Immune restoration affects 10-year survival in people living with HIV/AIDS.

INTRODUCTION: In recent years, a reduction in the life expectancy gap between people living with HIV (PLWH) and the general population has been observed, irrespective of CD4 lymphocyte count, due to widespread access to antiretroviral treatment. The increase in the life expectancy of PLWH has increased awareness of both the ageing process and gender discrepancies in immune restoration and survival. MATERIALS AND METHODS: Longitudinal data were collected for 2240 patients followed up at the Hospital for Infectious Diseases in Warsaw, Poland (n = 1482), and the Department of Acquired Immunodeficiency, Pomeranian Medical University, Szczecin, Poland (n = 758). Immune restoration was measured from the time of starting combination antiretroviral therapy until achieving 500 CD4 lymphocytes/µL, 800 CD4 lymphocytes/µL, and CD4/CD8 lymphocyte ratios of > 0.8 and > 1.0. Full recovery was achieved when the patient was restored to both 800 CD4 lymphocytes/µL and a CD4/CD8 lymphocyte ratio > 1.0. RESULTS: For all endpoints, immune restoration had a protective effect by reducing mortality. Patients who achieved immune restoration had a greater chance of reduced mortality than those who did not achieve immune restoration: for CD4 count > 500 cells/µL, HR = 5.4 (interquartile range: 3.09-9.41), p < 0.001; for CD4 > 800 cells/µL, HR = 5.37 (2.52-11.43), p < 0.001; for CD4/CD8 ratio > 0.8, HR = 3.16 (1.81-5.51), p < 0.001; for CD4/CD8 ratio > 1.0, HR = 2.67 (1.49-5.24), p = 0.001, and for full immune recovery, HR = 3.62 (1.63-8.04), p = 0.002. CONCLUSIONS: Immune restoration remains a powerful factor in improving the survival of PLWH, regardless of the speed of recovery.

ADHERENCE TO ANTIRETROVIRAL THERAPY (ART) AMONG PEOPLE LIVING WITH HIV/AIDS IN SECONDARY HEALTH FACILITIES IN KADUNA, NORTHWESTERN NIGERIA.

Introduction: HIV/AIDS is a disease of public health concern. UNAIDS at the global level aims to achieve 95% of people living with HIV know their status, 95% of those who know their status are accessing ART treatment, and 95% of people on treatment achieve suppressed viral load by the year 2030. Adherence remains a critical factor necessary to achieve this target. This study determines the factors affecting adherence to ART among PLWHA in secondary health facilities in Kaduna. Methodology: A descriptive cross-sectional study was conducted among 320 PLWHA ART in 4 secondary health facilities in the Kaduna metropolis using a cluster sampling technique. Data was analysed using SPSS version 26. Chi-square test and multivariate logistic regression were used to explore associations, level of statistical significance was set at p≤0.05. Results: The mean age of the respondents was 38.16 ± 11.95 Most 317 (99.1%) were on TDF/3TC/DTG, two PLWHA (0.6%) were on AZT/3TC/ATV/r combination of ART and one of the PLWHA (0.3%) was on ABC/3TC/DTG. Overall 25.9% had suboptimal adherence to ART. Factors affecting adherence include forgetfulness (ꭓ2=181, p=0.001) depression (ꭓ2 =41.8, p=0.001) stigma (ꭓ2 =12.1, p=0.001), lack of social support (ꭓ2 =30.8 p=0.0001) and duration on ART (ꭓ2 =11.1, p=0.012). The odds of sub-optimal adherence were significantly lower in those on ART for duration ≥ 24 months compared to duration of ART < 24 months among PLWHA on ART (AOR=0.36, 95% CI =0.18-0.73). Conclusion: Sub-optimal Adherence to ART was high in this setting. There is a need for the clients' health education, comprehensive pre-initiation ART adherence counseling and an intensified social support system.

HIV associated psychiatric comorbidity among attendees at a tertiary hospital, North-Eastern Nigeria.

