. Conclusion: It is a necessity to emphasize the use of condoms among the male population however in this study it was a challenge to do so because it goes against the government’s campaign of pro-natalism. Improving the knowledge of protected sex should start from the teenage years and at school to have maximum STD prevention planning. Most women in our study did not know about healthy sexual lifestyle and this shows the need of sexual health education before marriage or even at school.

Evaluation of Acquired HIV Drug Resistance among People Living with HIV Who Have Taken Antiretroviral Therapy for 9-15 Months in 14 Triangular Clinics in Iran, 2015-2016

AIMS

The aim of this study was to evaluate drug resistance patterns among Iranian people living with HIV who have taken antiretroviral therapy for 9-15 months.

METHODS

A cross-sectional study was conducted between December 2015 and May 2016. Two hundred fifty-two blood samples were collected from all eligible HIV-infected patients at fourteen healthcare settings, located in major provinces in Iran. The samples were examined for presence of drug resistance strains and viral load level. Moreover, a phylogenetic tree, using neighbor joining, was constructed and HIV subtypes were determined.

RESULTS

The most common subtypes were CRF35-AD (47.6%) and A1 (42.8%), followed by 45_CPX (4.8%) and C (4.8%). The resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors was reported as 19.2, 19.2, and 10.3%, respectively. M184I/V mutation was the most frequent (31.6%) mutation among NRTI-based regimens. Moreover, K103E/N was the most frequent (34.2%) NNRTI mutation.

CONCLUSIONS

This is the first study to illuminate the emergence of the CPX genotype among Iranian patients. The drug resistance rate of NNRTIs was similar to that of NRTIs. By assessing drug resistance, it is possible to evaluate the efficacy of treatment and patient adherence to treatment.

Woman's Sexual Health Knowledge and Needs Assessment in Behavioral Clinics and Shelters in Tehran

Objective: The aim of this study was to assess the sexual health knowledge among females seeking consultation in behavioral clinics or shelters with emphasis on sexual routs of HIV transmission. Materials and methods: In this study 250 women who have attended behavioral clinics or shelters in Tehran were recruited and a standardized questionnaire which asked about demographics, sexual partner and knowledge about HIV/STDs was used. Results: The median age of our cases was 40.82% and among them 16% were married but lived alone. Among the total 250 cases, 56% (140) were sexually active in the last 30 days, 19.2% (48) had a history of a one-night stand and 2.4% had more than 1 sexual partner. 212 cases answered questions about condom use, 60% (127) of them did not use condoms at all. For knowledge about signs and symptoms related to STDs, 63% believed that abdominal pain has no relation to STDs. Also 44%, 43%, 37%,and 40% believed that dyspareunia, dysuria, malodorous vaginal discharge and change in color of vaginal discharge, respectively had no relation to STDs and 13% of whom presented with these symptoms in the past 30 days had not seek medical evaluation. Conclusion: It is a necessity to emphasize the use of condoms among the male population however in this study it was a challenge to do so because it goes against the government's campaign of pro-natalism. Improving the knowledge of protected sex should start from the teenage years and at school to have maximum STD prevention planning. Most women in our study did not know about healthy sexual lifestyle and this shows the need of sexual health education before marriage or even at school.

The Effect of Psycho-Social Problems on Risky Behaviors in People Living With HIV in Tehran, Iran

Objective: Over the past years, the prevalence and the progression rate of HIV infection in Iran especially through high-risk sexual relationships have regrettably been reported at very high levels. This cross-sectional study tries to analyze stigma, mental health, and coping skills on risky behaviors in HIV-positive adults in Tehran- Iran. Materials and methods: This cross-sectional study was conducted on a sample of 450 HIV-positive adults. Participants completed a socio-demographic questionnaire, the General HealthQuestionnaire-28, the Berger HIV Stigma Scale as well as the Lazarus Ways of Coping Questionnaire (WOCQ). To analyze the data, the independent-samples t-test and Pearson Correlation were used. Results: The findings of this study revealed that mental health, stigma, and avoidance-escape coping mechanisms were correlated with risky behaviors (p ˂ 0.05).Furthermore, the amount of stigma among female individuals compared to men was reported at higher levels and mental health status in the given group was lower than among male individuals. Conclusion: It seems that psychological treatment techniques could be effective in improving mental health and reducing risky behaviors.

Assessing the Efficacy of Second-Line Antiretroviral Treatment for HIV Patients Failing First-Line Antiretroviral Therapy in Iran: A Cohort Study

There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.

Enhanced Immune Responses against HIV-1 with Adenovector (Gag and Tat) Prime/Protein Boost Regimen and GM-CSF Injection

Vaccines against the HIV-1 virus offers the best hope for eliminating HIV-associated mortality. Recombinant adenovector type 5 (rAd5) vaccine is a potential candidate for preventive vaccine strategies. In this study, we evaluated the rAd5 prime/protein boost strategy in a murine model. We used rAd5 harboring single HIV-1 genes. These genes, including gag (p24) and exon1 of tat, were amplified from HIV-1 (clade A) RNA using nested PCR. Recombinant vectors were constructed, purified and then injected at 1012 viral particles into four groups, each comprising five mice. The groups were each assigned to receive one of rAd5 prime/protein boost Gag, Tat with and without recombinant granulocyte-macrophage colony-stimulating factor (rGM-CSF), and rAd5 with and without genes. The humoral responses were evaluated using ELISA and cellular immune responses checked by cell proliferation and ELISpot assays (IL-2, IL-4 and IFN-γ). It was shown that compared with the rAd5 injection alone, the rAd5 prime/protein boost plan increased cellular immunity (p= 0.009) as well as humoral immunity (p= 0.009). Moreover, rGM-CSF as an adjuvant enhanced cell-mediated immunity and increased IL-4 expression (p=0.032). The results revealed that the simultaneous use of multiple antigens and heterologous prime/boost strategy can enhance both humoral and cellular immune systems. Moreover, subcutaneous injection of rGM-CSF increases IL-4 production and shifts the immune pattern to Th2. These strategies can potentially be used to develop an efficient HIV-1 vaccine.

HIV, HCV, HBV, HSV, and syphilis prevalence among female sex workers in Tehran, Iran, by using respondent-driven sampling

To find out the prevalence of HIV, HCV, HBV, HSV, and syphilis infections among female sex workers (FSWs) in Tehran, a cross-sectional study by using respondent-driven sampling (RDS) method was conducted. From December 2012 to April 2013 FSWs in Tehran were recruited. Inclusion criteria consisted of trading sex during the 12 months prior to this study and selling sex for at least 6 months in participants' lifetime. Among 161 consenting participants, 5% were infected with HIV. Moreover, 8.1% of FSWs were HCV positive, 37.9% were of HSV type1/type2, 1.2% of participants were infected with HBV, and none of the participants were infected with syphilis. HIV-positive participants were significantly more likely to be co-infected with HSV type1/type2, be younger, have more sexual partners and especially more clients during seven days prior to this study and report more history of having at least one of sexually transmitted infections symptoms in 12 months prior the study. In the multiple logistic regression analysis, being infected with HSV and also being under 25 years of age were found to be independently associated with HIV infection. Compared with the prevalence of HIV among general population of Tehran, relatively high prevalence of HIV and other viral infections among FSWs should be considered. All in all, it is critical to commence effective counter-measures for this high-risk group if the aim is to prevent spreading of these viruses to general population.