Suchergebnisse

Background: There are an estimated 80,100 female sex workers (FSWs) in Ukraine, of whom 7% are living with HIV. Early HIV diagnosis continues to be a public health priority in Ukraine as only approximately 54% of people living with HIV are diagnosed nationwide. This study aims to analyse the content, context and discourse of HIV testing policies among female sex workers in Ukraine and how these policies are understood and implemented in practice. Methods: To analyse past and current national policies, we searched the database of the Ukrainian Parliament and the Ministry of Health for relevant policy documents (e.g. legislation and orders). To analyse the day-to-day practice of those involved in the implementation of these HIV programmes, we conducted face-to-face semi-structured interviews with key stakeholders. All data were coded using deductive thematic analysis initially guided by the Policy Triangle, a framework which addresses policy content, the process of policy-making, the health policy context, actors involved in policy formulation and implementation. Results: HIV testing policies are formed and implemented in the post-Soviet context through a vertical system of AIDS clinics, resulting in the separation of key affected populations from the rest of the health system. Successive testing policies have been strongly influenced by international donors and non-governmental organisations. Furthermore, a lack of government funding for HIV prevention created a gap that international donors and local non-governmental organisations covered to ensure the implementation of testing policies. Their role, however, had limited influence on the Ukrainian government to increase funding for prevention, including testing of FSWs. Since the early 1990s, when stigmatising and discriminatory forced/mandatory HIV testing was applied, these approaches were slowly replaced with voluntary testing, self-testing and assisted HIV testing, yet stigma was found to be a barrier among FSWs to access testing. Conclusion: Poor governance and the fragmentation of the health system, ongoing health sector reforms, shrinking international funding, and persisting stigma towards people living with HIV and sex workers might impede the continuity and sustainability of HIV testing programmes. Local civil society may now have the opportunity to contribute to the development and further implementation of HIV testing policies in Ukraine.

Based on the current care guidelines from the CDC and elsewhere, this book addresses the current emphasis on managing the side effects of HIV/AIDS such as lypodystrophy, redistribution of body fat, cardiac risks, and vulnerability to other ailments. Combining the latest medical advice with the ideas of hundreds of people living with HIV/AIDS, the book is particularly helpful for friends, family members, and others who make up the support network for anyone struggling with HIV/AIDS

Here, US researchers discuss the intersections of violence, disease and substance abuse, adressing incarceration and health risks; health consequences of risk behaviors; public health interventions and high risk populations; and crime, space and health.

Foreword -- References -- Preface -- Contents -- Contributors -- Chapter-1 -- Mamoru Ito's Vision for the Future of Humanized Mouse Models -- 1.1 History of the Development of Immunodeficient Mice in Japan -- 1.2 Currently Available Humanized Mouse Models Generated Using NOG, NSG, and BRG Mice and Their Limitations -- 1.3 Novel Humanized Mouse Models Generated Using Improved Immunodeficient Mice -- 1.4 Generation of Humanized Mice in the Future -- 1.4.1 Improvements in Immunodeficient Mouse Models -- 1.4.2 Artificial Organ Formation -- 1.4.3 A Plentiful and Stable Supply of Stem Cells is Needed to Generate Humanized Mice -- 1.4.4 Mice with Human Immune Systems -- References -- Part I -- Mouse Genetic Background and Human Hematopoietic Stem Cells Biology -- Chapter-2 -- Humanized Mice as Models for Human Disease -- 2.1 Introduction -- 2.2 The Rationale Design of Animal Models -- 2.3 A Case in Point: The SCID-hu Thy/Liv Model -- 2.4 The Next Wave of Humanized Mice -- 2.5 Barriers to Cross -- References -- Chapter-3 -- Role of Mouse Innate Immunity in Immunodeficient Mice for Xenotransplantation -- 3.1 Natural Killer (NK) Cells -- 3.2 Macrophages -- 3.3 Complement Systems -- 3.4 Dendritic Cells: CD11c+B220+CD122+ Cells -- References -- Chapter-4 -- Mouse Genetic Background and Human Hematopoietic Stem Cells Biology -- Tips for Humanization -- 4.1 Genetic Backgrounds and Hematopoietic Cytokines for Better Function of Human HSC and Immune System -- 4.2 Human HSC Biology in Mouse Environment -- 4.3 Mouse Hematopoietic Stem Cell or Niche Defect in SCID BM -- 4.4 Role of Mouse Innate Immunity in the Engraftment of Human Cells: NOG versus NSG -- 4.5 Lymphoid Tissue Development: NOD/SCID versus NOG versus NSG Mice -- 4.6 Parameters in Donor and Recipient that Influence Humanization Efficiency.

Nearly 40 years into the HIV epidemic there is a wealth of information available, but it is difficult to determine what is factual and reliable. Whether you are a newly diagnosed patient or a friend or relative of someone living with HIV, this book can help. Offering both doctor and patient perspectives, 100 Questions & Answers About HIV and AIDS, Fifth Edition provides authoritative and practical answers to eh questions most commonly asked by people with HIV and their loved ones. What is the difference between HIV and AIDS? How can HIV be prevented? What are the most effective treatments? How do I find the right medical care? Along with eh answers to these and other questions, this book provides information on diagnosis, treatment, living with HIV, and more. Updated to provide the latest information, 100 Questions & Answers About HIV and AIDS, Fifth Edition is an invaluable resource for anyone coping with the physical and emotional uncertainty of having HIV.--

One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0·7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.

