Updated Data and Methods for the 2023 UNAIDS HIV Estimates.

ABSTRACT: Each year, supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS), country teams across the globe produce estimates that chart the state of their HIV epidemics. In 2023, HIV estimates were available for 174 countries, accounting for 99% of the global population, of which teams from 150 countries actively engaged in this process. The methods used to derive these estimates are developed under the guidance of the UNAIDS Reference Group on Estimates, Modeling, and Projections (www.epidem.org). Updates to these methods and epidemiological analyses that inform parameters and assumptions are documented in this supplement.

Epidemiological investigation and proteomic profiling of typical TCM syndrome in HIV/AIDS immunological nonresponders.

HIV/AIDS pandemic remains the world's most severe public health challenge, especially for HIV/AIDS immunological nonresponders (HIV/AIDS-INRs), who tend to have higher mortality. Due to the advantages in promoting patients' immune reconstitution, Traditional Chinese medicine (TCM) has become one of the mainstays of complementary treatments for HIV/AIDS-INRs. Given that effective TCM treatments largely depend on precise syndrome differentiation, there is an increasing interest in exploring biological evidence for the classification of TCM syndromes in HIV/AIDS-INRs. In our study, to identify the typical HIV/AIDS-INRs syndrome, an epidemiological survey was first conducted in the Liangshan prefecture (China), a high HIV/AIDS prevalence region. The key TCM syndrome, Yang deficiency of spleen and kidney (YDSK), was evaluated by using a tandem mass tag combined with liquid chromatography-tandem mass spectrometry (TMT-LC-MS/MS). A total of 62 differentially expressed proteins (DEPs) of YDSK syndrome compared with healthy people were screened out. Comparative bioinformatics analyses showed that DEPs in YDSK syndrome were mainly associated with response to wounding and acute inflammatory response in the biological process. The pathway annotation is mainly enriched in complement and coagulation cascades. Finally, the YDSK syndrome-specific DEPs such as HP and S100A9 were verified by ELISA, and confirmed as potential biomarkers for YDSK syndrome. Our study may lay the biological and scientific basis for the specificity of TCM syndromes in HIV/AIDs-INRs, and may provide more opportunities for the deep understanding of TCM syndromes and the developing more effective and stable TCM treatment for HIV/AIDS-INRs.

Study of 172 Cases of AIDS Associated Cancers.

OBJECTIVE: This retrospective study was conducted to evaluate the behaviour of AIDS associated cancers treated with comprehensive cancer treatment along with highly active anti-retroviral therapy (HAART). METHODS: 172 AIDS-associated cancers were diagnosed and treated during 2003 to 2021. HIV status was evaluated by ELISA, viral load and CD4/CD8 counts. They were treated with different cancer treatment modalities for cancers, HAART for HIV infection and followed up periodically. RESULTS: Of 172 cases of AIDS associated cancers, AIDS-Defining Cancers (ADCs) were seen in 84 (48.84%) and non-AIDS-Defining Cancers (NADC) in 88 patients (51.16%). Non-Hodgkin Lymphoma was the commonest AIDS-defining cancer in 58 (69.05%) patients. Extranodal presentations of ARLs was seen in 28 cases (19.86%) followed by cervical cancers in 26 (30.95%) women with HIV infection. Kaposi's sarcoma was not found. Head and neck cancers were the most common cancers in NADCs, followed by breast cancers and other types of cancers. Only two patients had HIV-2 associated cancers. One patient had immune reconstitution syndrome (IRIS).Long-term non-progressor HIV infection with cancer was seen in one patient. 49 patients (28.49%) were receiving HAART. CONCLUSIONS: AIDS-associated cancers are seen in advanced stage of HIV infection. Concurrent chemotherapy and anti-retroviral therapy for ADCs show good control of both diseases. Non-AIDS-defining cancers do not show predictable response to anti-retroviral therapy. KS is not seen in our study.

Ending the epidemic of HIV/AIDS by 2030: Will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries?

