HIV prevalence and TB in migrant miners communities of origin in Gaza Province, Mozambique: The need for increasing awareness and knowledge.

BACKGROUND: As part of ongoing efforts to generate evidence needed on HIV and tuberculosis (TB) to inform policies and programs aimed to improve the health outcomes of migrants and communities affected by migration and mining, a preliminary investigation was conducted through a biological and behavioral (BBS) approach related to HIV and TB in two communities of origin of migrant mineworkers in Gaza Province. The main objective was to determine the prevalence of HIV and the rates of asymptomatic infection by TB, and the social and behavioral risk factors associated. METHODS: A cross-sectional survey was conducted from May to June 2017 using a simple random sampling methodology. Eligible participants were individuals who were living in the community at the time the survey was conducted, which included adult mine workers and members of their families aged 18 and above. A socio-behavioral questionnaire was administered, blood specimens were collected for HIV testing (Determine/Unigold) and sputum for TB (GeneXpert MTB/RIF) was collected. The statistical analysis was performed using the R studio software to produce means, proportion and odds ratio at 95% confidence intervals. RESULTS: A total of 1012 participants were enrolled, 75.2% were females, with a median age of 34. The overall prevalence of HIV found in the two communities was 24.2% (CI: 21.6-27.0) and was higher in the rural community (31.6%; 95% CI: 27.0-35.3). The prevalence of active TB was found to be 0.3% (n = 3) while 7.5% of the participants self-reported to have been previously diagnosed with TB at some point in their life. Only 2.8% of participants had knowledge of the basic principles of TB transmission. Condom use at last sexual intercourse with a regular partner was low among both sexes (17.3% male and 12.6% female). A considerable proportion of participants had not been aware of their HIV positive serostatus(31.1% female and 25.0% male). About 1/3 of the participants had had a history of STIs. CONCLUSION: The results of this survey confirm a high prevalence of HIV in communities of origin of migrant miners in Gaza province. Findings also demonstrated low levels of awareness/ knowledge and prevention of TB and HIV. It is important to strengthen strategies that encourage regular HIV testing and TB screening. Appropriate communication interventions on methods of transmission and prevention of HIV and TB in these communities must be intensified, as well as ensuring ongoing linkage to TB and HIV social and healthcare services.

O autocuidado de idosos com HIV/aids: contribuições de Enfermagem / Self-care of elderly people with HIV/AIDS: nursing contributions

Pesquisa de abordagem qualitativa com o objetivo de discutir como idosos com HIV/aids realizam o autocuidado, quais as implicações para sua saúde e para o cuidado de enfermagem. Aprovada pelos Comitês de Ética em Pesquisa EEAN/HESFA e HUCFF/UFRJ, utilizou o método Grounded Theory (GT) ou Teoria Fundamentada em Dados (TFD) para guiar a coleta, análise e discussão dos dados de 25 idosos com HIV/aids, usuários do ambulatório de Doenças Infecciosas e Parasitárias do HUCFF/UFRJ. Na entrevista e pesquisa documental foram utilizados dois instrumentos: o roteiro da entrevista, com seções semiestruturada e estruturada, e a planilha de registro de informações nos prontuários. Do total de idosos entrevistados, 60% eram homens, 48% entre 60 e 64 anos, 68% heterossexuais, 32% solteiros e 32% viúvos, 84% aposentados ou pensionistas, 48% frequentaram a escola de nove (09) a onze (11) anos,e 68% informaram renda entre um (01) e três (03) salários mínimos. O tempo de diagnóstico HIV/aids variou de dois (02) a 30 anos, a idade no momento do diagnóstico de 30 a 70 anos, com 100% fazendo uso da TARV por períodos entre um (01) e 25 anos. As doenças oportunistas mais frequentes foram pneumonia, tuberculose e herpes zoster e as comorbidades foram hipertensão arterial sistêmica, diabetes mellitus e dislipidemia. A partir dos dados submetidos aos processos analíticos da TFD, emergiram 47 códigos, agrupados em oito (08) subcategorias - (1) O Mim, (2) Diagnóstico, (3) Saúde Mental, (4) Saúde Física, (5) Espiritualidade, (6) Sexualidade, (7) O Outro, (8) Preconceito - e três (03) categorias - "Idoso com HIV/aids", "Interação Social" e a categoria central "Autocuidado", ilustradas pelo diagrama de Venn. Em conclusão, dentre as demandas de cuidado físico e psicossocial de enfermagem aos idosos com HIV/aids, emergiram necessidades de instrumentalização para a adoção e sustentação do autocuidado e de fomentar a autoestima para o enfrentamento do preconceito.

