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1.
Cult Health Sex ; 24(9): 1199-1214, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-34254893

RESUMO

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16-20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Pessoas Transgênero , Adolescente , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Teste de HIV , Homossexualidade Masculina , Humanos , Masculino , Estigma Social , Tailândia , Adulto Jovem
2.
Sex Health ; 18(1): 21-30, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33632379

RESUMO

Men who have sex with men (MSM) in Western urban areas have seen substantive decreases in new diagnoses of HIV infection. This paper explores whether such declines are present among MSM and transgender women (TGW) in Southeast Asia and discusses implications for HIV policies and programming. A scoping review was conducted of scientific publications and selected documents regarding the spread of HIV infection among MSM and TGW in major urban centres of the Association of Southeast Asian Nations (ASEAN) region. Continued high HIV prevalence and incidence among MSM are found in integrated behavioural and biological surveillance (IBBS) and research studies. HIV prevalence among MSM under IBBS decreased only in Bangkok from 28.6% in 2014 to 10.3% in 2018, whereas it was increasing in Kuala Lumpur, Ho Chi Minh City, Vientiane, and Phnom Penh. HIV/AIDS case reports regarding new HIV infection diagnoses among MSM have started to decrease in Singapore since 2011 and have been plateauing in Metropolitan Manila since 2017. Where data were available, it was found that HIV prevalence among TGW was high and if IBBS was conducted, it was increasing. HIV prevalence among TGW under IBBS in Jakarta had risen to 34.0% (2015) and 14.0% (2019) in Phnom Penh. These findings suggest that most ASEAN member states have so far failed to effectively implement and scale-up scientifically proven biomedical HIV prevention measures and counter stigma and discrimination that impedes access to appropriate HIV prevention and treatment services for MSM and TGW.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Pessoas Transgênero , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Programas de Rastreamento , Filipinas , Políticas , Prevalência , Tailândia
3.
Sex Transm Infect ; 93(5): 356-362, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28729520

RESUMO

In Asia Pacific, most countries have expanded HIV treatment guidelines to include all those with HIV infection and adopted antiretroviral treatment for prevention (TFP) as a blanket strategy for HIV control. Although the overall epidemic development associated with this focus is positive, the HIV epidemic in men who have sex with men (MSM) is continuing unperturbed without any signs of decline or reversal. This raises doubt about whether TFP as a blanket HIV prevention policy is the right approach. This paper reviews currently available biomedical HIV prevention strategies, national HIV prevention policies and guidelines from selected countries and published data on the HIV cascade in MSM. No evidence for efficacy of TFP in protecting MSM from HIV infection was found. The rationale for this approach is based on assumptions about biological plausibility and external validity of latency-based efficacy found in heterosexual couples. This is different from the route and timing of HIV transmission in MSM. New HIV infections in MSM principally occur in chains of acutely HIV-infected highly sexually active young men, in whom acquisition and transmission are correlated in space and time. By the time TFP renders its effects, most new HIV infections in MSM will have already occurred. On a global level, less than 6% of all reports regarding the HIV care cascade from 1990 to 2016 included MSM, and only 2.3% concerned MSM in low/middle-income countries. Only one report originated from Asia Pacific. Generally, HIV cascade data in MSM show a sobering picture of TFP in engaging and retaining MSM along the continuum. Widening the cascade with a preventive extension, including pre-exposure prophylaxis, the first proven efficacious and only biomedical HIV prevention strategy in MSM, will be instrumental in achieving HIV epidemic control in this group.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/terapia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Síndrome da Imunodeficiência Adquirida/epidemiologia , Ásia/epidemiologia , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pobreza , Profilaxia Pré-Exposição , Fatores de Risco , Assunção de Riscos , Adulto Jovem
4.
Catheter Cardiovasc Interv ; 88(5): 755-764, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27567144