Background: There are a wide range of neuropsychiatric conditions associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These mental disorders may be unrecognised yet their presence can significantly affect outcome. Aim: This study aimed to determine psychiatric comorbidity associated with HIV and AIDS. Setting: The HIV clinic of a tertiary hospital in North-Eastern Nigeria. Methods: A cross-sectional descriptive study consecutively recruiting 328 adult persons living with HIV. The Mini International Neuropsychiatric Interview and a sociodemographic questionnaire were administered to the participants. Results: Two-thirds of the respondents were females. The mean age (±s.d.) was 42 years (±11.24). Majority of the participants had World Health Organization stage 1 HIV disease. The prevalence of psychiatry comorbidity among our respondents was 82.9%. Social phobia was the leading disorder (69.8%). Others were mixed depression anxiety disorder (49.4%) and post-traumatic stress disorder (36.6%). Current psychosis was 27.7%, while major depressive disorder was 12.2%. Psychiatric comorbidity was significantly associated with male gender, religion, ethnicity, marital status and being unemployed with p < 0.01. Human immunodeficiency virus stage was related to panic disorder with p < 0.01, while viral load was significantly associated with depressive disorder with p = 0.001. Conclusion: Majority of our HIV patients attending the clinic have undetected psychiatric morbidity. Clinicians need to be aware of the features of major psychiatric disorders and refer appropriately for improved overall outcome. Contribution: This study contributes to the body of work on unrecognised psychiatric comorbidity in people living with HIV and AIDS, especially in North-Eastern Nigeria, identifying issues which are relevant to clinical practice and buttressing the need for integration of mental healthcare services into HIV treatment and prevention services.

SARS-CoV-2 infection in people living with HIV: a systematic review.

BACKGROUND AND SETTING: Little is known about SARS-CoV-2 impact on some vulnerable subgroups, such as people living with HIV/AIDS (PLWHA). In our study we reviewed the current knowledge on SARS-CoV-2 cases in PLWHA. METHODS: A systematic review was conducted by searching the MEDLINE, EMBASE and Google Scholar databases. Studies reporting data on PLWHA affected by SARS-CoV-2 were considered for inclusion. The aim of this study was the systematic characterization of cases of SARS-CoV-2 infection among PLWHA, particularly focusing on age, clinical findings at diagnosis, radiological features, therapeutic management and clinical outcomes. RESULTS: Twenty three relevant articles were identified, which reported 164 adults with both HIV and SARS-CoV-2 infection. Of those, the large majority were males (120/142, 84.5%), often with one or more comorbidities. Fifteen cases needed intensive care treatment and 16 died. For each group, respectively three patients had underlying comorbidities. There were no studies on children. The included studies were mostly retrospective or case series/reports (19 studies). The overall risk of bias was moderate, due to the study types and characteristics. CONCLUSION: It is still unclear if HIV infection may influence SARS-CoV-2 infection and disease course, however some PLWHA and particularly males affected by ARV-related complications may be at greater risk of severe Covid-19 course.

What is polypharmacy in people living with HIV/AIDS? A systematic review.

Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as "minor" (N = 3); "major" (N = 29); "severe" (N = 2); "excessive" (N = 1); and "higher" (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.

Levels of HIV/AIDS stigma and associated factors among sexually active Ethiopians: analysis of 2016 Ethiopian Demographic and Health Survey Data.