Qualitative approach research with the objective to discuss how older adults with HIV/aids practice self-care, its health and nursing care implications. Approved by the EEAN/HESFA and HUCFF/UFRJ Institutional Review Boards (IRBs), used Grounded Theory (GT) or Teoria Fundamentada em Dados (TFD) to guide data collection, analysis and discussion of 25 older adults with HIV/aids, outpatients at the Infectious and Parasitic Diseases at the HUCFF/UFRJ ambulatory. Two instruments were used on the interview and documental research: the interview guide with two sections, one semi-structured and one structured, and a spreadsheet for data entry of information on patient files. From the overall number of participants, 60% were men, 48% between 60-64 years old, 68% heterosexuals, 32% single and 32% widowers, 84% were retired or received pensions, 48% attended school between nine (09) and eleven (11) years, and 68% declared income between one (01) e three (03) minimum wages. HIV/aids time of known diagnosis varied from two (02) to 30 years; age at the time of diagnosis between 30-70 years old, with 100% in use of Antiretroviral Therapy (ART) for periods varying between one (01) and 25 years long. The most frequent opportunist diseases were pneumonia, tuberculosis and herpes zoster and the comorbidities were systemic hypertension, diabetes mellitus and dyslipidemia. From the data submitted to GT analytic processes, emerged 47 codes, groups into eight (08) subcategories - (1) The Me, (2) Diagnose, (3) Mental Health, (4) Physical Health, (5) Spirituality, (6) Sexuality, (7) The Other, (8) Prejudice- and three (03) categories- "Older with HIV/aids", "Social Interaction" and the central category "Self-care", illustrated by a Venn diagram. In conclusion, among the nursing physical and psychosocial care demands of older adults with HIV/aids, emerged needs for effective support towards(i) the adoption and sustainingof self-care practices and (ii) the building up of self-esteem for coping against prejudice.

Investigación de abordaje cualitativa com el objetivo de discutir como ancianos con VIH/sida realizan el autocuidado, cuales las implicaciones para su salud y para el cuidado de enfermería. Aprobada por los Comités de Ética em Investigación EEAN/HESFA y HUCFF/UFRJ, utilizo el método Grounded Theory (GT) o Teoría Fundamentada em Datos (TFD) para conducir la recolección, análisis y discusión de los datos de 25 ancianos con VIH/sida, usuários del ambulatorio de Enfermedades Infecciosas y Parasitarias del HUCFF/UFRJ. En la entrevista e investigación documental fueron utilizados dos instrumentos: el guión de la entrevista, con secciones semiestructurada y estructurada, y una hoja de trabajo para registro de informaciones em los historiales clínicos. En la totalidad de participantes entrevistados, 60% eran hombres, 48% entre 60 y 64 años, 68% heterosexuales, 32% solteros y 32% viudos, 84% eran jubilados o pensionistas, 48% con nueve (09) a once (11) años de escolaridad, y 68% informaron renta entre una (01) y tres (03) remuneraciones mínimas. El tiempo de diagnóstico VIH/sida varió de dos (02) a 30 años, la edad en el momento del diagnóstico de 30 a 70 años, con 100% haciendo uso de la Terapia Antirretroviral (TAR) por periodos entre uno (01) y 25 años. Las enfermedades oportunistas más frecuentes fueronpulmonía, tuberculosis y herpes zóster y las comorbilidades fueron hipertensión arterial sistémica, diabetes mellitus y dislipimia. A partir de los datos sometidos a los procesos analíticos de la TFD, emergieron 47 códigos, agrupados en ocho (08) subcategorias - (1) El Mí, (2) Diagnóstico, (3) Salud Mental, (4) Salud Física, (5) Espiritualidad, (6) Sexualidad, (7) El Otro, (8) Prejuicio ­ y tres (03) categorías ­ "Anciano con VIH/sida", "Interacción Social" y la categoría central "Autocuidado", ilustradas por el diagrama de Venn. En conclusión, de las demandas del cuidado físico y psicosocial de enfermería a los ancianos con VIH/sida, emergieron necesidades de instrumentalización para la adopción y sustentación del autocuidado y de fomentar la autoestima para el enfrentamiento del prejuicio.