RESUMO

OBJECTIVES: To investigate incidence and patient characteristics of transient ST-segment elevation (TSTE) ACS and to compare outcome of early versus late invasive treatment. BACKGROUND: Optimal timing of treatment in TSTE-ACS patients is not outlined in current guidelines and no prospective randomized trials have been done so far. METHODS: Post hoc subgroup analysis of patients with TSTE randomized in the ELISA 3 trial. This study compared early (<12 h) versus late (>48 h) angiography and revascularization in 542 patients with high-risk NSTE-ACS. Primary endpoint was incidence of death, reinfarction, or recurrent ischemia at 30 days follow-up. RESULTS: TSTE was present in 129 patients (24.2%) and associated with male gender, smoking and younger age. The primary endpoint occurred in 8.9% of patients with and 13.0% of patients without TSTE (RR = 0.681, P = 0.214). Incidence of death or MI after 2 year follow-up was 5.7 and 14.6% respectively (RR = 0.384, P = 0.008). Within the group of patients with TSTE, incidence of the primary endpoint was 5.8% in the early and 12.7% in the late treatment group (RR = 0.455, P = 0.213), driven by reduction in recurrent ischemia. Enzymatic infarct size, bleeding and incidence of death or recurrent MI at 2 years follow-up was comparable between the treatment groups. CONCLUSIONS: In high-risk patients with NSTE-ACS, TSTE is frequently seen. Similar to findings in patients with high-risk NSTE-ACS, immediate angiography and revascularization in these patients is feasible but not superior to later treatment. Prospective randomized trials are needed to provide more evidence in the optimal timing of treatment in patients with TSTE-ACS. © 2016 Wiley Periodicals, Inc.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Eletrocardiografia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Idoso , Angiografia Coronária , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
5.
Cult Health Sex ; 18(4): 377-90, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26416166

RESUMO

Young Thai men who have sex with men continue to have high HIV prevalence and incidence in spite of much investment in community-based prevention approaches. To make HIV services more appropriate for same-sex attracted young men in Thailand, it needs to be considered how target groups view themselves and manage their identities. This paper derives from a qualitative study of 25 same-sex attracted rural young Thai men. It identifies five tactics men employed to manage the discrepancy between their preferences and parental/societal expectations regarding gender and sexuality, and discusses how the young men viewed themselves in the wider context of Thai society, including whether they felt part of a separate gay community. Participants usually did not adopt a gay social identity and were reluctant to join in gay community activities beyond dating. Hence, they would likely experience barriers in accessing gay community-based HIV services. HIV services targeting young same-sex attracted Thai men need to be diversified if they are to be more inclusive, appropriate and effective.


Assuntos
Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , População Rural , Comportamento Sexual , Adolescente , Humanos , Masculino , Tailândia , Adulto Jovem
6.
Cult Health Sex ; 16(9): 1128-40, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25118098

RESUMO

Twenty-five same-sex-attracted rural young Thai men were interviewed three times to investigate how their sexual subjectivity changed over an 18-month period after they completed high school and moved into a new life-phase. Many young men grew up with strong gender-based understandings of homosexuality, in which a masculine (top) partner is seen as complementing a feminine (bottom) partner. The discursive division between the masculine and feminine domains became increasingly blurred in the actual practice of dating, forcing the young men to develop new understandings of homosexuality and same-sex relations. The shift from a rural to urban environment, the use of the Internet and the experience of falling in love played important roles in this experimentation with new, increasingly masculine presentations of the self, also influenced by a modern urban masculine aesthetic. The paper concludes that the encounter between 'traditional' gender-based homosexuality and new ideas, in which masculine object-choice is important in defining sexual identity leads to a variety of fluid ideas and expressions. This process created confusion among some, and opportunities for exploration of new ways of defining sexual subjectivities among others.


Assuntos
Identidade de Gênero , Homossexualidade Masculina/psicologia , Masculinidade , Homens/psicologia , Comportamento Sexual/psicologia , Atitude , Humanos , Masculino , Pesquisa Qualitativa , Tailândia , Adulto Jovem
7.
Cult Health Sex ; 16(5): 562-74, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24666177

RESUMO

As part of a study on the sexual health and social protection needs of men who have sex with men in Pakistan, 11 young men employed as assistants to truckers ('truck cleaners') who acknowledged having had sexual experiences with men, were interviewed and their social background and sexual initiation and their subsequent sexual lives were explored. For most truck cleaners, the first instance of sexual contact between the truck cleaner and the driver was forced and happened at an early age. Sex with other men, as well as with women (including sex workers) was widely reported. Drug and alcohol use was common. There is strong potential for HIV and STIs to spread through these sexual networks. Measures to prevent young men from entering into a career as truck helpers should be considered, as well as interventions to improve the health and social situation of those already employed.