BACKGROUND: Stigma and discrimination have fueled the transmission of the disease and dramatically increased its negative public health impact. Even though the disease has extremely ravaged human life, stigma, and discrimination attached to it are not well addressed in Ethiopia at the country level. The reduction of stigma and discrimination in a population are important indicators of the success of programs that target HIV prevention and control. This study aimed to assess the level of HIV-related stigma and its determinants among sexually active Ethiopians. METHODS: A public domain data were obtained from 2016 Ethiopian Demographic and Health Survey in which two-stage cross-sectional stratified cluster sampling was applied. A total of 28,371 sexually active Ethiopians were interviewed from both rural and urban parts of Ethiopia. Descriptive Statistics and multilevel ordinal logistic regression (proportional odds model) were used to summarize data and to investigate correlates of HIV-related stigma. RESULTS: Only 5.1% (95% CI: 4.5%, 5.8%) of sexually active Ethiopians did not have a stigmatizing attitude, whereas, 59.2% (95% CI: 57.3%, 61.1%) and 35.65% (95% CI: 33.5%, 37.9%) of them had a moderate and high level of stigma respectively. Regression results show that residence (AOR = 1.82, 95% CI:1.46, 2.27), education (AOR = 0.65,95% CI: 0.50,0.84), owning mobile (AOR = 0.63,95% CI:0.55,0.72), HIV-testing (AOR = 0.77, 95% CI:0.70,0.84), age (AOR = 0.81, 95% CI: 0.73, 0.91), religion (AOR = 1.53,95% CI:1.33,1.76), and marital status (AOR = 1.38, 95% CI:1.19, 1.61) were significantly associated with HIV-related stigma (p < 0.0001). CONCLUSION: Regardless of all efforts put in a place to prevent and control HIV, a significant proportion of sexually active Ethiopians have stigmatizing attitudes. Residence, educational level, owning mobile, HIV test uptake, age, religion, and marital status were determinants of HIV-related stigma. Expanding mobile coverage, promoting HIV counseling and tests, promoting HIV education, and working with religious leaders, among other strategies could be used to minimize the stigma attached to the disease to best prevent and control it.

Perceptions, practices and barriers to reporting of adverse drug reactions among HIV infected patients and their doctors in 3 public sector hospitals of the Ethekwini Metropolitan, Kwa-Zulu Natal: a cross sectional and retrospective analysis.

BACKGROUND: Adverse drug reactions (ADRs) remain a global public health concern. Pharmacovigilance practises are essential in ensuring patients safety and post drug marketing surveillance. This study aimed to describe practices, perceptions and barriers towards ADR reporting practices amongst People Living with HIV/AIDS (PLWHA), who are on Highly Active Anti-Retroviral Therapy (HAART) and their doctors. METHODS: The study took place at 3 public sector hospitals. The first phase of the study was a quantitative cross-sectional study using a closed ended questionnaire that was given to PLWHA. Phase two was a retrospective analysis of these patients' medical files, whilst phase 3 included a descriptive statistics to determine the frequencies and percentages for variables such as ADR reporting practices by doctors. RESULTS: Spontaneous reporting, was evident with 202 patients (48%) indicating that they reported experiencing ADRs to their doctors. Ten doctors (77%) indicated that they received PV training. Eight (62%) doctors indicated that the completed ADR reporting forms were submitted to the pharmacy manager in the hospital for forwarding to the regulatory authority, with 2 (15%) indicating that they submitted directly to the South African Health Products Regulatory Authority. Four (31%) doctors stated that the system of reporting ADRs is ineffective with the majority of the doctors 12 (92%) responding that the reporting of ADRs is very important/critical. A barrier cited by 4 patients (0.9%) for non-reporting of their ADRs was transport cost. Whilst doctors' barriers included reporting being time consuming (31%), and a lack of availability of reporting forms (31%). CONCLUSION: Patients and doctors are reporting ADRs but more education and easier reporting process should be available to strengthen the knowledge and reporting of ADRs. Doctors agree that it is critical to report ADRs. Electronic reporting should be encouraged to lessen the time it takes to report ADRs.

Acceptability of patient-centered hypertension education delivered by community health workers among people living with HIV/AIDS in rural Uganda.

BACKGROUND: The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda. METHODS: We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon's model of acceptability of health Interventions to explore participants' perceptions. RESULTS: Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material (PocketDoktor™) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor™, financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting. CONCLUSIONS: Hypertension patient-centered education delivered by CHWs using the PocketDoktor™ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings.

Metastereotypes, perceived mattering, and well-being among minority groups.