The third Sustainable Development Goal (SDG-3) has a target to end the epidemic of HIV/AIDS by 2030 (Project 2030). This will be achieved when the number of new HIV infections and 'AIDS-related deaths' decline by 90% between 2010 and 2030. So far, the rate of drop in AIDS-related deaths is on track, whereas the rate of drop in new HIV infections is off track to achieve Project 2030. Even if Project 2030 was achieved, HIV would be an endemic health problem. Hence, HIV prevention and control programmes cannot close down for the foreseeable future. This rather demands a paradigm shift from a fully vertical to an integrated health systems response that provides services according to disease burden towards universal health coverage. This will ensure the sustainability of HIV services in the post-2030 era. These all entail unrelenting political commitment, and increased and sustainable funding from both national and global sources.

Global Research on Quality of Life of Patients with HIV/AIDS: Is It Socio-Culturally Addressed? (GAPRESEARCH).

Quality of life (QOL) has been considered as an important outcome indicator in holistic care for HIV-infected people, especially as HIV/AIDS transforms from a fatal illness to a chronic condition. This study aimed to identify trends and emerging topics among research concerning the QOL of people living with HIV/AIDS (PLWHA). The analyzed data were English papers published from 1996 to 2017, searched and extracted from the Web of Science Core Collection. Collaborations between countries and the correlation between the keywords were visualized by VOSviewer while the abstracts' content was analyzed using exploratory factor analysis and Jaccard's' similarity index. There has been an increase in both the number of publications and citations. The United Nations of America leads in terms of paper volume. The cross-nation collaborations are mainly regional. Despite a rather comprehensive coverage of topics relating to QOL in PLWHA, there has evidently been a lack of studies focusing on socio-cultural factors and their impacts on the QOL of those who are HIV-infected. Further studies should consider investigating the role of socio-cultural factors, especially where long-term treatment is involved. Policy-level decisions are recommended to be made based on the consideration of cultural factors, while collaborations between developed and developing nations, in particular in HIV/AIDS-ridden countries, are strongly recommended.

Strategies to facilitate safe sexual practices in adolescents through integrated health systems in selected districts of Zimbabwe: a mixed method study protocol.

BACKGROUND: Zimbabwe has the highest teenage pregnancy rate in Sub Saharan Africa. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence which is estimated at 12% (18 and 13.6% respectively) in Zimbabwe. Indigenous Health Systems (IHSs) and Modern Health Systems (MHSs) in Zimbabwe run parallel thereby introducing challenges in the management of adolescent sexual health due to conflicts. This study seeks to develop strategies that will facilitate the integration of IHSs and MHS in Mberengwa and Umguza districts. METHODS: This research will be conducted in two phases. The first phase would utilise a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches would be merged through a comparison of findings side by side. The second phase would focus on the development and validation of strategies that would facilitate the integration of IHSs and MHSs. The Strength, Weakness, Opportunity and Threat (SWOT) analysis would be applied on interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore and Minimise (BOEM) models would then be used to develop strategies based on the SWOT findings. The developed strategies would be validated through the application of Delphi technique and administration of checklist to selected key stakeholders through organised workshops. DISCUSSION: There have been no known studies found in the literature that explores the possibility and developed strategies of integrating IHSs and MHSs so as to promote safe sexual practices in adolescents. Most programs on sexual health have ignored the role of IHSs and MHSs in influencing safe sexual practices leading to them failing to attain desired goals. A lot of emphases has been targeted at minimising the spread of Sexually Transmitted Infections (STIs) through advocating for utilisation MHSs rather than focussing on an integrating systems that are meant to manage Adolescent Sexual Health (ASH) related issues. The study protocol was approved by the University of Venda Ethics Committee Registration (SHS/19/PH/17/2608) on the 26th of August 2019.

People don't live on the care cascade: The life of the HIV care cascade as an international AIDS policy and its implications.

This article analyses how the HIV care cascade, an analytical tool, has become a policy practice that determines the direction and content of international AIDS policy. It traces the development of the cascade through from its emergence around 2011 to its position framing global AIDS policy by 2018. The article distinguishes between the cascade model as a mapping tool and the care cascade as a policy that aims to end the AIDS epidemic. It then argues that the move from an analytical to a policy tool has important implications, both for the scope of policies and for policy-relevant research. It concludes by considering its implications in determining policy direction. The qualitative research that informs the article is based on published care cascade research and policy documents, and observations of the presentations and discussions at the 2012 and 2018 International AIDS Conferences (IAS). The article uses textual analysis to develop its argument.

A role for traditional doctors in health promotion: experience from a trial of HIV prevention in Botswana.