Assuntos
Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Veículos Automotores , Delitos Sexuais/psicologia , Trabalho Sexual/psicologia , Parceiros Sexuais/psicologia , Adulto , Condução de Veículo , Humanos , Masculino , Paquistão , Infecções Sexualmente Transmissíveis , Adulto Jovem
8.
Cult Health Sex ; 15(1): 73-84, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23157327

RESUMO

This study describes the experiences of 10 young feminised men in Pakistan. They face high levels of stigma, violence and sexual abuse. The average age of first sex was 11 years old and all reported having been been raped during childhood and early adolescence, often several times. While some mothers and siblings were quietly supportive, young feminised men often end up running away from home, finding support as a member of a hijra dera, a 'pseudo-household' led by an older feminised man or guru, in which they find employment as dancers or sex workers. After their entry into sex work there is little or no opportunity to use condoms. The hijra dera offer an important entry point for improved social support and sexual health programmes, including efforts to ensure young feminised men postpone their sexual debut and/or improve their sexual health, retain access to education, explore alternative forms of employment and improve access to health care.


Assuntos
Feminização , Infecções por HIV , Delitos Sexuais , Estigma Social , Populações Vulneráveis , Adolescente , Infecções por HIV/transmissão , Homossexualidade Masculina , Humanos , Masculino , Paquistão , Pesquisa Qualitativa , Infecções Sexualmente Transmissíveis/transmissão , Adulto Jovem
9.
J Int Assoc Provid AIDS Care ; 22: 23259582231188221, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37461326

RESUMO

Half of new HIV infections in Thailand are among young people, the majority of whom are young gay and other men who have sex with men (YMSM) and young transgender women (YTGW). Amid low pre-exposure prophylaxis (PrEP) coverage, we explored practice-based factors that impact PrEP engagement among YMSM and YTGW. In 2018, we conducted 4 focus group discussions with 20 YMSM and 5 YTGW, and 22 in-depth interviews (5 in 2022) with healthcare providers (HCPs), community-based organization (CBO)/nongovernmental organization (NGO) staff, and peer educators. The inclusion of PrEP in universal healthcare coverage, including YMSM and YTGW, is a substantial facilitator of PrEP use; however, systemic barriers at microsocial (lack of communication about PrEP from HCPs, teachers, parents), mesosocial (healthcare-service fragmentation, lack of PrEP-competent HCPs), and macrosocial levels (annual quotas on free HIV-testing, HIV- and sexual-stigma) constrain and disincentivize adolescents' engagement with PrEP. National scale-up of youth-friendly and LGBT-affirmative CBO/NGO clinics, HCP training, and tailored programs to support adolescents' adherence may promote PrEP engagement among YMSM and YTGW in Thailand.


Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Pessoas Transgênero , Masculino , Adolescente , Humanos , Feminino , Homossexualidade Masculina , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Tailândia/epidemiologia
10.
Circulation ; 124(25): 2865-73, 2011 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-22104551

RESUMO

BACKGROUND: Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging. METHODS AND RESULTS: This is a cross-sectional diagnostic accuracy study with external validation. Seven hundred twenty-one consecutive patients suspected of new-onset heart failure underwent standardized diagnostic work-up including chest x-ray, spirometry, ECG, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and echocardiography in specially equipped outpatient diagnostic heart failure clinics. The presence of heart failure was determined by an outcome panel using the initial clinical data and 6-month follow-up data, blinded to biomarker data. Of the 721 patients, 207 (28.7%) had heart failure. The combination of 3 items from history (age, coronary artery disease, and loop diuretic use) plus 6 from physical examination (pulse rate and regularity, displaced apex beat, rales, heart murmur, and increased jugular vein pressure) showed independent diagnostic value (c-statistic 0.83). NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69% (P<0.0001). A simplified diagnostic rule was applied to 2 external validation datasets, resulting in c- statistics of 0.95 and 0.88, confirming the results. CONCLUSIONS: In this study, we estimated the quantitative diagnostic contribution of elements of the history and physical examination in the diagnosis of heart failure in primary care outpatients, which may help to improve clinical decision making. The largest additional quantitative diagnostic contribution to those elements was provided by measurement of NT-proBNP. For daily practice, a diagnostic rule was derived that may be useful to quantify the probability of heart failure in patients with new symptoms suggestive of heart failure.