Perception of mattering may be especially important for those who are more likely to be the object of negative stereotypes, such as members of minority groups. The present study aimed to analyse the relationship between perceived mattering to family and friends, metastereotypes, and well-being among two minority groups: people living with HIV (PLWHA) and people with disabilities (PWDs). Of 100 participants, 39 were living with HIV and 61 were individuals with disabilities. Multiple regression analyses showed that positive (more than negative) metastereotypes could significantly predict perceived mattering and well-being among both groups. Mattering to both family and friends significantly predicted many dimensions of well-being among both PLWHA and PWDs. These findings show that perception of mattering is related to the well-being of minority group members. Interventions aimed at improving the well-being of individuals who belong to minority groups should focus on positive metastereotypes and the perception of being important to significant others, considering both friends and family members.

Human immunodeficiency virus positive status disclosure to a sexual partner and its determinant factors in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Disclosure of Human Immunodeficiency Virus positive status significantly reduced the transmission of HIV; yet, it remains a challenge for many HIV patients. Disclosure serves plays a crucial role to raise awareness and to reduce risky behaviors. Hence, this study aimed to determine the pooled prevalence and effect sizes of determinant factors of HIV positive status disclosure through a systematic review and meta-analysis of the results of the existing primary studies in Ethiopia. METHOD: This systematic review and meta-analysis was aimed to determine prevalence of HIV positive status disclosure and associated factors by considering and searching published primary articles from different sources. A sensitivity test was conducted to evaluate the presence of influential studies. Besides, the heterogeneity test has been conducted; and publication bias was examined through observing the funnel plot as well as objectively by interpreting the Egger's regression test. Following the Egger's regression test, P-value < 0.05 was considered as statistically significant at 95% Confidence Interval. RESULT: A total of 18 primary studies were searched from different data sources. The overall pooled prevalence of HIV positive status disclosure among adult PLWHA in Ethiopia was indicated to be 75.95% (95% CI:69.93-81.98); the highest and lowest pooled estimated HIV status disclosure was in Amhara (82.78%) and Tigray (54.31%) regions respectively. Furthermore, Knowing the HIV positive status of sexual partner, AOR = 19.66(95% CI: 10.19-37.91), having prior discussion about HIV testing with their partner, AOR = 9.18(95% CI: 5.53-15.24), got Human Immunodeficiency Virus pretest counseling service AOR = 4.29(95% CI: 2.56-7.21) and being a member of HIV/AIDS associations, AOR = 3.34(95% CI: 2.17-5.12), were significantly associated with HIV positive status disclosure among People living With HIV/AIDS in Ethiopia. CONCLUSION: The pooled national estimate of HIV/AIDS positive status disclosure is low as compared to the WHO disclosure rate of developing countries and the findings of other national and international studies. Ministry of health and other stakeholders shall design new approaches and strategies to encourage disclosure of HIV status, educate the public about the negative impact of nondisclosure within family members. Health care providers working at Human HIV test centers shall emphasis extensive counseling on disclosure of status to a partner. Moreover, different stakeholders, health workers and community members shall establish, organize, and support HIV/AIDS Associations and motivate HIV positive people to be engaged and participated.

The HIV/AIDS pandemic in Kenya: an investigation into the perceptions of Kenyans toward people living with HIV/AIDS and government programmes.

The HIV/AIDS pandemic is compounded by the continued stigmatization of the virus/disease and of people living with HIV/AIDS (PLWHA). Employing structuration theory, this study sought to examine the perceptions of Kenyans toward their government's efforts to curtail HIV/AIDS as well as their attitudes toward PLWHA. Data for this study were collected using an open-ended online survey. In total, 103 participants (25.3%) completed the survey. We used snowball sampling to select prospective participants known to the researcher; they were sent a link to the survey via email or direct message on a social networking site like Facebook or WhatsApp, and were asked to share the survey with people in their social circles. Data were analysed using thematic analysis. Findings revealed that some participants had confidence in the Kenyan government's efforts to address the HIV/AIDS pandemic, while others showed no confidence in government-led initiatives. Consistent with previous research, this study found that stigma towards HIV/ AIDS and PLWHA still exists. Practical and theoretical implications of the findings are discussed.

