Observation of interband Berry phase in laser-driven crystals.

Ever since its discovery1, the notion of the Berry phase has permeated all branches of physics and plays an important part in a variety of quantum phenomena2. However, so far all its realizations have been based on a continuous evolution of the quantum state, following a cyclic path. Here we introduce and demonstrate a conceptually new manifestation of the Berry phase in light-driven crystals, in which the electronic wavefunction accumulates a geometric phase during a discrete evolution between different bands, while preserving the coherence of the process. We experimentally reveal this phase by using a strong laser field to engineer an internal interferometer, induced during less than one cycle of the driving field, which maps the phase onto the emission of higher-order harmonics. Our work provides an opportunity for the study of geometric phases, leading to a variety of observations in light-driven topological phenomena and attosecond solid-state physics.

Stepping out of secrecy: heterosexuality, quality of life, and experiences of HIV peer navigation in Australia.

Heterosexual people make up a small, but growing proportion of people living with HIV in Australia. This article draws on semi-structured interviews with thirteen heterosexual men and women living with HIV to examine the bearing that sexual identity had on their participation in a peer navigation programme. Our analyses consider the influence of sexuality and gender on the quality of peer relations and the effects of HIV-related stigma on health service engagement and quality of life. Gender and sexuality were significant factors in establishing understanding, acceptance, and community for participants. Having their heterosexuality mirrored by a peer was affirming for men. Women instead emphasised their gendered experiences of HIV. Otherwise, participants' narratives suggested that an experienced peer could reassure, guide interactions with community and services, and ease treatment-related and nonclinical aspects of life. We see peer navigation as a promising intervention to improve the quality of life for heterosexual people living with HIV. Person-centred support from a peer may be particularly important in HIV service environments adapting to the needs of heterosexual people. Peer navigation programmes should promote choice and employ peers of diverse experiences. Implications for referral and the improvement of social services for heterosexual people living with HIV are discussed.

A call for health systems to monitor the health-related quality of life of people living with HIV.

INTRODUCTION: The World Health Organization's (WHO's) new global health strategy on HIV represents a major step toward a broader conceptualization of HIV care. It recognizes the importance of addressing chronic care more fully and-for the first time ever-the health-related quality of life (HRQoL) of people living with HIV (PLHIV). METHODS: A thorough literature review was conducted in order to analyse how the WHO strategy on HIV for 2022-2030 addresses the monitoring of the HRQoL of PLHIV for the next decade and compared it to that of other countries and health authorities. RESULTS: Unlike for other issues, the strategy does not include quantitative targets for 2030, thus falling short of committing to monitoring global progress in improving the long-term well-being of PLHIV. CONCLUSIONS: We urge national health systems not to wait for WHO to lead on this issue. Seeking good HRQoL outcomes for PLHIV can confer far-reaching benefits on health systems. The feasibility of monitoring population-level HRQoL has been demonstrated through the use of simple tools like patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Many countries can already set HRQoL monitoring targets, similar to those presented in this viewpoint, while we work toward an agreed minimum metric for use by all countries.

Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing.

OBJECTIVES: Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions. METHODS: In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services. RESULTS: Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (ß -0.49; 95% CI -0.74 to -0.24), stigma (ß -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (ß -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (ß -0.50; 95% CI -0.71 to -0.30). CONCLUSIONS: Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.

Agreements, Behaviour, and Change: Sex Outside the Relationship in Male HIV-negative Partners in HIV Serodiscordant Relationships in Australia, Brazil, and Thailand.

Male HIV serodiscordant couples have diverse relationship agreements regarding sex outside the relationship. We examined the relationship agreements as described by 343 male HIV-negative partners in HIV serodiscordant relationships in Australia, Brazil and Thailand participating in a multi-year cohort study. At baseline, 125 (34.1%) HIV-negative partners reported no agreement, 115 (33.5%) had a monogamous agreement, and 103 (37.9%) had an open agreement allowing sex outside the relationship. Relationship agreements were largely stable over time, with 76% of HIV-negative men reporting the same agreement across follow up, while changes were predominantly towards having an open agreement. Behaviour largely matched relationship agreements, and the predictors of breaking an agreement by having condomless anal intercourse (CLAI) with an outside partner were CLAI within the relationship (OR = 3.17, 95%CI: 1.64-6.14, p < 0.001) and PrEP use in the last three months (OR = 3.42, 95%CI: 1.48-7.92, p = 0.004). When considering HIV transmission risk for HIV-negative men in serodiscordant relationships, greater focus needs to be placed on sex that is occurring outside the relationship and the agreements that facilitate this.