[Cryptococcal meningitis and neuropsychiatric consequences of HIV-infection]. / Cryptokokkenmeningitis en neuro-psychiatrische gevolgen van hiv-besmetting.

A 49-year-old African-born male was admitted to hospital with an acute psychosis. He had been treated by an internist after being found to have hiv; as a result of non-compliance over a period of about four months his cd4-count had dropped to 40. Six months earlier he had developed a cryptococcal meningitis, which left him a number of neurological and psychiatric symptoms. During his stay in hospital there had to be good collaboration with the specialist in internal medicine whose dual task was to manage the patient's dramatically low cd4-account as well as his psychosis. Cryptococcal meningitis is a risk factor for psychiatric disorders and mortality in hiv-infected persons.

Complex care needs of patients with late-stage HIV disease: a retrospective study.

This retrospective chart review provides a profile of an emerging population of vulnerable HIV patients with complex comorbidities. Data were abstracted from all 83 patients admitted in 2008 to Casey House, a community-based hospital dedicated to supportive and palliative care for persons with HIV in Toronto, Canada. We describe patient characteristics, including medical and psychiatric conditions, and use a Venn diagram and case study to illustrate the frequency and reality of co-occurring conditions that contribute to the complexity of patients' health and health care needs. The mean age at admission was 49.2 years (SD10.5). Sixty-seven patients (80.7%) were male. Patients experienced a mean of 5.9 medical comorbidities (SD2.3) and 1.9 psychiatric disorders (lifetime Axis I diagnoses). Forty patients (48.2%) experienced cognitive impairment including HIV-associated dementia. Patients were on a mean of 11.5 (SD5.3) medications at admission; 74.7% were on antiretroviral medications with 55.0% reporting full adherence. Current alcohol and drug use was common with 50.6% reporting active use at admission. Our Venn diagram illustrates the breadth of complexity in the clients with 8.4% of clients living in unstable housing with three or more medical comorbidities and two or more psychiatric diagnoses. Comprehensive HIV program planning should include interventions that can flexibly adapt to meet the multidimensional and complex needs of this segment of patients. Researchers, policy-makers, and clinicians need to have greater awareness of overlapping medical, psychiatric and psychosocial comorbidities. Inclusion of the needs of these most vulnerable patients in the development of evidence-based guidelines is an important step for effectively treating, preventing, and planning for the future of HIV/AIDS care.

Assessing the influence of health literacy on HIV-positive women's cervical cancer prevention knowledge and behaviors.

Women living with HIV (WLH) bear a disproportionate burden of cervical cancer and may face challenges understanding health information. The purpose of this study was to assess the influence of health literacy on WLH cervical cancer screening knowledge and behaviors. WLH were recruited from clinic- and community-based settings in the southeastern USA. The majority of women completing a questionnaire assessing factors related to cervical cancer were African American (90 %). About 38 % of women reported low health literacy. Compared to women with high health literacy, these women were more likely to report having had ≥ 2 Pap tests during the year after HIV diagnosis (p=0.02), and less likely to have had a Pap test <1 year previously (p=0.05). There was no difference in cervical cancer or human papillomavirus knowledge among those with low versus high health literacy. Results revealed mixed finding on the influence of health literacy on screening knowledge and behaviors.

Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients.

Dental treatment procedures frequently involve blood and saliva that may be contaminated with HIV. The purpose of this cross-sectional survey was to assess Iranian dental students' knowledge of and attitudes towards HIV/AIDS patients. In 2008, a fifty-three-item self-administered questionnaire was conducted on all 750 dental students who participated in the 10(th) Dental Student Congress in Isfahan, Iran. The overall response rate to the questionnaire was 60.7 percent. The total mean knowledge and attitudes scores were 82.1 percent (excellent) and 57.4 percent (negative), respectively. There were no significant differences in the knowledge or attitude scores between male and female students. A majority of the students were aware of the association between HIV and oral candidiasis (98.1 percent), major aphthous (95.8 percent), and Kaposi's sarcoma (93.8 percent). Although a majority of the students had excellent knowledge (78.4 percent), only 1 percent had professional attitudes about treating patients with HIV/AIDS. Therefore, it is important that dental students, as future dentists, develop not only the necessary practical skills but also attitudes that will prepare them to treat HIV/AIDS patients.