Self-Stigma Reduction Interventions for People Living with HIV/AIDS and Their Families: A Systematic Review.

Stigma is a primary concern for people living with human immunodeficiency virus (HIV)/AIDS (PLWHA), and has great impact on their and their family members' health. While previous reviews have largely focused on the public stigma, this systematic review aims to evaluate the impact of HIV/acquired immunodeficiency syndrome (AIDS)-related self-stigma reduction interventions among PLWHA and their families. A literature search using eight databases found 23 studies meeting the inclusion criteria. Five types of intervention approaches were identified: (1) psycho-educational intervention, (2) supportive intervention for treatment adherence (antiretroviral therapy), (3) psychotherapy intervention, (4) narrative intervention, and (5) community participation intervention. Overall, the reviewed articles suggested a general trend of promising effectiveness of these interventions for PLWHA and their family members. Psycho-educational interventions were the main approach. The results highlighted the need for more interventions targeting family members of PLWHA, and mixed-methods intervention studies.

Training the next generation of HIV providers: impact of trainees on patient satisfaction in an urban HIV clinic.

For persons living with HIV and AIDS (PLWHA), care by an HIV-specialist improves outcomes and satisfaction with one's HIV primary care provider (PCP) promotes engagement with care. In the United States, we are facing a workforce shortage of HIV providers. As we aim to train a new generation of HIV providers, it is unclear how PLWHA perceive their experience when cared for by trainees compared to experienced providers. Therefore we assessed patient satisfaction with HIV providers, both trainees in an HIV Primary Care residency program and HIV-specialists. A secondary objective was to evaluate providers' performance in adhering to standard management guidelines for HIV-associated and non-HIV-associated conditions. We surveyed 75 PLWHA, including 51 (68%) assigned to an HIV-specialist PCP and 24 (32%) to a trainee PCP. Overall patient satisfaction on a 10-point scale was similar (mean 9.6 HIV-specialist vs 9.7 trainee, p = 0.71) and remained similar in multivariate logistic regression analysis when controlling for patient age, gender, race, and recently establishing care (Odds Ratio 1.1, 95% Confidence Interval 0.3-5.0). Participants in the trainee group were more likely to feel their provider "always" spent enough time with them (100% vs 81%, p = 0.03). Adherence to HIV guidelines was similar, though trainees were more likely to document counseling on risk reduction (83% vs 47%, p = 0.005) and adherence to antiretroviral therapy (100% vs 66%, p = 0.001). In conclusion, in a structured HIV-training program, residents can provide subspecialty level care in an HIV continuity clinic with levels of performance and patient satisfaction equivalent to those of experienced specialists.

HIV testing experiences in Nairobi slums: the good, the bad and the ugly.

BACKGROUND: HIV testing is an integral component of HIV prevention, treatment and care and, therefore, is crucial in achieving UNAIDS 90-90-90 targets. HIV testing in Kenya follows both the voluntary counselling and testing (VCT) and provider initiated testing and counselling (PITC) models. However, little is known about the individual experiences of undergoing an HIV test in the two testing models. This study provides experiential evidence of undergoing an HIV test in a resource poor urban slum setting. METHODS: The study explored testing experiences and challenges faced in respect to ensuring the 3 Cs (consent, counselling and confidentiality), using in-depth interviews (N = 41) with HIV-infected men and women in two slum settlements of Nairobi City. The in-depth interview respondents were aged above 18 years with 56% being females. All interviews were audio-recorded, transcribed and then translated into English. The transcribed data were analysed using thematic analysis method. RESULTS: The respondent HIV-testing experiences were varied and greatly shaped by circumstances and motivation for HIV testing. The findings show both positive and negative experiences, with sporadic adherence to the 3Cs principle in both HIV testing models. Although some respondents were satisfied with the HIV testing process, a number of them raised a number of concerns, with instances of coercion and testing without consent being reported. CONCLUSION: The 3Cs (consent, counselling and confidentiality) principle must underlie HIV testing and counselling practices in order to achieve positive testing outcomes. The study concludes that adherence to the 3Cs during HIV testing contributes to both the individual and public health good - irrespective of whether testing is initiated by the individual or by the health provider.