Corrigendum: Mineral supply for sustainable development requires resource governance.

This corrects the article DOI: 10.1038/nature21359.

Mineral supply for sustainable development requires resource governance.

Successful delivery of the United Nations sustainable development goals and implementation of the Paris Agreement requires technologies that utilize a wide range of minerals in vast quantities. Metal recycling and technological change will contribute to sustaining supply, but mining must continue and grow for the foreseeable future to ensure that such minerals remain available to industry. New links are needed between existing institutional frameworks to oversee responsible sourcing of minerals, trajectories for mineral exploration, environmental practices, and consumer awareness of the effects of consumption. Here we present, through analysis of a comprehensive set of data and demand forecasts, an interdisciplinary perspective on how best to ensure ecologically viable continuity of global mineral supply over the coming decades.

A Scoping Review of Peer Navigation Programs for People Living with HIV: Form, Function and Effects.

This scoping review maps recent research into peer navigation programs for people living with HIV. Four databases were systematically searched in June 2020. Results were screened according to defined criteria and were not restricted to any design, outcome or country. Six papers drew from randomised control trials, five from quasi-experimental or pragmatic trials, and four panel, eight qualitative, three mixed method and one cross-sectional designs were included for review. Programs incorporated health systems navigation and social support. Authors provided strong theoretical bases for peers to enhance program effects. Studies primarily reported program effects on continuum of care outcomes. Further research is required to capture the role HIV peer navigators play in preventing disease and promoting quality of life, mental health, and disease self-management in diverse settings and populations. Peer programs are complex, social interventions. Future work should evaluate detailed information about peer navigators, their activities, the quality of peer engagement as well as employee and community support structures to improve quality and impact.

Anxiety about HIV criminalisation among people living with HIV in Australia.

Many countries, including Australia, have laws that enable criminal prosecution of an individual based on reckless or intentional transmission of HIV to another person. Previous research has suggested that criminalisation of HIV may serve to hamper public health efforts by inhibiting HIV status disclosure or testing. Limited research to date has sought to examine the broader impact of criminalisation on the health and wellbeing of people living with HIV, which this paper aims to address. Drawing on cross-sectional data from 895 people living with HIV in Australia, this paper describes associations between standard measures of mental health and resilience with a newly devised scale measuring anxiety about HIV criminalisation. Findings suggest that laws criminalising HIV transmission have a broadly negative impact on wellbeing of people living with HIV, a situation that is exacerbated for gay and bisexual men, and other people living with HIV who may face intersecting forms of marginalisation based on race, gender or class. There is little justification for these laws being applied in Australia and the findings add weight to advocacy seeking to overturn criminalisation across the world.

Domestic mobility and experiences of disconnection from sexual health care among gay and bisexual men in Australia: insights from a qualitative study.

Background Previous research on mobility and HIV acquisition among gay and bisexual men (GBM) has focused on: (1) changed sexual practices in the context of travel; and (2) the association between migration and increased HIV risk. To date, little attention has been given to continuity of sexual health and HIV-prevention services in the context of relocating between different cities or regions within the same country. Methods Drawing on in-depth interviews with 17 GBM recently diagnosed with HIV, we explored these men's access to sexual health care in the period prior to diagnosis. Results At least five of these 17 men's accounts provided examples of becoming disconnected from sexual health care because of mobility within Australia. For some men, this disconnection from care also included loss of access to pre-exposure prophylaxis (PrEP). In all these men's accounts, reconnection with services only came about at the time of seeking the HIV test associated with their diagnosis. The fact that men who had previously been well connected to sexual health services (as indicated by early uptake of PrEP, or regular HIV/STI testing) did not easily access similar services after relocating suggest that there are other factors - such as the social and physical environment - that have an important bearing on retention in sexual health care. Conclusions There is a need for more comprehensive data collection related to mobility in order to ascertain its relative importance. Regarding policy and practice, there are also opportunities for a more formalised process for interstate referral of clients of sexual health services.

Patient-centred approaches to providing care at HIV diagnosis: perspectives from healthcare and peer-support workers.

