Late HIV detection among adult males in Los Angeles County, 2000-2004.

We analyzed HIV surveillance data on white, black, and Latino males diagnosed with HIV between 2000 and 2004 in Los Angeles County (LAC) to identify associations between individual- and community-level factors and late HIV detection by race/ethnicity. We defined late HIV detection as an AIDS diagnosis within 6 months of HIV diagnosis. We conducted multilevel analysis to determine individual- and community-level risk factors associated with late HIV detection stratified by race/ethnicity. We mapped HIV-positive males with late HIV detection by race/ethnicity at the zip code level within LAC to determine high burden areas. Overall, 38% of all males met the definition of late HIV detection. By race/ethnicity, 44% of Latinos, 38% of blacks, and 30% of whites were detected late in their course of HIV infection. Latinos and whites had multiple individual-level risk factors associated with late HIV detection. Among black males, only older age at HIV diagnosis was associated with late HIV detection. The only community-level risk factor associated with late HIV detection was among Latinos living in communities with less than 6% of men who have sex with men (proxy for stigma). Mapping the distribution of late HIV detection showed late detection areas generalized across LAC for Latino males in comparison with white and black males whose maps showed clustered areas of late HIV detection. Analysis and mapping of individual- and community-level risk factors associated with late HIV detection provides an important tool for targeting prevention resources to areas and populations with the highest burden of disease.

Virtual reality and surgical oncology.

More than 80% of people diagnosed with cancer will require surgery. However, less than 5% have access to safe, affordable and timely surgery in low- and middle-income countries (LMICs) settings mostly due to the lack of trained workforce. Since its creation, virtual reality (VR) has been heralded as a viable adjunct to surgical training, but its adoption in surgical oncology to date is poorly understood. We undertook a systematic review to determine the application of VR across different surgical specialties, modalities and cancer pathway globally between January 2011 and 2021. We reviewed their characteristics and respective methods of validation of 24 articles. The results revealed gaps in application and accessibility of VR with a proclivity for high-income countries and high-risk, complex oncological surgeries. There is a lack of standardisation of clinical evaluation of VR, both in terms of clinical trials and implementation science. While all VR illustrated face and content validity, only around two-third exhibited construct validity and predictive validity was lacking overall. In conclusion, the asynchrony between VR development and actual global cancer surgery demand means the technology is not effectively, efficiently and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise cost-effective VR technologies with predictive validity for high demand, open cancer surgeries required in LMICs.

COVID-19 and mental health among college students in the southwestern United States.

Objective: We examined COVID-19-related experiences, mental health, and future plans among US undergraduate and graduate students in the initial months of the pandemic. Participants: 72 students (68% female; 51.4% white; age x- =24.4) from 21 colleges in the US southwest concurrently enrolled in a stress-reduction study. Methods: Between March and June 2020, participants completed an online survey about demographics, personal and vicarious COVID-19 experiences, mood, and future plans. Anxiety and depression symptoms were assessed with the GAD-7 and PHQ-9, respectively. Results: Worry about COVID-19 was associated with anxiety and depression symptoms and personal and vicarious experiences with COVID-19. COVID-19 worry varied by illness severity and level of intimacy with those impacted. Most participants reported changing educational (66.7%) and life (55.6%) plans due to COVID-19. Conclusions: Given the continued impact of COVID-19 on physical/emotional health and future plans, universities should assist students in managing COVID-19-related stress so they can continue to learn and grow.

User Experience With Low-Cost Virtual Reality Cancer Surgery Simulation in an African Setting.

PURPOSE: Limited access to adequate cancer surgery training is one of the driving forces behind global inequities in surgical cancer care. Affordable virtual reality (VR) surgical training could enhance surgical skills in low- and middle-income settings, but most VR and augmented reality systems are too expensive and do not teach open surgical techniques commonly practiced in these contexts. New low-cost VR can offer skill development simulations relevant to these settings, but little is known about how knowledge is gained and applied by surgeons training and working in specific resource-constrained settings. This study addresses this gap, exploring gynecologic oncology trainee learning and user experience using a low-cost VR simulator to learn to perform an open radical abdominal hysterectomy in Lusaka, Zambia. METHODS: Eleven surgical trainees rotating through the gynecologic oncology service were sequentially recruited from the University Teaching Hospital in Lusaka to participate in a study evaluating a VR radical abdominal hysterectomy training designed to replicate the experience in a Zambian hospital. Six participated in semi-structured interviews following the training. Interviews were analyzed using open and axial coding, informed by grounded theory. RESULTS: Simulator participation increased participants' perception of their surgical knowledge, confidence, and skills. Participants believed their skills transferred to other related surgical procedures. Having clear goals and motivation to improve were described as factors that influenced success. CONCLUSION: For cancer surgery trainees in lower-resourced settings learning medical and surgical skills, even for those with limited VR experience, low-cost VR simulators may enhance anatomical knowledge and confidence. The VR simulator reinforced anatomical and clinical knowledge acquired through other modalities. VR-enhanced learning may be particularly valuable when mentored learning opportunities are limited.