An Exploratory Study of Stigma and Discrimination among People Living with HIV/ AIDS in Abuja Municipal Area Council, Nigeria.

This study examined the magnitude of HIV/AIDS stigma and discrimination among people living with HIV/AIDS (PLWHA) in Abuja Municipal Area Council (AMAC). A descriptive cross-sectional study was conducted using both qualitative and quantitative methods to survey 100 PLWHA resident in AMAC-FCT. Participants were selected through a combination of two- stage and systematic random sampling technique using a table of random numbers. A 40-item structured questionnaire adapted from the HIV Stigma Scale and a semi-structured focus group discussion (FGD) guide were used to collect data. Quantitative data were coded and entered SPSS statistical software. Frequency tables were generated, and data subjected to descriptive and inferential statistics. Cross tabulations examined pattern of associations between respondent's characteristics while qualitative findings utilized content analysis along five specific themes to demonstrate the way HIV/AIDS stigma manifested among respondents. Participation was 100% and HIV/AIDS stigma prevalence was high at 67%, with mean age 33.01years (SD±5.94years) for respondents. Findings confirmed rejection of PLWHA by sexual partners, family members and friends, dismissal from work, decrease in the quality of health care services and sometimes outright denial of services. A high correlation was found between the scales and subscales of the HIV Stigma Scale with all correlation values reaching statistical significance (p =0.01). Regret for disclosure of status and ending social interaction by PLWHA was reported as consequences of disclosure and potential hindrance for disclosure which will encourage ongoing transmission of the virus. Our study provides evidence on stigma and discrimination of PLWHA in AMAC, FCT-Abuja in the face of limited evidence to drive HIV prevention interventions. Further studies should investigate other predictors and reasons for stigma and discrimination among this population.

HIV/AIDS-related stigma, immediate families, and proactive coping processes among a clinical sample of people living with HIV/AIDS in Philadelphia, Pennsylvania.

People living with HIV/AIDS (PLWHA) engage in proactive coping behaviors to minimize the risk of interpersonal stigma. This study explores proactive coping processes in navigating HIV/AIDS-related stigma within immediate families. Data for this study come from 19 one-on-one, qualitative interviews with a diverse, clinical sample of PLWHA in Philadelphia, PA. Thematic analysis indicated that participants continue to experience enacted, anticipated, and internalized forms of HIV/AIDS-related stigma. Participants discussed status concealment and selective disclosure as proactive coping resulting from anticipated stigma and physical distancing as proactive coping motivated by internalized HIV/AIDS-related stigma. Study findings demonstrate how living with a stigmatized condition can affect PLWHA social interactions with close networks like immediate families, specifically in eliciting stigma-avoidant behaviors. Anti-stigma efforts that educate immediate families to overcome stigmatizing attitudes and provide HIV-positive family members with high-quality social support should be coupled with efforts that target health-promotive self-management strategies for PLWHA.

HIV and Cardiovascular Disease: Update on Clinical Events, Special Populations, and Novel Biomarkers.

PURPOSE OF REVIEW: The objective of this review is to provide an update on the link between HIV infection and cardiovascular disease (CVD). We will focus our review mainly on literature describing clinical CVD events and understudied topics of importance. RECENT FINDINGS: Heart failure, peripheral artery disease, and stroke are CVD modalities deserving more attention in the context of HIV infection in the highly active antiretroviral therapy era. Incidence data on clinical CVD from HIV populations in low- and middle-income countries are limited. Multisubstance use is common in HIV, but understudied as a moderator or mediator of the association between HIV and CVD. CVD risk assessment in HIV remains challenging, but new research into novel biomarkers may provide further insights. There is also a need for inclusion of non-biologic factors in our attempts to understand, quantify, and predict CVD risk among PLWHA. Significant attention has been paid to generating and testing hypotheses to understand the mechanisms of myocardial infarction in HIV. Similar attention is deserving for heart failure, PAD, stroke, and cardiovascular disease risk in resource-limited settings and among substance users with HIV.