BACKGROUND: Early uptake of HIV treatment among those newly diagnosed with HIV can improve individual health and prevent onward transmission. Patient-centred care is considered an important aspect in health care, the management of HIV, and can improve uptake of and adherence to HIV treatments. METHODS: Semi-structured interviews were conducted with sexual health clinicians (n , 10) and HIV support workers (n , 4) to understand how they approached HIV diagnosis delivery and care immediately thereafter. RESULTS: Our thematic analysis identified three themes: (1) centring patient needs at diagnosis; (2) assessing patients' readiness to begin treatment; and (3) referrals to psychosocial support services. Our findings highlight centring patients was an important aspect of how participants delivered HIV diagnoses. By taking this approach, clinicians were best able to consider patient readiness to initiate treatment and referrals to social support services. CONCLUSIONS: Given HIV diagnoses are increasingly occurring in generalist health services, our findings offer an important opportunity to learn from the experiences of specialist sexual health clinicians and HIV support workers.

Social determinants of quality of life among PLHIV in Australia: implications for health promotion.

A cascade of care model is central to contemporary approaches to HIV prevention. The model prioritizes strategies to increase rates of HIV testing and promote early and sustained uptake of antiretroviral treatment (ART) among people living with HIV (PLHIV). The model aims to prevent new HIV transmissions by increasing the number of PLHIV who have achieved HIV viral suppression. However, good quality of life (QoL) among PLHIV has been proposed as an additional goal. This prioritizes the basic right of PLHIV to lead meaningful lives and acknowledges the relationship between better QoL and consistent ART use. A better understanding of factors associated with the QoL can thus inform health promotion programmes for PLHIV. In this study, N=465 Australian participants, recruited through social media and various HIV community organizations, completed an online survey that included a measure of QoL and a range of demographic, health-related and social variables. Overall, social factors accounted uniquely for the most variance in QoL (18%), followed by health-related (11%) and demographic factors (2%). Social support, HIV-related discrimination and treatment convenience were among the strongest determinants of QoL. These findings reinforce the importance of a more holistic approach to health promotion among PLHIV. Specifically, our results indicate that to improve the QoL of PLHIV and to boost related public health benefits, community advocates and healthcare professionals must be responsive to the broader psychological, social and functional needs of PLHIV.

Client-led care in HIV: perspectives from community and practice.

OBJECTIVES: While current antiretroviral and care strategies can effectively suppress HIV, achieving optimal quality of life (QoL) requires a wider consideration of clients' well-being, the complexity of individuals' lives and social determinants of health. The objective of this commentary was to develop a definition of client-led care in the Australian context and its key supporting principles for people living with HIV (PLHIV). METHODS: The authors used two sources of evidence to support their HIV community experience with client-led care: (1) a scoping review of the literature, and (2) consultations with colleagues who were PLHIV advocates or HIV specialist physicians. The findings from the scoping review and consultations were summarised and the key principles of client-led care compared with those identified by the authors. RESULTS: Seven articles met the inclusion criteria for qualitative analysis in the scoping review. Five PLHIV advocates and three HIV specialist physicians were consulted. Key principles supporting client-led care identified by the authors based on their experience centred around the themes of: (1) clients and healthcare providers working in partnership, (2) information and communication, (3) coordinating access to care, (4) building trust, and (5) respect for client's needs and preferences. The principles identified by the authors were supported by those of the scoping review and colleague consultations. CONCLUSIONS: A client-led approach can complement conventional HIV care strategies and enable empowerment and greater engagement with care, potentially improving the care continuum and overall QoL for individuals living with HIV who can, and want to, lead their own care.

The Plasmodium falciparum transcriptome in severe malaria reveals altered expression of genes involved in important processes including surface antigen-encoding var genes.

Within the human host, the malaria parasite Plasmodium falciparum is exposed to multiple selection pressures. The host environment changes dramatically in severe malaria, but the extent to which the parasite responds to-or is selected by-this environment remains unclear. From previous studies, the parasites that cause severe malaria appear to increase expression of a restricted but poorly defined subset of the PfEMP1 variant, surface antigens. PfEMP1s are major targets of protective immunity. Here, we used RNA sequencing (RNAseq) to analyse gene expression in 44 parasite isolates that caused severe and uncomplicated malaria in Papuan patients. The transcriptomes of 19 parasite isolates associated with severe malaria indicated that these parasites had decreased glycolysis without activation of compensatory pathways; altered chromatin structure and probably transcriptional regulation through decreased histone methylation; reduced surface expression of PfEMP1; and down-regulated expression of multiple chaperone proteins. Our RNAseq also identified novel associations between disease severity and PfEMP1 transcripts, domains, and smaller sequence segments and also confirmed all previously reported associations between expressed PfEMP1 sequences and severe disease. These findings will inform efforts to identify vaccine targets for severe malaria and also indicate how parasites adapt to-or are selected by-the host environment in severe malaria.