Assuntos
Diagnóstico Precoce , Insuficiência Cardíaca/diagnóstico , Exame Físico/normas , Atenção Primária à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Progressão da Doença , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Pacientes Ambulatoriais , Fragmentos de Peptídeos/sangue , Prevalência , Radiografia Torácica , Espirometria
11.
Sex Reprod Health Matters ; 30(1): 2129374, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36305756

RESUMO

WHO-recommended rights-based approaches to sexual health emphasise participatory and youth-centred processes. Among these, peer education (PE) interventions are commonly used to promote HIV prevention and sexual health for young people, particularly in low-resource, high HIV prevalence contexts. We conducted a scoping review to identify key characteristics, implementation challenges, and knowledge gaps in the literature regarding PE interventions in Mekong Region countries. Out of 6521 publications identified through database searches, 17 peer-reviewed articles were included in the review (n = 21,469 participants). Studies from Thailand (n = 7), Vietnam (n = 5), Myanmar (n = 3), Cambodia (n = 1), and Lao PDR (n = 1) included adolescent and young key populations (n = 11) and general population youth (n = 6). Findings from quantitative (descriptive) and qualitative (thematic) analysis illustrate benefits and challenges of various elements of multicomponent PE interventions in reaching vulnerable young people and improving HIV prevention and sexual health outcomes. Focal knowledge gaps emerged in regard to peer educator outcomes (increased knowledge, skill-building, empowerment); interpersonal processes between peer educators and young people (role modelling, social dynamics); and social-structural contexts (sociocultural influences, gendered power relations), which may affect PE programme implementation and effectiveness. Future research should evaluate the potential benefits of complementing evidence-based intervention approaches - focused predominantly on assessing individual-level behavioural outcomes conceptualised as external to PE programmes - with evidence-making intervention approaches that support rights-based PE programmes: incorporating a focus on dialectical and relational processes between peer educators and young people; assessing salutary outcomes among peer educators themselves; and evaluating the situated implementation of youth-engaged PE interventions in complex sociocultural systems.


Assuntos
Síndrome da Imunodeficiência Adquirida , Saúde Sexual , Adolescente , Humanos , Comportamento Sexual , Grupo Associado , Meio Social
12.
PLoS One ; 17(1): e0262694, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35061803

RESUMO

To reach its goal of ending AIDS by 2030, Thailand has adopted antiretroviral treatment as prevention and HIV pre-exposure prophylaxis for men who have sex with men (MSM) and transgender women (TGW) as its core HIV control strategy. However, in the absence of reliable epidemiologic indicators, the impact of these policies on the course of the HIV epidemic in these groups remains unknown. To help answer this question, we formulated an HIV epidemic consensus initiative for Bangkok, Thailand, to analyze epidemiologic and program data and reach agreement between experts and stakeholders on the evolving state of the HIV epidemic among MSM and TGW. A customized Delphi process was used to consult and consolidate viewpoints of experts and stakeholders. Experts presented and discussed HIV prevalence and incidence data from recent and ongoing studies among MSM and TGW in Bangkok (2014 to 2018) during a meeting with stakeholders representing government, donors, and civil society. Agreement about the course of the HIV epidemic among MSM and TGW was attained by voting consensus. Based on presented data, meeting participants agreed that HIV prevalence and incidence had decreased among Bangkok MSM from 2014 to 2018. Despite these declines, HIV prevalence and incidence were found to remain high. This was particularly the case among younger MSM. Participants agreed that there was no evidence for a decrease in HIV prevalence and incidence among Bangkok TGW. Introduction of antiretroviral treatment as prevention and HIV pre-exposure prophylaxis may have contributed to these declines. However, HIV prevalence and incidence remained high, and no signs of a decrease were reported among Bangkok TGW. At the current rate of new HIV infections in MSM and TGW, Thailand will not reach its goal of ending AIDS by 2030. This HIV consensus initiative may serve as a model for building agreement and advocacy on epidemiologic and program data and their implications for a large metropolitan city.


