Disclosure Events and Psychosocial Well-Being Among Young South African Adults Living with HIV.

BACKGROUND: Poor psychological well-being is both prevalent among South Africans living with HIV and has been associated with poor HIV clinical outcomes. However, the relationship between disclosure and psychological well-being remains unclear. This analysis sought to examine the relationship between two disclosure-related variables, disclosure status and reaction received, and psychosocial well-being among a sample of young adults living with HIV (YALWH) in urban South Africa. METHOD: This was a secondary analysis using observational data from Standing Tall, a randomized controlled trial that recruited 100 participants ages 18-24 who tested positive for HIV after initially presenting to two well-established mobile clinics for HIV testing. Interviews investigating primary and secondary outcomes of interest were done at baseline and 6 months following recruitment. RESULTS: About half (51%) of participants disclosed their HIV status within 6 months after recruitment. Simple linear regression analyses revealed that disclosure of HIV status within 6 months after study enrollment predicted significantly lower levels of disclosure concerns and internalized stigma (p < 0.05). Reactions to disclosure were not significantly associated with any of the measures of psychosocial well-being considered in this analysis (p > 0.05). CONCLUSION: The results suggest that the act of disclosure among newly diagnosed YALWH may be associated with reductions in internalized stigma. In addition, the finding that the act of disclosure may be a more important determinant of psychosocial well-being than the reaction to disclosure has important implications for interventions designed to promote disclosure and psychosocial well-being in YALWH.

Lived experience, social support, and challenges to health service use during the COVID-19 pandemic among HIV key populations in Indonesia.

The COVID-19 pandemic has greatly affected the lives, health, and social well-being of people globally including presenting special challenges in low to middle income countries for people living with HIV. This study investigates the pandemic experiences of the four key HIV-positive populations in Indonesia: men who have sex with men, transgender women, female sex workers, and people who use drugs. In-depth interviews were conducted with a convenience sample of 22 key population members recruited through 9 nongovernment HIV agencies in Jakarta and Bali, Indonesia. Indonesia's Large-scale Social Restrictions Policy mandating physical distancing and stay-at-home orders had been in effect for 7-10 months at the time of the interviews. The interviews were audio-recorded, transcribed, and coded using NVivo™ (R1.7) software. A grounded theory approach identified key concepts along with similarities, differences, and reoccurring patterns of COVID-19 lived experience among participants. Participants recounted the impact of both the pandemic and the Restriction Policy on their interpersonal, financial, medical, and psychosocial well-being. When in need, they turned to formal and informal sources of financial and social support plus their own resourcefulness. Along with other factors, HIV medication shortages, HIV and COVID-19 related stigma, and fear of acquiring COVID-19 negatively impacted their antiretroviral adherence and the use of health services. The results point to the latent consequences of government attempts to curb a pandemic through public health lockdowns and enforced policies of physical separation. Its findings reveal the importance of ensuring that public safety nets for HIV key populations are available to supplement more informal personal sources of needed support.

Morbilidad, mortalidad y falla al tratamiento antirretroviral en adolescentes con VIH / Sida enun hospital de referencia en Caracas, Venezuela / Morbidity, mortality and therapeutic failure in adolescents with HIV/AIDS in a referal hospital in Caracas, Venezuela

Objetivo: describir las causas de morbilidad, mortalidad y de falla antirretroviral y relacionarlo con el mecanismo de adquisición del virus en adolescentes con VIH / SIDA atendidos en el Hospital Universitario de Caracas, período 2009 - 2013. Métodos: Estudio descriptivo de tipo retrospectivo a través del seguimiento de una cohorte. Se recolectaron los datos de las historias clínicas de pacientes con infección por VIH/SIDA con edades comprendidas entre 10 y 19 años del Hospital Universitario de Caracas durante el período 2009 - 2013. Resultados: se analizaron 79 historias y registros, según el mecanismo de transmisión, 29 (36,71 %) fueron de transmisión vertical (TV) y 50 (63,29 %) de transmisión horizontal (TH). La principal enfermedad oportunista encontrada fue tuberculosis, y no se encontró diferencias significativas para padecerla según el mecanismo de transmisión (p: 0,54). Al considerar los factores demográficos y diagnóstico inicial se observó que a una mayor edad de diagnóstico hay menor probabilidad de falla antirretroviral (OR: 0,75). Así mismo, independientemente del mecanismo de transmisión, sexo y tratamiento inicial el 50% de los pacientes presentará falla virológica luego de 90 meses de tratamiento. Discusión: el aumento en el número de casos de VIH en la población adolescente en Venezuela es un tema de relevancia en Salud Pública. Se necesita realizar un estudio en donde se apliquen estrategias dirigidas a mejorar las causas asociadas a la poca adherencia a los medicamentos antirretrovirales en esta población y determinar si dicha estrategia permite disminuir el número de fallas.