Bisexual Men Living with HIV: Wellbeing, Connectedness and the Impact of Stigma.

Social research with people living with HIV (PLHIV) rarely distinguishes between gay men and bisexual men. However, bisexual men may have unique experiences of HIV-related stigma and distinct support needs. In this paper, findings are presented from a cross-sectional survey of Australian PLHIV, which included the Berger (HIV) stigma scale. A total of 872 PLHIV completed the survey, of which 48 (6.0%) were bisexual men. Bisexual men reported higher levels of internalised HIV-related stigma, greater negative self-image and poorer emotional wellbeing than gay men. Bisexual men also reported less social support, less connection with lesbian, gay, bisexual, transgender and queer (LGBTQ) communities, and less connection with other PLHIV. Analysis of data from an open-text question revealed feelings of social isolation and fear of rejection was associated with participant's HIV diagnosis. Study findings suggest that existing social supports for PLHIV may not adequately address the unique support needs of bisexual men.

Quality of life in people living with HIV in Romania and Spain.

BACKGROUND: Health-related quality of life (HRQoL) is a crucial component in assessing and addressing the unmet needs of people, especially those with chronic illnesses such as HIV. The aim of the study was to examine and compare the health-related quality of life of people living with HIV in Romania and Spain, compared to the general populations of each country. METHODS: A cross-sectional survey was conducted among adults (≥ 18 years) attending for HIV care in Romania and Spain from October 2019 to March 2020. The survey included two validated HRQoL instruments: a generic instrument, EQ-5D-5L, and an HIV-specific instrument, PozQoL, and questions on socio-demographics, HIV-related characteristics, physical and mental health conditions, and substance use. Multivariable linear regression was used to determine factors associated with HRQoL. RESULTS: 570 people living with HIV responded (170 in Romania and 400 in Spain). The median age was 31 (18-67) in Romania and 52 (19-83) in Spain. Anxiety/depression symptoms were frequently reported by people with HIV (Romania: 50% vs 30% in the Romanian population; Spain: 38% vs 15% in Spanish population). Spain reported higher mean EQ-5Dutility scores than Romania (0.88 and 0.85, respectively) but identical PozQoL scores (3.5, on a scale of 0-5). In both countries, health concerns were highlighted as a key issue for people with HIV. In multivariable analysis, two factors were consistently associated with worse HRQoL in people with HIV: bad or very bad self-rated health status and presence of a mental health condition. In Romania, being gay/bisexual and being disabled/unemployed were associated with worse HRQoL. Whereas in Spain, older age and financial insecurity were significant predictors. CONCLUSIONS: Our results indicated a good HRQoL for people living with HIV in Romania and Spain; however, worse HRQoL profiles were characterized by health concerns, poor self-rated health status, and the presence of mental health conditions. This study highlights the importance of monitoring HRQoL in people living with HIV due to the chronic nature of the disease. In this highly-treatment experienced group, disparities were found, particularly highlighting mental health as an area which needs more attention to improve the well-being of people living with HIV.

Effectiveness of health consumer representative involvement in implementation of interventions to change health professional behaviour.

BACKGROUND: The adoption of research evidence to improve client outcomes may be enhanced using the principles of implementation science. This systematic review aimed to understand the effect of involving consumers to change health professional behaviours and practices. The barriers and enablers to consumer engagement will also be examined. METHODS: We searched Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials and PDQ-Evidence from 2004 to February 2019. Implementation studies involving consumers in at least one phase (development, intervention or facilitation) of an intervention that aimed to change health professional behaviour to align with evidence-based practice were included. Studies in the areas of paediatrics and primary care were excluded. Two review authors independently screened studies for inclusion, and one author extracted data and conducted quality assessments with review of a second author. Knowledge translation interventions were categorized using the Effective Practice and Organisation of Care taxonomy. The primary outcome was measures of change in health professional behaviour. RESULTS: Sixteen articles met the inclusion criteria. Meta-analysis of three studies found support for consumer involvement in changing healthcare professionals' behaviour (Hedges' g = 0.41, 95% CI [0.27, 0.57], P < 0.001). Most knowledge translation studies involved consumers during the development phase only (n = 12). Most studies (n = 9) included one type of knowledge translation intervention. Professional interventions (including education of health professionals, educational outreach, and audit and feedback) were described in 13 studies. CONCLUSIONS: Consumer involvement rarely moves beyond the design phase of knowledge translation research in healthcare settings. Further research of the barriers to and effect of increased consumer engagement across all stages of knowledge translation interventions is needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019119179.