The impact of environmental risk factors on HIV-associated cognitive decline in children.

Both the human immunodeficiency virus (HIV) and environmental stress have been independently associated with decreased cognitive functioning in children. Given that they are also known to have a strong relationship with each other, the present study sought to test the hypothesis that children in conditions of high environmental risk would be at greater risk for the cognitive complications related to immunosuppression. A retrospective review was conducted to examine the records of 141 children treated at a large pediatric AIDS clinic from 1993 to 2000. CD4+ lymphocyte levels were recorded from laboratory results and IQ scores were recorded from routine psychological evaluations. Key indicators of environmental risk were collected and combined into one measure of overall environmental risk. Pearson product moment correlations were conducted to examine the relationship between environmental risk, age-adjusted CD4 and IQ. Results indicated a significant correlation between CD4 and IQ, with higher levels of immunocompetence predicting higher IQ scores. When subjects were dichotomized based on their environmental risk score, there was no relationship between CD4 count and IQ in the low environmental risk group. In contrast, CD4 was positively associated with IQ in the high environmental risk group. It is proposed that this may be due to gp120 levels in immunocompromised children being particularly toxic to the hippocampus and cortex under conditions of high stress but not so under conditions of low stress.

Stressful events, pessimism, natural killer cell cytotoxicity, and cytotoxic/suppressor T cells in HIV+ black women at risk for cervical cancer.

OBJECTIVE: This study examines whether stressful negative life events and pessimism were associated with lower natural killer cell cytotoxicity (NKCC) and T cytotoxic/suppressor cell (CD8+CD3+) percentage in black women co-infected with human immunodeficiency virus Type 1 (HIV-1) and human papillomavirus (HPV), a viral initiator of cervical cancer. METHOD: Psychosocial interviews, immunological evaluations, and cervical swabs for HPV detection and subtyping were conducted on 36 HIV+ African-American, Haitian, and Caribbean women. RESULTS: Greater pessimism was related to lower NKCC and cytotoxic/suppressor cells after controlling for presence/absence of HPV Types 16 or 18, behavioral/lifestyle factors, and subjective impact of negative life events. CONCLUSIONS: A pessimistic attitude may be associated with immune decrements, and possibly poorer control over HPV infection and increased risk for future promotion of cervical dysplasia to invasive cervical cancer in HIV+ minority women co-infected with HPV.

Severe mental illness and HIV-related medical and neuropsychiatric sequelae.

Medical and neuropsychiatric sequelae of HIV infection present a spectrum of diagnostic and treatment challenges to mental health clinicians. Both HIV and the many opportunistic infections that manifest in patients due to their immunocompromised state also can affect the central nervous system (CNS). Thus, mental health clinicians need to be familiar with the diagnosis and management of HIV-related medical and psychiatric complications. This article provides an overview of the CNS-related manifestations resulting from HIV disease, including HIV-related dementia, psychotic disorders, delirium, CNS opportunistic infections and tumors, systemic abnormalities, psychoactive substances, and the adverse effects of certain medical treatments. Treatment strategies for individuals with HIV disease and comorbid severe mental illness are outlined and recommendations for future research are offered.

Reasons for HIV antibody test refusal in a heterosexual sexually transmitted disease clinic population.