Traditional doctors have been largely ignored in HIV prevention, particularly primary prevention. As part of a structural intervention programme to reduce HIV risk among young women in Botswana, we trained 147 traditional doctors in four districts as well as government health education assistants (HEAs) and teachers to run discussion groups in the community and schools, using an evidence-based eight-episode audio-drama, covering gender roles, gender violence, and how these are related to HIV risk. One year later, we contacted 43 of the 87 trained traditional doctors in two districts. Most (32) were running discussion groups with men and women, with links to the local HEAs and teachers. They were adept at recruiting men to their groups, often a challenge with community interventions, and reported positive changes in attitudes and behaviour of group participants. Traditional doctors can play an important role in primary prevention of gender violence and HIV.

Association of Low Vitamin D with Complications of HIV and AIDS: A literature Review.

With the advent of combination antiretroviral therapy (cART), the survival of HIV patients has improved dramatically, but the complications of the disease and treatment have become an important issue in the management of HIV patients. Vitamin-D deficiency is common in HIV patients. Low vitamin-D is associated with different comorbidities in the HIV uninfected general population. In this review, we first briefly describe vitamin D synthesis and mechanism of action and we focus on the epidemiological and clinical data dealing with the relationship between vitamin D deficiency in HIV infection with several comorbidities which has been found to be increasingly common in patients living with HIV infection. We searched the PubMed database using the keywords "HIV," "vitamin D" and other common disorders or conditions that are relatively common in HIV infection. The other conditions included in the search were osteoporosis and fracture, cardiovascular disease, diabetes and insulin resistance, active tuberculosis, hepatitis-C co-infection, and HIV disease progression. Articles presenting original data as well as systematic reviews and met analysis related to HIV population were included in our analysis. Vitamin-D deficiency seems to be associated with several adverse outcomes in HIV patients but a definite cause and effect relationship with vitamin-D is yet to be confirmed in most of the cases. However, the literature supporting the efficacy of vitamin-D supplementation is lacking.

Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d'Ivoire, West Africa: A cross-sectional study.

BACKGROUND: In Côte d'Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d'Ivoire. METHODS: A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. RESULTS: A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. CONCLUSION: Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.

Role of medicinal plants in HIV/AIDS therapy.

Human immunodeficiency virus (HIV) causes the potentially life-threatening and chronic disease called acquired immune deficiency syndrome (AIDS). The main target of this viral disease is to suppress the immune system and make the body unresponsive to external stimuli. According to global health observatory data since epidemic, more than 78 million people were affected by HIV and 39 million people died globally. Until 2017, 36.5 million people were living with HIV. An estimated 0.8% (0.6%-0.9%) of adults aged 15-49 years worldwide is living with HIV. The World Health Organization (WHO) reported that the African region remains most severely affected, with nearly one in every 25 adults (4.1%) living with HIV and accounting for nearly two-thirds of the people living with HIV worldwide. WHO reported that globally only 21.7 million (19.1 million-22.6 million) people have had access to antiretroviral therapy up to 2017. Currently, antiretroviral therapy (ART) is available for the control of HIV but has serious associated side effects such as lipodystrophy. Because of the limitations, associated with ART, researchers throughout the world are trying to explore and develop more reliable and safe drugs from natural resources to manage HIV infection. A wide range of medicinal plants have been studied and have reported significant potential against HIV. Plants like Rheum palmatum L., Rheum officinale, Trigonostem axyphophylloides, Vatica astrotricha, Vernonia amygdalina, Hypoxias pelargonium, Sidoides hemerocallidea and Sutherlandia frutescens etc. have high efficacy to cure HIV. The exact mechanism of action is still not known but various phytoconstituents isolated from medicinal plants such as alkaloids, flavonoids, polyphenols, terpenoids, tannins, proteins and coumarins have the potential to interrupt the life cycle of HIV as well as act as immunomodulators to enhance the immune system of infected patients with no well reported side effects. It could be concluded that medicinal plants have potential for the management of HIV/AIDS but more studies are needed to reveal rigorous efficacy and safety concerns by conducting clinical trials at vast level to explore therapeutic impact of medicinal plants.

[Clinical presentation and requests for support of people with HIV/AIDS seeking counselling and psychotherapy in Greece].