When did Homo sapiens first reach Southeast Asia and Sahul?

Anatomically modern humans (Homo sapiens, AMH) began spreading across Eurasia from Africa and adjacent Southwest Asia about 50,000-55,000 years ago (ca 50-55 ka). Some have argued that human genetic, fossil, and archaeological data indicate one or more prior dispersals, possibly as early as 120 ka. A recently reported age estimate of 65 ka for Madjedbebe, an archaeological site in northern Sahul (Pleistocene Australia-New Guinea), if correct, offers what might be the strongest support yet presented for a pre-55-ka African AMH exodus. We review evidence for AMH arrival on an arc spanning South China through Sahul and then evaluate data from Madjedbebe. We find that an age estimate of >50 ka for this site is unlikely to be valid. While AMH may have moved far beyond Africa well before 50-55 ka, data from the region of interest offered in support of this idea are not compelling.

Talking about sex with friends: perspectives of older adults from the Sex, Age & Me study in Australia.

This qualitative study explored the barriers and facilitators to sexual communication between older adults and friends. Fifty-three women and men aged 58 and older were interviewed about their intimate relationships and sexual behaviours and attitudes. Findings indicated that talking about sex with friends played an important role in providing support and sharing information. The privacy of the topic meant that trust and confidentiality had to be in place before sexual conversations occurred, and that discretion was required for those married or in a relationship due to potential breaches of privacy. Stereotypes associated with older age made talking about sex 'risky' as participants were vulnerable to scrutiny. Growing-up during a time when sex was taboo influenced willingness and comfort in talking about sex today. Among those who did talk with friends, women tended to talk to women and men to men. These findings are significant in the context of an increasing global population of older adults and silence around sex and ageing. By exploring sexual communication outside of the healthcare context, where previous research has focused, the findings indicate novel ways to support the sexual health and well-being of older adults.

High levels of engagement with testing for HIV and sexually transmissible infection among gay Asian men in Sydney and Melbourne: an observational study.

Background Gay and other men who have sex with men of Asian background (GAM) have been identified as a key population in efforts to eradicate HIV in New South Wales. The aims of the present study were to evaluate current levels of engagement with HIV and sexually transmissible infection (STI) testing services, assess knowledge of pre- and post-exposure prophylaxis and to identify factors associated with service engagement in this group. METHODS: A survey of 604 GAM residing in Sydney and Melbourne was undertaken. RESULTS: The data identified that a significant proportion of non-HIV-positive men (i.e. HIV-negative men and men whose HIV status was unknown) surveyed (n = 567; 93.9%) had engaged in frequent HIV testing and comprehensive STI testing in the 12 months prior to the survey (n = 180; 31.7%). There were significant differences (P < 0.05) in sexual practices at the bivariate level between those who reported frequent and comprehensive HIV/STI testing and those who did not. Those who tested regularly were substantially more sexually active, were more likely to have multiple partners (P = 0.001) and were more likely to engage in condomless anal intercourse with both casual (P < 0.001) and regular (P = 0.002) partners. Those who engaged with testing initiatives were more likely to discuss HIV status with both regular (P = 0.008) and casual (P < 0.001) partners, and identified more reasons to test than their counterparts (P < 0.001). The data also highlighted key service venues, with gay men most likely to have used public sexual health clinics (46.9%) as their most recent testing venue. CONCLUSIONS: The data demonstrate an association between high levels of male-to-male sexual activity and engagement in frequent and comprehensive HIV and STI testing. This likely derives from both self-perceived notions of risk and current reliance on established gay community organisations to convey information around testing. Increasing engagement with testing initiatives beyond GAM who self-identify as being at high HIV and STI risk will require the use of novel routes by which to disseminate this information.