Assuntos
Infecções por HIV/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Cidades/epidemiologia , Técnica Delphi , Feminino , Infecções por HIV/etiologia , Homossexualidade Masculina , Humanos , Incidência , Masculino , Prevalência , Fatores de Risco , Tailândia/epidemiologia , Adulto Jovem
13.
Cult Health Sex ; 13(9): 1061-72, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21815728

RESUMO

This paper reports on findings from four interviews held with young men who have experienced male adolescent concubinage relationships with adult men in Peshawar, Northwestern Pakistan. These relationships are referred to by the Pashtun people involved as bacha baazi. Similar relationships (called bacabozlik) were described by Ingeborg Baldauf among the Uzbeks and Pashtun of Afghanistan, based on observations made in the late-1970s. This paper compares Baldauf's observations with our own, indicating significant differences and similarities. Implications for future research and for social protection programmes are discussed.


Assuntos
Homossexualidade Masculina/psicologia , Relação entre Gerações , Trabalho Sexual/psicologia , Adolescente , Fatores Etários , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Paquistão , Preconceito , Trabalho Sexual/estatística & dados numéricos , Adulto Jovem
14.
J Homosex ; 68(14): 2533-2550, 2021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-32841090

RESUMO

This study explores the ways Thai transgender women are affected by internalized, perceived, vicarious and enacted stigma. Participants were eleven Thai transgender women living with HIV, who were asked about experiences of stigma in their daily lives. Various forms of verbal, psychological and physical harassment were reported. Internalized stigma and stigma within the transgender community itself were significant. Participants tended not to blame their family members or others in their social structure for their experiences of stigma. They tended to see the solution to tackle the problem of stigma mainly in changes in the behavior of transgender women themselves. This paper suggests that transgender people themselves should better understand how the structure, culture and institutions of mainstream society instill, reinforce and perpetuate stigma against, within and among them. There is a need for advocacy directed toward manifesting societal emancipation of Thai transgender people-starting with legal reform.


Assuntos
Infecções por HIV , Pessoas Transgênero , Feminino , Homossexualidade Masculina , Humanos , Masculino , Estigma Social , Tailândia
15.
PLoS One ; 16(7): e0254490, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34270600

RESUMO

BACKGROUND: Cambodia is widely credited for its successful HIV epidemic control. However, in recent years there have been signs of increasing HIV prevalence among men who have sex with men (MSM) and transgender women (TGW). This paper reviews HIV epidemiological, social science and HIV program implementation studies conducted over the past 20 years to explore possible reasons for the rising HIV prevalence among these groups and to formulate recommendations for improved policies, HIV programmatic interventions and further research. METHODS: For this scoping review, we searched the PubMed and Google Scholar databases for scientific publications related to HIV and MSM and TGW in Cambodia published since 1999. From each of the returned citations we subsequently studied reference lists to find additional data sources. We also searched websites for reports commissioned by national and international governmental and non-governmental organizations. RESULTS: Twenty-seven relevant studies and papers were found and reviewed; most were epidemiological in nature. Recent epidemiological studies and reports show an increase in HIV prevalence among Cambodian MSM and TGW. The epidemiology of HIV infection in these groups has been relatively well-described and analyzed. While initially MSM and TGW were grouped together, in more recent years they have been studied in their own right, recognizing their specific HIV and other prevention needs. Few studies were found investigating Cambodian same-sex cultures and social and cultural contexts in which HIV transmission among MSM and TGW occurs. A few evaluation studies were found, but it remains unknown how effective current HIV service implementation modalities are, or how successful strategies to increase access to essential HIV prevention, testing and treatment services have been employed for MSM and TGW in Cambodia. CONCLUSIONS: Research about Cambodian MSM and TGW in the context of HIV primarily concerns bio-behavioral knowledge generation. Cambodia is unlikely to achieve control of the HIV epidemic among MSM and TGW without doing better in-depth social science research on its multiple sexual- and gender minority cultures, and without understanding what differentiated implementation modalities, strategies and approaches are most effective to address HIV among its increasingly diverse MSM and TGW populations.