The Use of Female Commercial Sex Workers' Services by Latino Day Laborers.

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was utilized. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day laborers reported having had sex with a CSW in the previous 12 months. A lower likelihood of having sex with a CSW was found for those with more than six years of education and for those who were married and living with their spouses. A higher likelihood of having sex with a CSW was found for those who met the criteria for harmful drinking or drug dependence. Commercial sex work has been associated with sexually transmitted infections and other problems among clients of CSWs and warrants further attention by providers working with day laborers.

Creating a low-cost virtual reality surgical simulation to increase surgical oncology capacity and capability.

Worldwide, more than 80% of people with cancer will require surgery during their disease course, but less than 25% have access to safe, affordable and timely surgery. Among the barriers to increasing surgical capacity are the time and costs required to train novices. Virtual reality (VR) surgical simulations can reduce the time required for novices to reach surgical proficiency, though their costs may exceed USD $100,000. The goal of this study was to determine if a low-cost system, using commercially available technology designed for in-home computer gaming, could be used to create a realistic VR surgical oncology simulation. Standard commercially available VR software and Oculus Rift hardware have been used to provide high-quality visuals and believable surgeon hand interactions. Near identical VR reproduction of an operating room using 1:1 scale matching of real-world elements, including equipment, instruments, supplies and sounds, maintaining frame rate greater than 60 fps to maintain visual fidelity has been created. Internal anatomy was designed as VR replica of human female pelvic anatomy, including organs, veins and other vessels, peritoneum and connective tissue. Internal anatomy was designed to run at 120 fps and to allow for a realistic abdominal radical hysterectomy simulation. Surgical hands were modelled to scale for those with large and small hands. Multiple hand positions were simulated using Oculus touch hardware. Reconstructing the virtual environment to simulate reality as accurately as possible was done to immerse users in the simulator so that they focus on learning and practise without distractions. Training modules were co-designed by experts in learning sciences, human behaviour, VR and gynaecologic oncology. We have successfully created a low-cost VR simulation to help prepare novice surgeons to perform a radical abdominal hysterectomy surgery procedure. The simulation can be used with commercially available computer gaming hardware that currently costs less than USD $1,500. Low-cost VR simulation has the potential to reduce the time and cost to train surgeons to perform surgical oncology procedures, as well as both improve and audit quality. If effective in real-world clinical trials, such simulations have relevance to multiple surgical procedures and applicability in both resource-limited and high-income settings.

Using Low-Cost Virtual Reality Simulation to Build Surgical Capacity for Cervical Cancer Treatment.

PURPOSE: Worldwide, more than 80% of people diagnosed with cancer will require surgery during their disease course, but only 5% to 20% of low- and middle-income countries have access to safe, affordable, and timely surgery. Developing surgical oncology skills requires significant time and mentoring. Virtual reality (VR) simulators can reduce the time required to master surgical procedures but are prohibitively expensive. We sought to determine whether a VR simulator using low-cost computer gaming equipment could train novice surgeons in Africa to perform a virtual radical abdominal (open) hysterectomy (RAH). METHODS: Our RAH VR simulator used the Oculus Rift (Oculus VR, Menlo Park, CA), a VR headset with hand controllers that costs less than $1,500. Surgical novices learned to perform five key steps of a virtual RAH. We measured and identified predictors of movement and time efficiency for the simulation. RESULTS: Ten novice surgeons in Lusaka, Zambia, enrolled in the study. Movement and time efficiency greatly improved over time. Independent predictors of movement efficiency were number of simulations, surgical experience, and time since college graduation. Independent predictors of time efficiency were number of simulations, surgical experience, days between simulation sessions, age, sex, and an interaction between number of simulations and surgical experience. CONCLUSION: Low-cost VR may be an effective tool to help surgical novices learn complex surgical oncology procedures. If learning to perform VR surgical procedures with low-cost hardware leads to faster mastery of surgical procedures in the operating room, low-cost VR may represent one of the solutions to increasing access to surgical cancer care globally.