Risk factors associated with multi-dimensional stigma among people living with HIV/AIDS who are homeless/unstably housed.

BACKGROUND: Stigma may serve as a barrier to HIV care among homeless living with HIV/AIDS (PLWHA). The role of layered stigma related to the syndemic of homelessness, mental health, and substance use among PLWHA has not been examined. We explored the syndemic of HIV, homelessness, mental health, and substance use, as well as perceived and experienced provider stigma. We also examined factors contributing to high levels of stigma. METHODS: We identified PLWHA who were homeless with co-existing mental health and/or substance abuse. Surveys were conducted at study enrollment. External HIV stigma, external stigma related to homelessness, mental health, and substance abuse, HIV provider stigma, and provider stigma related to homelessness, mental health, and substance abuse were measured. Multivariable regression and psychometric assessments were conducted. RESULTS: Over 2/3 of participants (n = 528) reported HIV stigma. About 30% responded affirmatively to perceiving stigma related to their homelessness, 26% to substance use, and 19% to having a mental health condition in the past 12 months. Less than 20% reported perceiving stigma related to both homelessness and substance use, and 16% reported perceiving stigma related to both homelessness and mental health. Only15% reported HIV-related provider stigma. Those with lower mental functioning, greater unmet need, and less social support reported greater levels of stigma. CONCLUSIONS: Almost 70% of participants reported HIV stigma, with 1/4 experiencing stigma related to homelessness, substance use and mental health. Our current study highlights the complexity of stigma in vulnerable PLWHA and the importance of allocating resources to help improve outcomes.

Association between coping strategies, social support, and depression and anxiety symptoms among rural Ugandan women living with HIV/AIDS.

Poor mental health detrimentally affects quality of life among women living with HIV/AIDS. An improved understanding of how coping and social support relate to depression and anxiety in this population can facilitate the design and implementation of appropriate mental health treatment and support services. Secondary analysis was conducted on baseline data from 288 HIV-positive women enrolled in a parenting intervention in Uganda. Depression and anxiety symptoms, social support, and coping were assessed with the Hopkins Symptom Checklist and adapted versions of the Multidimensional Scale for Perceived Social Support and Ways of Coping Questionnaire. General linear regression models were used to estimate associations between coping and mental health. Based on report of elevated symptoms, approximately 10% of women were categorized as having clinically-relevant depression or anxiety. Emotion-focused (EF: p < .001) and problem-focused (PF: p = .01) coping were associated with more depressive symptoms while greater family support (EF: p = .002; PF: p = .003) was associated with fewer depression symptoms. More anxiety symptoms were associated with reporting both coping strategies (EF: p < .001; PF: p = .02) and higher community support (EF&PF: p = .01). The cross-sectional nature of the study limits our ability to rule out the role of reverse causation in the significant relationship between coping and mental health. Findings do suggest that high family support can be protective against depression and anxiety symptoms among women living with HIV.

Associations between HIV-related stigma, self-esteem, social support, and depressive symptoms in Namibia.

OBJECTIVE: The current study sought to investigate the association between HIV-related stigma, self-esteem, social support, and depression of people living with HIV and AIDS (PLWHA) in Namibia. METHOD: Purposive sampling was used to recruit a total of 124 men and women living with HIV/AIDS in the Katima Mulilo region of northern Namibia. A cross-sectional survey was used to collect information on demographics, self-esteem, social support, HIV-related stigma, and depression. RESULTS: Correlation analysis revealed that HIV-related stigma, self-esteem, and social support were all significantly correlated with depression. Further, Ordinary Least Squares (OLS) regression analysis indicated that HIV-related stigma was the largest risk factor and self-esteem was the largest protective factor with respect to depressive symptoms. DISCUSSION: Findings indicated the necessity of appropriate assessment and intervention for psychosocial distress among PLWHA. Helping professionals should design evidence-based interventions that address individual and societal challenges that impact people living with HIV and AIDS.