Objective: To describe the causes of morbidity, mortality and antiretroviral failure and to relate them to the mechanism of acquisition of the virus in adolescents with HIV / AIDS treated at the Hospital Universitario de Caracas, in the period 2009 - 2013. Methods: Descriptive, retrospective analysis of the follow up of a cohort. Data from patient with HIV / AIDS aged between 10 and 19 years of the Hospital Universitario de Caracas during the period 2009 - 2013. Results: 79 records were analyzed, according to the transmission mechanism 29 (36.7%) acquired the virus by vertical transmission and 50 (63.2%) by horizontal transmission. The main opportunistic disease was tuberculosis, and no significant differences were found to have it according to the transmission mechanism (p: 0.54). When considering demographic factors and initial diagnosis it was observed that when diagnosis was made at older age there were less probability of antiretroviral failure (OR: 0.75). Also, 50% of patients presented virologic failure after 90 months of treatment independently of the transmission mechanism, gender or type of initial treatment. Discussion: The increase in the number of HIV cases in the adolescent population in Venezuela is a major issue in public health. It is important to study which strategies can improve poor adherence to antiretroviral drugs in this population and to determine whether this strategy can decrease the number of failures.

Relación entre adherencia al tratamiento antirretroviral y subpoblaciones linfocitarias en niños con HIV/Sida / Antiretroviral treatment adherence and its association with TCD4+ lymphocyte subsets in children with HIV/Aids

El curso de la infección por HIV se caracteriza principalmente por una depleción grave de los linfocitos TCD4+ y una activación inmune marcada, hallazgos centrales que conducen a variaciones numéricas y fenotípicas de las poblaciones linfocitarias TCD4+. El tratamiento antirretroviral (TARV) combinado ha modificado sustancialmente el curso de la infección por HIV, y la correcta adherencia al mismo resulta en una disminución de la carga viral a niveles indetectables, y a un incremento significativo en la repoblación de los linfocitos T periféricos. En este trabajo se evaluó en 28 niños HIV (+) la relación entre los cambios en los niveles de las poblaciones linfocitarias y la adherencia al TARV, luego de 9 meses en promedio de iniciado el mismo. El grupo de 18 niños con buena adherencia, superior al 95%, presentó un aumento significativo en los porcentajes de células naive CD4+CD45RA+CD62L+ y un descenso en las células de memoria central CD4+CD45RA-CD62L+, entre ambos momentos del seguimiento. Por el contrario, los 10 niños con fallas en la adherencia no mostraron diferencias significativas en los niveles de tales poblaciones. La buena adherencia al TARV produce el rápido y significativo descenso de la replicación viral lo cual se asocia a la progresiva reconstitución cuantitativa y funcional del sistema inmune.

Human immunodeficiency virus infection causes a severe depletion of TCD4+ lymphocytes and a sustained immune activation state, hallmarks findings that led to numerical and phenotypic changes in the TCD4+ subsets. Highly active anti-retroviral therapy has substantially modified the course of HIV infection. Correct adherence to the treatment results in a decrease in viral load at undetectable levels and a significant increase in the number of peripheral T cell lymphocytes. In the present study association between changes in T cell subsets and treatment adherence was evaluated in 28 HIV (+) infected children, before and after 9 months on average, from starting anti-retroviral therapy. The group of 18 patients with good adherence, above 95%, showed a significant increase in CD4+CD45RA+CD62L+ naive cells percentual levels and a decrease in the CD4+CD45RA-CD62L+ central memory subset, between the two points of the follow-up period. Conversely, 10 children with failure in the adherence did not show significant differences in the percentual levels of both subsets. Improvement in the percentage of adherence among paediatric population, optimizing antiretroviral treatment, allows a quick and significant reduction of viral replication. This feature is associated with the progressive reconstitution of the immune system.