Research needed to more effectively combat HIV among African-American men who have sex with men.

It is estimated that nearly half of all African-American men who have sex with men (AAMSM) living in major U.S. cities are already infected with HIV. Without a substantial and committed investment in research in HIV prevention among AAMSM and subsequent evidence-based policies and community programs, it is unlikely that we will ever be able to curtail the HIV epidemic among African Americans in general, regardless of gender, age or sexual orientation. In this paper, we briefly review what is known and what research questions remain in order to curtail the epidemic among AAMSM. Finally, we provide recommendations for future research that include the: 1) development of a national cohort of young AAMSM to prospectively study biological, behavioral, social and contextual factors that place AAMSM at risk for infection with HIV and other STDs; 2) adapting existing interventions in HIV prevention to the unique characteristics of AAMSM and evaluating their effectiveness; 3) evaluating factors such as intracommunity and familial discrimination against AAMSM that may lead to lack of disclosure; and 4) enhancing our understanding of how cultural and social factors can be used in a positive and self-affirming way to strengthen HIV prevention and care for AAMSM.

Sexual solicitation of Latino male day laborers by other men.

OBJECTIVE: To examine the likelihood of Latino day laborers being solicited for sex by other men. MATERIAL AND METHODS: 450 Latino day laborers were recruited in Los Angeles, California, from July to September 2005. Logistic regression analysis was used to determine which day laborers were more likely to be solicited and subsequently to have sex. RESULTS: Thirty-eight percent reported being solicited for sex by another man while seeking work. Those solicited were more likely to live longer in the US, be more educated and screen positive for drug dependence. Of those solicited, 9.4% had sex with their solicitors. Those screening positive for drug dependence were more likely to have sex. Most of the day laborers who had anal sex with their solicitors did not always use condoms. CONCLUSIONS: HIV prevention efforts should target drug dependent day laborers, who may place themselves at risk for HIV through sex with male solicitors.

Screening for sexually transmitted diseases in non-traditional settings: a personal view.

We conducted a literature search to review studies that presented quantitative data on sexually transmitted disease (STD) screening in non-traditional settings in the United States. We examined the studies for evidence of the feasibility of screening, population size reached, acceptability, yield, and potential for contributing to STD control. We found 17 studies in jails, eight in emergency room, five in schools and 15 in other community settings. Jail-based and emergency room-based STD screenings have the highest yields and the largest numbers screened and thus hold significant promise as settings for routine STD screening. More research needs to be done in school and community settings to better identify their potential.

Alcohol use and adherence to prescribed therapy among under-served Latino and African-American patients using emergency department services.

UNLABELLED: Non-adherence to prescribed therapy is a factor that results in many patients attending emergency departments. However, increasingly, we recognize that patients who seek health care from inner-city emergency departments are among those experiencing health disparities. For these marginalized patients, emergency departments can play an important role in complementing the process of individualized care to achieve successful health outcomes. Research that examines socio-psychological characteristics and correlates of healthcare utilization of emergency department service users among under-served minority patients is needed for redirecting appropriate care among this segment of our population. OBJECTIVE: This study examines the prevalence and correlates of adherence to prescribed therapy among patients presenting to an inner-city emergency department for a medical emergency or trauma injury. Specific attention is paid to the role of alcohol. METHOD: A cross-sectional face-to-face survey was conducted among a consecutive sample of 412 Hispanic and African Americans aged 18 years and older who sought care at an inner-city emergency department facility. RESULTS: Among patients who use medication (N=145), 32% reported low adherence. More than 24% scored positive for alcohol problems based on the Alcohol Use Disorders Identification Test (AUDIT). Results of multivariate regression analysis showed that those emergency department patients who: 1) identified themselves as Hispanic, 2) reported excessive use of alcohol, 3) reported a higher number of depressive symptoms, and 4) reported a higher number of alcohol related consequences were less likely to adhere to prescribed therapy. CONCLUSION: Future investigation regarding factors related to adherence to prescribed medication among emergency department patients should take into consideration the role of alcohol and depression in this process. Further research is also needed to factor in patient's ethnicity in the context of treatment adherence.

Protecting our militaries: a systematic literature review of military human immunodeficiency virus/acquired immunodeficiency syndrome prevention programs worldwide.

