Revista de SIDA e investigación clínica

Advancements in the fight against HIV/AIDS could be achieved by thinking differently, breaking paradigms and forging together in a shared vision of tackling one of the toughest challenges of mankind. Vulgarization of nonoccupational post exposure prophylaxis especially in low-income settings which bear the brunt of HIV/AIDS, could complement the comprehensive preventive strategies available to break the transmission chain and reduce the incidence of HIV/AIDS.

Introduction: Cervical cancer is the second most common cancer in women worldwide. 80% of cases occur in low-income countries. In Zimbabwe 7000 women are diagnosed of cervical cancer annually and about 1300 of these are treated with radiotherapy. This study was conducted to asses knowledge of cervical cancer among ART patients in Mberengwa district 2012

Materials and methods: A descriptive study was conducted among female ART patients in Mberengwa District Zimbabwe. Simple random sampling was used to select participants using ART register as sampling frame. Sample size was calculated using the dopson formula. Ninety six participants were required. Knowledge of cervical cancer was assessed through knowledge of cardinal signs and symptoms of the cancer. A pre tested interviewer administered questionnaire was used. Observations were also used to asses availability of case definition for cervical cancer. Record reviews of health education session at health facilities was also done Epi info was used to analyse data. Written consent was sought from all participants. Permission to carry out study was granted from the Ministry of Health.

Results: Ninety six patients were recruited . (18.5%) did not attend primary school; none had been offered cervical cancer screening. (75%) did not know what is cervical cancer was, (97.9%) did not know prevention strategies for cervical cancer, (70%) reported that they were not susceptible to cervical cancer and (38.1%) reported that cervical cancer does not kill. Reported signs and symptoms of cervical cancer included; bleeding per vagina (8.6%), pain in lower abdomen (19.8%) . Other causes of cervical cancer that were reported were; witchcraft (31.2%), or curse (37.5%). There were no cervical cancer case definitions in the health centres

Discussion and conclusion: Knowledge of cervical cancer among participants was low. There is need for health education, promotion and awareness on cervical cancer as well as provision of case definition for cervical cancer in all health institutions in the district.

Background: Ukraine has one of the largest burdens of HIV in the European region. Over the past decade, significant strides have been made to successfully decrease the rate of HIV transmission. This analysis of HIV testing and entry into care in Western Ukraine provides data in an understudied region of Ukraine.

Methods and findings: We analyzed records of HIV testing by category performed within the Lviv Oblast between 2005 and 2013. We also analyzed aggregate registration data from the Lviv Regional AIDS Center. The three highest HIV risk testing categories and their relative percent positive were 1) sexual contact with known HIV partner (20.5%) 2) current or past intravenous drug use (IDU) (13.5%) and 3) history of incarceration (11.5%). The rates of positive tests for IDU and incarcerated patients decreased over this time period. Evaluation of registration into care demonstrated that between 2005-2008, 36.6 % of positive tests resulted in registration into care compared to 54.5% between 2009- 2013.

Conclusions: New HIV diagnoses have shifted from within predominantly IDU and incarcerated populations to more broad based screening categories consistent with the known shift to a generalized HIV epidemic. The overall rate of registration into care remains low. More efforts are needed to target HIV positive patients to engage them to register for care.

Objectives: This effort provides the first description of barriers and facilitators that Hepatitis C Virus (HCV) and/or Human Immunodeficiency Virus (HIV) -infected Veterans face in seeking medical care after community re-entry from Los Angeles County (LAC) jails.

Design: An evaluation of in-depth qualitative interviews with re-entry HCV and HIV-infected Veterans, and clinical and social service providers. The key variables in the analyses are HIV/HCV linkage to care, barriers/facilitators to linkage to care, and staff perspectives.

Setting: Qualitative data was collected in person at the VA hospital or by telephone interview within the year the study was conducted. Correctional institutions offer opportunities to identify Veterans with HCV and HIV, and for the US Department of Veterans Affairs (VA) to link them to medical care upon release.

Participants: Semi-structured interviews of two cohorts: 1) 16 clinical/non-clinical VA/LAC jail staff; 2) 9 postincarcerated Veterans with HIV and/or HCV. Main outcome measure: Feedback about barriers and facilitators to reduce gaps, strengthen and improve linkage to care efforts.