Assuntos
Infecções por HIV/epidemiologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Camboja , Feminino , Humanos , Masculino , Fatores Socioeconômicos
16.
Sex Transm Dis ; 36(5): 319-24, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19265728

RESUMO

BACKGROUND: Little systematic knowledge is available regarding risk behaviors and the prevalence of human immunodeficiency virus (HIV) and sexually transmitted infections (STI) in populations of men having sex with men (MSM) in the Mekong Subregion and China. METHODS: Data on HIV/STI prevalence and risk behavior of MSM in the region were collected through Internet searches, were summarized and assessed for their policy and programming implications. RESULTS: Twenty-four articles, reports and abstracts of research studies were identified for review. High levels of HIV, STI and associated risk behavior were reported among MSM throughout the region. The HIV prevalence among MSM in urban areas varied between 5.5% and 28.3% in Thailand and Cambodia and between 0.0% and 9.4% in Vietnam and China. No HIV/STI prevalence data were available for Lao PDR and Myanmar. CONCLUSION: Levels of HIV/STI prevalence and risk behavior among MSM in the Mekong Subregion and China are high. Continued monitoring and surveillance and targeted preventive interventions are necessary to stop the spread of HIV in this vulnerable population.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Camboja/epidemiologia , China/epidemiologia , Preservativos/estatística & dados numéricos , Infecções por HIV/transmissão , Política de Saúde , Humanos , Laos/epidemiologia , Masculino , Mianmar/epidemiologia , Prevalência , Fatores de Risco , Infecções Sexualmente Transmissíveis/transmissão , Tailândia/epidemiologia , Sexo sem Proteção , Vietnã/epidemiologia
17.
Eur Heart J ; 29(12): 1510-5, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18495690

RESUMO

AIMS: We examined the adequacy of endogenous erythropoietin (EPO) levels for the degree of anaemia in patients with chronic heart failure (CHF) and its relation to prognosis. METHODS AND RESULTS: We studied 74 anaemic CHF patients from a cohort of 240 patients. The adequacy of endogenous EPO levels was assessed by derived observed/predicted (O/P) ratio. A ratio value < 0.92 indicates EPO levels lower than expected, whereas a value > 1.09 indicates EPO levels higher than expected. The primary endpoint was mortality. During a median follow up of 4.9 years, 35 of the 74 (47.3%) anaemic patients died. EPO levels lower than expected were observed in 29 patients (39%), whereas EPO levels higher than expected were present in 22 anaemic patients (29%). The Kaplan-Meier analysis revealed that anaemic patients with EPO levels higher than expected had a significantly higher mortality rate compared to patients with EPO levels as expected or EPO levels lower than expected (log-rank: P = 0.024). A higher O/P ratio was an independent predictor of increased mortality risk adjusted for variables including age, sex, haemoglobin, NT-proBNP, and renal function; hazard ratio (HR): 1.020 95%CI (1.004-1.036), P = 0.012. CONCLUSION: EPO levels higher than expected, suggesting resistance to the hormone, are common in CHF patients and are associated with a higher mortality.


Assuntos
Anemia Ferropriva/mortalidade , Eritropoetina/sangue , Insuficiência Cardíaca/mortalidade , Idoso , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Biomarcadores/sangue , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Prognóstico , Volume Sistólico/fisiologia
18.
J Ultrason ; 19(78): 193-197, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31807324