OBJECTIVE: To evaluate acceptance of confidential HIV antibody testing and reasons for test refusal among heterosexual clients of Los Angeles County sexually transmitted disease (STD) clinics. METHODS: From January 1993 through June 1994, all blood specimens routinely collected for syphilis serology were tested blindly for HIV antibody at seven STD clinics. Patients were counseled and offered a confidential HIV test. Rate of refusal of confidential testing and primary reason for test refusal were examined by demographic group and HIV serostatus, as determined in the blinded survey, for all heterosexual clients. RESULTS: Of 20,125 persons offered confidential testing, 35.6% refused the test. Test refusal was higher among men (38.7%) than women [31.1%; adjusted odds ratio (OR), 1.4; 95% confidence interval (CI), 1.3-1.4] and among blacks (38.6%) than whites (28.6%; adjusted OR, 1.7; 95% CI, 1.5-2.0). The most common reason for refusal was 'already know my HIV status' (40.6%), followed by 'don't want to know' (23.9%), and 'not at risk' (19.4%). Confidentiality concerns were cited as the primary reason for refusal by 2.2%. Among the 180 (0.9%) persons who tested positive in the blinded survey, 99 (55.0%) refused the confidential test. Of the 44 seropositive persons who refused the confidential test because they "already knew their HIV status', 29 (65.9%) reported their previous test to be negative. CONCLUSIONS: Efforts are needed to increase acceptance of confidential HIV testing in this heterosexual population and should (1) include a client-centered counseling approach that facilitates accurate self-assessment of risk and addresses the misperception that a prior negative test result implies an absence of risk, and (2) highlight the potential benefits of early intervention medical and psychosocial services.

Bacillary angiomatosis: a treatable cause of acute psychiatric symptoms in human immunodeficiency virus infection.

BACKGROUND: Bacillary angiomatosis is a systemic infection that has been most commonly reported in the setting of immunosuppression, especially human immunodeficiency virus (HIV) disease. METHOD: We report two patients who had bacillary angiomatosis who presented with psychiatric symptoms. RESULTS: The first patient presented with marked exacerbation of previous depressive disease. The second patient presented with new psychotic symptoms. In both cases psychiatric symptoms did not resolve until antibiotic treatment was given. CONCLUSION: Our report expands the clinical spectrum of bacillary angiomatosis and identifies a new cause of treatable psychiatric disease in HIV-infected persons.

Somatic care wanted by HIV-infected intravenous drug abusers: the patients' opinions and experiences.

The somatic care of HIV-infected intravenous drug abusers (IVDUs) is often combined with many problems. The addict is often an unpopular patient, but society must assume responsibility for him or her and it is important to solve care problems in an appropriate way. This study was undertaken in order to investigate what kind of care addicts want when they become somatically ill. A questionnaire was given to patients who acquired HIV infection due to intravenous drug abuse, who visited an outpatient clinic for HIV-infected patients at the Department of Infectious Disease, Huddinge Hospital, Stockholm, Sweden. A total of 72 of the original 78 questionnaires could be evaluated. Thirty respondents took part in the Stockholm Methadone Programme. The patients were asked to rank the importance of professional competence among the staff. The patients ranked competence in pain treatment highest followed by competence in somatic medical care. Lower ranked, but still perceived as important, was competence in psychiatric medical care and social welfare work. Experience in treatment of addiction was ranked as less important. It can be concluded that it is fruitful to ask IVDUs about their preferences concerning care.

HIV infections of the central nervous system. What are the nursing implications?

HIV disease attacks people without regard to age, race, gender or socioeconomic status, and the number of people affected continues to increase. The increased incidence of disease and increased length of survival will lead to a rise in HIV-related CNS syndromes. CNS involvement adds to the complexity of the disease and necessitates involvement of many disciplines. The nurse is responsibility for facilitating and coordinating the multidisciplinary team effort. The nurse must also be an advocate to provide access to beneficial services and to develop services that are not in place. The task of nursing is to assist the person living with AIDS to maintain his or her quality of life however they wish to define it.

Cognitive performance in HIV-1 infection: relationship to severity of disease and brain atrophy.

We examined cognitive performance in 72 HIV-1 infected patients and 34 controls. None of the patients had opportunistic infections or unusual neoplasms of the central nervous system (CNS). Factors other than HIV-1 known to cause cognitive decline were excluded from both groups. Cognitive functioning analysed with special emphasis on the severity of HIV infection was related to neuroradiological and immunological findings. In patients with AIDS-related complex (CDC IVa) or AIDS (CDC IVc,d), a deterioration of memory as well as cognitive speed and flexibility was detected. Furthermore, memory deficits were associated with central cerebral and infratentorial atrophy in those patients, while no association was found between cognitive deficits and immunological abnormalities. Patients at CDC stages II or III showed slight association between altered cognitive speed and flexibility and elevated leukocyte count, suggesting a subclinical CNS disease already at early stages of HIV infection.