OBJECTIVES: To systematically review published studies of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) prevention programs targeting the world's military populations. METHODS: We systematically searched eight electronic databases (publications from 1983 to February 2005) and hand-searched the bibliographies of HIV/AIDS prevention reviews to identify evaluative studies of HIV/AIDS prevention interventions for military personnel. RESULTS: Five hundred eighty-four abstracts were identified, of which eight met formal acceptance criteria. Four prevention interventions were identified, with each reporting a positive intervention effect on one or more of the following outcomes: increasing soldiers' knowledge of HIV/AIDS, willingness to engage in preventive behaviors, changing their attitudes toward greater compliance with prevention guidelines, and HIV/AIDS incidence and prevalence. CONCLUSIONS: Published interventions to reduce the risk of HIV/AIDS among military personnel are effective under certain conditions and with a limited number of populations. We discuss problems inherent in such research and make recommendations to improve the development, evaluation, and dissemination of findings of comprehensive HIV/AIDS prevention programs among military populations.

Evidence-based recommendations for prevention of human immunodeficiency virus and sexually transmitted infections in the Angolan Armed Forces: challenges and opportunities at the end of 30 years of war.

OBJECTIVE: The goal was the development of culturally sensitive, evidence-based recommendations for human immunodeficiency virus (HIV) prevention for Angolan soldiers. METHODS: Eight focus groups (N = 68) were conducted with Angolan soldiers in 2002. Qualitative data were analyzed for soldiers' HIV/sexually transmitted infections (STIs)-related knowledge and behaviors. RESULTS: More than 37% of participants reported having more than one sexual partner at the time of the study. Many soldiers had little knowledge regarding HIV/STI transmission and symptoms, and most did not use condoms. Soldiers identified the following factors that need to be addressed in HIV/STI prevention campaigns among military personnel: lack of HIV awareness and knowledge, limited condom availability and use, heavy alcohol use before sex, and the tendency to have multiple sexual partners. CONCLUSIONS: Recommendations for prevention in the Angolan military are presented. A multifaceted HIV prevention program for the Angolan military that addresses informational, interpersonal, and system-level barriers must be implemented now.

Use of psychotropic medications among HIV-infected patients in the United States.

OBJECTIVE: This study describes the prevalence and pattern of use of psychotropic medications by HIV-positive patients receiving medical care in the United States and the search for possible predictors of use. METHOD: The HIV Cost and Services Utilization Study database was analyzed. From the estimated 231,400 HIV-positive patients in medical care in the contiguous United States, a probability sample of 2,864 adults who had paid at least one visit to their medical provider in early 1996 was selected. A representative group of 1,561 received the long form of the Composite International Diagnostic Interview and a questionnaire on psychotropic medications used during the previous 6 months; 1,489 patients (95.4%) completed the assessments. RESULTS: An estimated 27.2% of HIV-positive patients took psychotropic medications in 1996. Antidepressants were the most commonly prescribed drug class (20.9% of patients), followed by anxiolytics (16.7%), antipsychotics (4.7%), and psychostimulants (3.0%). Among patients with major depression or dysthymia, 43.2% reported receiving antidepressants, and 34.3% reported receiving anxiolytics. Psychiatric comorbidity was associated with greater use of psychotropics. Use of psychotropics in general, and antidepressants in particular, was significantly lower among African Americans than whites or Hispanics. Among patients with mood disorders, 61.0% of whites, 51.4% of African Americans, and 66.7% of Hispanics reported use of antidepressant medications or some type of psychosocial intervention. CONCLUSIONS: Psychotropics were commonly used by HIV-positive patients in medical care. About half of the patients suffering from depressive disorders did not receive antidepressants. Psychotropic drug use was lower among African Americans than other ethnic groups.

Re-estimating the prevalence of psychiatric disorders in a nationally representative sample of persons receiving care for HIV: results from the HIV Cost and Services Utilization Study.

The objective of this study was to obtain accurate estimates of the prevalence of psychiatric disorder in the population represented by the HIV Costs and Services Utilization Study cohort. We constructed logistic regression models to predict DSM-IV diagnoses of depression, generalized anxiety disorder, panic, and dysthymia among a subsample of the HCSUS cohort who in separate interviews completed the CIDI-SF and the full CIDI diagnostic interview. Diagnoses were predicted using responses to the CIDI-SF as well as other variables contained in the baseline and first follow-up interviews. Resulting regression equations were applied to the entire baseline and first follow-up samples to obtain new estimates of the prevalence of disorder. Compared to estimates based on the CIDI-SF alone, estimates obtained from this procedure provide a more accurate representation of the prevalence of the presence of any one of these four psychiatric disorders in this population, yielding more correct classifications and a lower false-positive rate. Prevalence rates reported in this study are as much as 16% lower than rates estimated using the CIDI-SF alone, but are still considerably higher than estimates for the general community population.