RESUMO

Introduction: Echocardiography is essential in the evaluation of patients with cardiovascular disease. Repetitive movements, however, expose ultrasound operators to a high risk of musculoskeletal strain injuries. Aim: We investigated to what extent a probe stabilizer could reduce repetitive movements. Materials and methods: The study population consisted of 31 male patients referred for routine transthoracic echocardiography. A good apical acoustic window was prerequisite for inclusion. Standard apical views and measurements were first recorded without using the probe stabilizer. Afterwards, the same apical views and measurements were acquired with utilization of the probe stabilizer. During the entire procedure, shoulder abduction and muscle activity of right forearm flexor and extensor muscles were recorded. To this purpose, an EMG-sensor was attached to the right lower arm and a gyroscope to the right shoulder blade. Results: Extreme right arm abduction (>30˚) occurred in 58% of the time with use of the stabilizer and in 98% of the time without (p <0.01). Activity of right forearm extensor muscles was 42% with and 60% without stabilizer (p = 0.04). For the flexor muscles these percentages were 47% and 87%, respectively (p <0.01). Use of the stabilizer did not affect the time needed for image acquisition (308s versus 309s, respectively, p = 0.46). Conclusions: This study demonstrated that the use of a stabilizer during acquisition of apical views in routine transthoracic echocardiography reduces the total time of shoulder abduction and the use of the right forearm muscles, while acquisition time was not affected.

19.
Eur Geriatr Med ; 9(6): 853-861, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30546796

RESUMO

PURPOSE: Cardiac rehabilitation in older patients after hospitalization because of cardiovascular disease is recommended. However, many older patients do not receive cardiac rehabilitation in daily practice, due to lack of referral and poor adherence. This can be related to impaired clinical and functional status of these patients, who are more likely to present with frailty, frequent comorbidities, and disability. Geriatric rehabilitation might be a possible solution to reduce barriers to cardiac rehabilitation attendance. We developed and implemented an inpatient geriatric rehabilitation programme that was provided immediately after discharge from the hospital, for older patients with a significant functional decline during hospital admission because of cardiovascular disease: 'the GR-cardio programme'. The primary aim of the present study is to investigate feasibility of the GR-cardio programme. METHODS: This is a retrospective real-life feasibility study describing a consecutive series of older patients receiving the GR-cardio programme, with no control group. All patients had been hospitalized because of cardiovascular disease. Data on patient characteristics, functional status, health-related quality of life (HRQoL), readmissions, and mortality were collected from the patients file on admission, at discharge and 6 months after discharge from the GR-cardio programme. Feasibility of the programme was evaluated using the following outcomes: recruitment, resulting sample characteristics, safety, and preliminary evaluation of patients' responses to the GR-cardio programme. RESULTS: In total, 58 patients [mean age 78.8 (± 9.8) years; 43% male] were included in the study. On admission, functional status and HRQoL were severely impaired but showed clinically relevant improvements. During the programme, three patients died. Eighty-three percent of all patients were discharged back home after completing the rehabilitation programme with a mean length of 38 days. Mortality rate during follow-up was the highest in patients with heart failure (32%). CONCLUSIONS: This study indicates that geriatric rehabilitation for patients with cardiovascular disease is feasible. Furthermore, our results show that the GR-cardio programme can probably offer substantial benefits for patients in terms of improving functional status and HRQoL.

20.
PLoS One ; 13(7): e0200256, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29979766

RESUMO

The Philippines faces a severe HIV epidemic among gay and other men who have sex with men (MSM). HIV testing uptake remains low. A case series of 12 men from Metro Manila were interviewed to explore barriers to uptake of HIV testing services. Most did not see the need to get tested for HIV despite significant risk, based on the misconception they were feeling well or showed no symptoms. Being of a higher socioeconomic class, feeling morally superior to other gay men, distance of the testing facility, fear of what will happen once infected, fear of HIV- and sexual stigma, fear of side effects of antiretroviral drugs and fear of high health care expenses after testing positive for HIV were key reasons why MSM kept postponing their test. Misconceptions about HIV risk, disease, and treatment and care need to be addressed in order to increase uptake of HIV services in this population.


Assuntos
Infecções por HIV/diagnóstico , Homossexualidade Masculina , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/psicologia , Estigma Social , Adulto , Atitude , Emoções , Medo/psicologia , Humanos , Masculino , Programas de Rastreamento , Filipinas , Assunção de Riscos , Fatores Socioeconômicos , Adulto Jovem
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