Despite the large progress during the last decades in the medical treatment of HIV/AIDS infection, people living with HIV nevertheless face multiple adversities at various levels of their lives. Mental disorders, in particular, are the most common comorbidities in HIV infection with negative consequences in adherence to antiretroviral medication, disease progress and overall quality of life. HIVrelated stigma, still quite intense in Greece, is one of the most debilitating factors concerning people's living with HIV mental health. The present study looked at the clinical presentation at intake and treatment requests of 191 (83% males) people living with HIV who addressed the psychological support service of the non-governmental organization 'Centre for Life' during the years 2016- 18. Data were collected through a semi-structured clinical interview and administration of adapted questionnaires (PHQ-9, BAI, CAGE), which resulted in 7 dichotomous variables related to clinical presentation and 13 dichotomous variables related to treatment requests at intake. To analyze data, we constructed frequency tables and performed chi-square tests. In the whole sample, 42.2% presented anxiety disorders, 40.3% depression, 28.8% occasional substance use, 17.5% problematic use of alcohol and 13.6% intravenous drug use. Moreover, 14% reported at least one suicide attempt in the past and 9.2% current suicidal ideation. Apart from more frequent intravenous drug use among heterosexual males and more frequent occasional/recreational drug use among men who have sex with men, no other differences related to gender, age group, sexual orientation or ethnicity were observed in the initial clinical presentation. Similarly, the most frequent treatment requests were homogenously distributed in our sample, such as depressive symptoms (58.6%), difficulties in romantic relationships (48.7%), accepting being HIV positive (42.9%), anxiety symptoms (42.4%) and issues of negative self-esteem (40.8%). The presence of clinically significant depression was found to be related to a wider range of treatment requests compared to other mental health problems. A large group of requests focused on interpersonal relationships difficulties (e.g. disclosure anxiety, social isolation, disturbed relationships with familiar persons). This indicates an important area of psychological intervention. HIV infection may affect many levels of an individual's life, including their mental health. Respectively, HIV treatment needs to adopt a more holistic approach.

Reaching key populations through key venues: Insights from the Jamaica HIV Prevention Program.

INTRODUCTION: HIV prevention strategies often include outreach to female sex workers at social venues identified as places where people meet new sexual partners. Patrons and staff at these venues may include female sex workers, their clients, as well as others who have high rates of new sexual partnerships. Few studies have compared HIV/STI among venue-based and general populations, across types of venues, or by sub-group of the venue population. Program planners often assume that the prevalence of infection is highest among female sex workers and considerably lower among other people at these venues, but there are few empiric studies assessing the prevalence of infection by sex worker status and type of venue. METHODS: In 2011, we used the PLACE method to identify public venues where people meet new sexual partners across Jamaica. The study team visited all venues with reported sex work as well as a 10% random sample of other venues and subsequently interviewed and tested a probability sample of 991 venue patrons and workers for HIV and other STI. RESULTS: Community informants identified 1207 venues. All venues where sex work was reported (735 venues) and a random sample of the remainder (134 of 472) were selected for onsite visits. Of these, 585 were found and operational. At a stratified random sample of venues, survey teams interviewed and tested 717 women and 274 men. 394 women reported recent sex work and 211 of these women reported soliciting clients on the street. Women exchanging sex for money were more likely to be infected with HIV (5.4% vs 1.0%; OR = 5.6, 95% CI = 1.8,17.3) or syphilis (11.7% vs. 5.8%, OR = 2.2, 95% CI = 1.7,4,0) than other women, but not significantly more likely to be infected with gonorrhea (8.4% vs 7.8%; OR = 1.1,95% CI = 0.6,1.9), chlamydia (16.2% vs 21.6%;OR = 0.7,95% CI = 0.5,1.0) or trichomoniasis (23.0% vs 17.0%, OR = 1.5,95% CI = 0.9,2.2). Women at venues were more likely to report sex work and multiple partners than women interviewed in a 2008 national population-based household survey commissioned by the Ministry of Health. CONCLUSIONS: In Jamaica, although the highest HIV prevalence was among street-based sex workers, the risk of HIV and STI extends to men and women at high risk venues, even those who do not self-identify as sex workers. Findings confirm the appropriateness of outreach to all men and women at these venues.

Prevalence and factors associated with the use of traditional medicines among human immunodeficiency virus and acquired immunodeficiency syndrome patients in Sokoto, Nigeria.