Response to symptoms among a U.S. national probability sample of adults infected with human immunodeficiency virus.

Previous studies concerning disparities in Human Immunodeficiency Virus (HIV) services use among vulnerable groups did not control for specific clinical need for care such as symptom events. Using the Andersen Behavioral Model of Health Services Use, the authors determined whether minorities, women, and the less educated (vulnerable groups) were less likely to receive care for HIV symptoms. Persons enrolled in the HIV Cost and Services Utilization Study were asked whether they received care for their most bothersome symptom. Surprisingly, minorities and women were no more likely to go without care than other groups. Those with Medicaid, Medicare, private health maintenance organization (HMO) insurance, or no insurance were less likely to receive care for symptoms than those with private-non-HMO insurance. Vulnerable groups were no less likely to use services for HIV-related symptoms when need for care was considered. However, disparities may exist for symptom-specific care among HIV infected persons covered by public or HMO insurance.

The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study.

OBJECTIVE: To establish population-based estimates of the prevalence of any alcohol consumption and heavy drinking among individuals who tested positive for human immunodeficiency virus (HIV) and to identify the factors associated with alcohol consumption and heavy drinking in this population. METHOD: Data from the HIV Cost and Services Utilization Study (HCSUS), a national probability survey of HIV-infected adults receiving medical care in the U.S. in early 1996 (N = 2,864: 2,017 men, 847 women), were used to estimate the prevalence of any alcohol consumption and heavy drinking. Logistic regression was used to identify independent influences of sociodemographic, health status, and substance use variables on alcohol consumption and heavy drinking. RESULTS: Approximately 53% of persons in care for HIV reported drinking alcohol in the preceding month and 8% were classified as heavy drinkers. Of those who drank, 15% were heavy drinkers. The odds of heavy drinking were significantly higher among users of cocaine or heroin and significantly lower among the better educated and those with an AIDS-defining illness. CONCLUSIONS: Alcohol consumption is common among people in care for HIV, with rates of heavy drinking almost twice those found in the general population. Heavy drinking is especially higher among individuals with lower educational levels and users of cocaine or heroin.

Co-occurring psychiatric symptoms and drug dependence or heavy drinking among HIV-positive people.

This study sought to establish population-based estimates of the prevalence of co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking among individuals who test positive for the human immunodeficiency virus (HIV) and to identify the factors associated with such comorbidity. Data from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of HIV-infected adults receiving medical care in the U.S. in 1996 (N = 2,864), were used to estimate the prevalence of comorbidity. Logistic regression was used to identify the independent influences of sociodemographic and HIV-related variables on comorbidity. The authors estimate that 13% of people with HIV receiving care in the U.S. in 1996 had co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking. The odds of having a comorbid condition were higher for males, heterosexuals, and people with more HIV-related symptoms. The odds were lower for people living with AIDS, African Americans, people who were gay or sexually abstinent, those living with a spouse, those aged 50 years or older, and those with private insurance. Sixty-nine percent of those with a substance-related condition also had psychiatric symptoms; 27% of those with psychiatric symptoms also had a substance-related condition.

HIV stigma and social support among African Americans.

HIV-related stigma and discrimination negatively impact African Americans living with HIV. Social support theory hypothesizes that social support can serve to protect individuals against the negative effects of stressors, such as discrimination, by leading them to interpret stressful occasions less negatively. This study sought to examine the relationship between perceived social support and perceived HIV stigma among HIV-positive African Americans. A cross-sectional convenience sample of 283 HIV-positive African Americans was recruited from three social service agencies. Bivariate and multivariate regressions were used to determine the variables predicting perceived HIV stigma. The study participants were found to have a wide variety of opinions concerning perceived HIV stigma. Of the three different sources of perceived social support examined (from family, friends and a "special person"), only perceived social support from friends was found to be related to perceived HIV stigma when controlling for the presence of other relevant factors. High perceived social support from friends was associated with less perceived HIV stigma. Other factors associated with low perceived HIV stigma included a lack of current symptoms of major depression, a longer time since HIV diagnosis and higher education. Information about the beneficial effects of perceived social support from friends and other factors can help to provide guidance to those working to decrease the negative impact of HIV stigma among HIV-positive African Americans.