Background: Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. Methods: Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, MSM activity indicators, and other variables at the aggregated level. Results: New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be signicantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P<0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P=0.003), a higher proportion of MSM (IRR, 1.230; P=0.030), a higher proportion of men from Western Europe (IRR, 1.281; P=0.003), a higher proportion of men from Latin America (IRR, 1.260; P=0.003), and a higher number of gay locations (IRR, 2.665; P<0.001). No association was observed between the HIV diagnosis rate and economic deprivation. Conclusions: Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.

Background: Integration of sexual and reproductive health (SRH) and HIV policies and services delivered by the same provider is prioritised worldwide, especially in sub-Saharan Africa where HIV prevalence is highest. South Africa has the largest antiretroviral treatment (ART) programme in the world, with an estimated 2.7 million people on ART, elevating South Africa's prominence as a global leader in HIV treatment. In 2011, the Southern African HIV Clinicians Society published safer conception guidelines for people living with HIV (PLWH) and in 2013, the South African government published contraceptive guidelines highlighting the importance of SRH and fertility planning services for people living with HIV. Addressing unintended pregnancies, safer conception and maternal health issues is crucial for improving PLWH's SRH and combatting the global HIV epidemic. This paper explores South African policymakers' perspectives on public sector SRH-HIV policy integration, with a special focus on the need for national and regional policies on safer conception for PLWH and contraceptive guidelines implementation. Methods: It draws on 42 in-depth interviews with national, provincial and civil society policymakers conducted between 2008–2009 and 2011–2012, as the number of people on ART escalated. Interviews focused on three key domains: opinions on PLWH's childbearing; the status of SRH-HIV integration policies and services; and thoughts and suggestions on SRH-HIV integration within the restructuring of South African primary care services. Data were coded and analysed according to themes. Results: Participants supported SRH-HIV integrated policy and services. However, integration challenges identified included a lack of policy and guidelines, inadequately trained providers, vertical programming, provider work overload, and a weak health system. Participants acknowledged that SRH-HIV integration policies, particularly for safer conception, contraception and cervical cancer, had been neglected. Policymakers supported public sector adoption of safer conception policy and services. Participants interviewed after expanded ART were more positive about safer conception policies for PLWH than participants interviewed earlier. Conclusion: The past decade's HIV policy changes have increased opportunities for SRH–HIV integration. The findings provide important insights for international, regional and national SRH-HIV policy and service integration initiatives.

To determine whether hepatitis E virus (HEV) is a cause of hepatitis among HIV-infected persons, we evaluated 1985–2009 data for US military beneficiaries. Evidence of acute or prior HEV infection was detected for 7 (4%) and 5 (3%) of 194 HIV-infected persons, respectively. HEV might be a cause of acute hepatitis among HIV-infected persons.

Shared needle and syringe use among injection drug users continues to be a major mode of transmission of HIV. Needle and syringe exchange (NSE) may be a viable strategy to reduce the transmission of the virus; yet the difficulty in measuring the actual efficacy of NSE has limited attempts to evaluate the cost-effectiveness of the intervention. Using data specific to the Lower East Side Harm Reduction Center in New York City, we assessed the cost-effectiveness of NSE over a range of conservative estimates of efficacy, obtained from both longitudinal and small-area studies. A decision-analysis model was created to compare the outcomes and costs associated with NSE. Model inputs included the cost of living with HIV and the seroprevalence of HIV among injection drug users in New York City. This analysis was conducted from both the government and societal perspectives. Tested over a range of conservative parameter estimates, NSE appears to save money and lives. The NSE program we evaluated cost $502 per client and produced a gain of 0.01 quality adjusted life years per client. It also reduced HIV treatment costs by $325,000 per case of HIV averted, and averted 4–7 HIV infections per 1000 clients, producing a net cost savings.

Historically, the Netherlands has hosted a large number of migrant sex workers. Since sex work is considered a legal profession it might serve as an example of better access to health services, including HIV testing, at least for those working within the legal framework. However, migrant sex workers, especially non-European Union (EU) nationals, might not be eligible to register for official employment and thus face obstacles in obtaining access to health services, becoming essentially invisible. This study examined context-specific vulnerabilities of migrant female sex workers (FSWs) from Belarus, Moldova, Russia and Ukraine, whether and how they have access to HIV testing compared to other EE, non-EU migrant FSWs in Amsterdam in the Netherlands. We conducted a multi-stakeholder perspective study from November 2015 to September 2017 in Amsterdam. The study comprised 1) semi-structured interviews with key stakeholders (N = 19); 2) in-depth interviews with Eastern European, non-EU migrant FSWs (N = 5) and field observations of the escort agency working with them; and 3) in-depth interviews with key stakeholders (N = 12). We found six key barriers to HIV testing: 1) migration and sex-work policies; 2) stigma, including self-stigmatization; 3) lack of trust in healthcare providers or social workers; 4) low levels of Dutch or English languages; 5) negative experience in accessing healthcare services in the home country; and 6) low perceived risk and HIV-related knowledge. Having a family and children, social support and working at the licensed sex-work venues might facilitate HIV testing. However, Internet-based sex workers remain invisible in the sex-work industry. Our findings indicate the importance of addressing women's diverse experiences, shaped by intrapersonal, interpersonal, community, network and policy-level factors, with stigma being at the core. We call for the scaling up of outreach interventions focusing on FSWs and, in particular, migrant FSWs working online

Males and females -- Uniform trends -- False positives or contaminated samples? -- HIV is not an infection -- HIV discriminates by race -- What is it about race? -- Racism -- What do HIV tests detect? -- HIV and AIDS are not correlated -- AIDS -- Missteps in modern medical science -- How science progresses -- Research cartels and knowledge monopolies -- It's a virus -- Maintaining the monopoly -- The end of the beginning

Background: To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC) 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. Methods: We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS). Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. Results: The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. Conclusions: Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.