Background: In resource-scarce settings like Nigeria, access to conventional drugs and antiretroviral therapy (ART) is highly limited, hence the resort to use of traditional herbal medicine by a significant number of people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). Traditional medicine (TM) continues to provide health coverage for most of the people in developing countries, and it is equally becoming increasingly popular in western countries. Aim: This study aims to present the status and use of TM and determine the factors associated with its use among patients with HIV/AIDS on highly active ART in a tertiary health institution in Sokoto, Northwest Nigeria. Methodology: This was a descriptive, cross-sectional study involving HIV/AIDS patients attending antiretroviral treatment center of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The study population comprised PLWHAs attending the ART clinic of the hospital (UDUTH). A total of 271 respondents were recruited into the study and administered a set of pretested structured questionnaire. Ethical approval for this study was obtained from the ethical committee of the teaching hospital. Results: Only 11 (4.2%) of the respondents had used TM before, of whom 9 (5%) were females and 2 (2.7%) were males with P = 0.399. Only one of the respondents had side effects following the use of TM, and the most common reason for the use of TM was as a result of too much weight loss. Conclusion: Although the use of TM among the study participants in Sokoto was low, there is need to educate PLWHAs about the possible risks of interactions following the concurrent use of TM and ART.

Evolutionary view of the AIDS process.

It is generally accepted that human immunodeficiency virus (HIV) is the etiological agent of acquired immune deficiency syndrome. According to this claim, HIV was transferred to humans from contact with monkeys around 35-50 years ago. However, this claim has not been sufficiently confirmed epidemiologically. The spread and incubation period of the plague epidemic has led to the theory that the Black Death was caused by hemorrhagic viruses. Having examined detailed historical data, we have concluded that the bacterium Yersenia pestis was an infectious agent in the epidemic, together with another agent which we suggest was HIV. Our considerations were mainly based on the existence of the CCR5 delta 32 mutation, which protects against HIV infection and has been present in the Caucasian population for over 2000 years. The combination of two infectious agents led to the devastation of the Black Death, the removal of HIV carriers, and an increase in the number of CCR5Δ32 mutations in the Caucasian population. In sub-Saharan Africa, this epidemic and subsequent sanitation process did not occur, which explains the much higher level of HIV genetic information in this part of the world.

ACTing in Partnership to Accelerate Impact.

Partnership between funders plays a vital role in tackling the AIDS epidemic and can help partners deliver "more than the sum of their parts." But how do partnerships form? How is value leveraged and maximized? How can partnerships achieve policy change? This article addresses these questions through the example of the Accelerating Children's HIV/AIDS Treatment Initiative, an ambitious $200 million public private partnership with a goal of doubling the number of children living with HIV on treatment in 9 priority African countries over a 2-year period. It describes how the partnership formed between the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Children's Investment Fund Foundation (CIFF), and the differing styles, vision, and resources each organization contributed. It also gives examples of policy influence at global level and policy change at national level. Finally, the article considers whether working in partnership was more or less effective than independent funding, with reflections on the value and challenges of collaboration.

A six week contextualised physical activity intervention for women living with HIV and AIDS of low socioeconomic status: a pilot study.

Research has consistently shown the benefits of regular physical activity (PA) for women living with HIV and AIDS (WLWHA). This study is a pilot, randomised controlled crossover trial, reporting the effects of a contextualised PA intervention amongst a sample of 21 HIV positive Xhosa-speaking women of low socioeconomic status (SES). The study determined total moderate-to-vigorous PA (TMVPA) as measured subjectively by the Global Physical Activity Questionnaire (GPAQ), total weekly steps (TWS) as measured by a pedometer, and self-efficacy for PA as measured by the Physical Exercise Self-efficacy scale (PESES). Multivariate analysis of covariance (MANCOVA) was used to compute the impact of the intervention on TMVPA, TWS, and self-efficacy for PA from baseline to six weeks, and baseline to 12 weeks post-intervention controlling for pre-test differences in TMVPA. Results showed that participants exposed to the intervention had significant increases in PA as measured by TMVPA (p = .027), TWS (p = .032), as well as exercise self-efficacy (p = .000) from pre-test to 6 weeks. Insignificant findings were reported for all three variables when measured from baseline to 12 weeks. In conclusion, the findings of the pilot study suggest that the intervention was effective in producing significant increases in PA in a sample of PLWHA of low SES over six weeks. Careful consideration of behavioural constructs, such as self-efficacy, can help WLWHA of low SES to adopt regular PA as a complementary therapy for managing their health.

Culture, myths and panic: Three decades and beyond with an HIV/AIDS epidemic in Zimbabwe.

Zimbabwe is going through a generalised acquired immunodeficiency syndrome (AIDS) epidemic. The first five years of the epidemic (1985-1990) were characterised by lack of medicines against human immunodeficiency virus (HIV), and an exponential increase in prevalence (65-fold) and incidence (13-fold), which were fuelled by high-risk sexual behaviour. The high HIV prevalence, mortality and stigma yielded great fear and panic in the population, which are thought to have led to confusion and hopelessness, and, in turn, increased risky sexual behaviour. The country's government and civil society embarked on HIV awareness campaigns that are claimed to have played a central role in slowing down the epidemic since the mid-2000s. HIV-related mortality then fell by 70% between 2003 and 2013, which is attributed to high uptake of antiretroviral therapy (ART) and prevention of mother-to-child transmission (95%) prophylaxis. However, the epidemic has been characterised by a low paediatric ART coverage (35% in 2011 to 46.12% in 2013). Year 2014 saw an increase in adolescent and young adult HIV prevalence, which may be signalling a rebound of the epidemic. A more holistic approach which deals with the epidemic in its socio-political context is required to effectively lower the country's HIV burden.

Bewitching sex workers, blaming wives: HIV/AIDS, stigma, and the gender politics of panic in western Kenya.

Since access to HIV testing, counselling, and drug therapy has improved so dramatically, scholars have investigated ways this 'scale-up' has interacted with HIV/AIDS-related stigma in sub-Saharan Africa. Drawing on data collected during ethnographic research in a trading centre in western Kenya, this paper critically analyses two violent and localised case studies of panic over the ill health of particular community residents as a nuanced lens through which to explore the dynamic interplay of gender politics and processes of HIV/AIDS-related stigma in the aftershocks of the AIDS crisis. Gaining theoretical momentum from literatures focusing on stigma, gender, witchcraft, gossip, and accusation, we argue that the cases highlight collective anxieties, as well as local critiques of shifting gender roles and the strain of globalisation and legacies of uneven development on myriad forms of relationships. We further contend that these heightened moments of panic and accusation were deployments of power that ultimately sharpened local gender politics and conflicts on the ground in ways that complicated the social solidarity necessary to tackle social and health inequalities. The paper highlights one community's challenge to eradicate the stigma associated with HIV/AIDS during a period of increased access to HIV services.

Water insecurity in a syndemic context: Understanding the psycho-emotional stress of water insecurity in Lesotho, Africa.

Syndemics occur when populations experience synergistic and multiplicative effects of co-occurring epidemics. Proponents of syndemic theory highlight the importance of understanding the social context in which diseases spread and cogently argue that there are biocultural effects of external stresses such as food insecurity and water insecurity. Thus, a holistic understanding of disease or social vulnerability must incorporate an examination of the emotional and social effects of these phenomena. This paper is a response to the call for a renewed focus on measuring the psycho-emotional and psychosocial effects of food insecurity and water insecurity. Using a mixed-method approach of qualitative interviews and quantitative assessment, including a household demographic, illness, and water insecurity scale, the Household Food Insecurity Access Scale, and the Hopkins Symptoms Checklist-25, this research explored the psycho-emotional effects of water insecurity, food insecurity, and household illness on women and men residing in three low-land districts in Lesotho (n = 75). Conducted between February and November of 2011, this exploratory study first examined the complicated interaction of water insecurity, food insecurity and illness to understand and quantify the relationship between these co-occurring stresses in the context of HIV/AIDS. Second, it sought to separate the role of water insecurity in predicting psycho-emotional stress from other factors, such as food insecurity and household illness. When asked directly about water, qualitative research revealed water availability, access, usage amount, and perceived water cleanliness as important dimensions of water insecurity, creating stress in respondents' daily lives. Qualitative and quantitative data show that water insecurity, food insecurity and changing household demographics, likely resulting from the HIV/AIDS epidemic, are all associated with increased anxiety and depression, and support the conclusion that water insecurity is a critical syndemic dimension in Lesotho. Together, these data provide compelling evidence of the psycho-emotional burden of water insecurity.