Results: Although some characterized efforts positively, barriers were highlighted. Veterans and staff described insufficient strategies for identifying Veterans, ineffective outreach, and inadequate staffing. Strategies for improving linkage, including routine in-take identification of Veteran status, greater program dissemination and increased staff were noted.

Conclusions: Results highlight existing gaps for Veterans transitioning to VA healthcare from LAC jails. Findings can guide future efforts to strengthen gaps between local and federal government

The effect of long term administration of nevirapine (NVP) on serum levels of some liver enzymes in albino Wistar rat was investigated. A group of rats treated with NVP (0.4 mg/kg body weight) for 2 weeks thereafter, two times daily in addition to normal rodent chow for 12 weeks were examined for serum levels of aspartate transaminase, alanine aminotransferase, alkanine phosphatase, gamma glutamyl transferase. The levels of aspartate transaminase (AST), alanine aminotransferase (ALT), alkanine phosphatase (ALP) and gamma glutamyl transferase (GGT) for the NVPtreated group were significantly (p < 0.001) higher as compared to their control(s), respectively. In conclusion, results of the study indicate that long term administration of NVP may be injurious to liver cell integrity, and this might impair liver function in the rat. If this result is applicable to humans, long term administration of NVP could hamper the integrity and function of the liver in individual users.

Background: HIV/AIDS has become a global health crisis and a leading cause of death in the developing world. Since 1981, more than 25 million people worldwide have died from this immunodeficiency syndrome. Very early in the AIDS epidemic, it was recognized that protein calorie malnutrition and specific micronutrient deficiencies were common in HIV and AIDS patients. Non-diversified diet and inadequate dietary intake could contribute to this severity of HIV/AIDS progression and to the depletion of CD4 count. Therefore, this study assess factors associated with dietary diversity among HIV positive adults (≥ 18 years) attending Anti-retroviral treatment clinic in Mettema hospital, Northwest Ethiopia.

Methods: Facility based cross sectional study design was used in Mettema hospital at anti-retroviral treatment clinic from March 18 to May 16, 2013. A total of 378 adult HIV positive individuals who are attending ART clinic selected by systematic random sampling technique were included in the study. Data were collected using a pretested structured questionnaire using interview data collection method. Data were entered into Epinfo software and analyzed using Statistical Package for Social Sciences for windows version 16 and logistic regression methods were used.

Result: A total of 376 respondents (with 99.5% response rate) were included in the study. Mean individual dietary diversity score showed that more than half (58.8%) of adult HIV positive individuals had low dietary diversity (95% CI: 0.49, 0.69). Significant factors associated with low dietary diversity were being lowest wealth quintile [AOR = 9.51, CI: 2.69, 33.48], being self-employed [AOR = 0.33; 95% CI: 0.13, 0.83] and daily laborer [AOR = 0.24; 95%: 0.08, 0.73], individuals with shorter duration of anti-retroviral treatment (less than one and half year) [AOR = 3.69; 95% CI: 1.47, 9.25] and taking Cotrimoxazole prophylaxis [AOR = 2.26; 95% CI: 1.3, 4.96].

Conclusion: Low dietary diversity was nutritional problem among HIV positive adults. Therefore efforts should be strengthened to improve employment status and consumption of animal based food items.

Hypermasculinity is a psychological term for the exaggeration of male stereotypical behaviour such as an emphasis on physical strength, aggression and sexuality while exhibiting emotional self-control as a sign of toughness as well as composure and impassiveness in times of great stress. "Alcohol Use, Sexual Health Risks and HIV Prevention among Young Men in Low Income Communities in Mumbai, India (ASHRA)" data have been analysed to find out the correlates of Hypermasculinity and its influence on sexual behaviour and sexual satisfaction among youth residing in low income settings of Mumbai. In the slums of Mumbai, a little over one-third of youth is having low masculinity, twofifths is having moderate masculinity, and one-fourth is having hypermasculinity which shows that hypermasculinity is very much pervasive in the community. Standard of Living (SLI) and migratory status do not have a significant association with Hypermasculinity whereas, education, marital status (both models) religion (both models), occupation (both models), exposure to pornographic materials, exposure to sexual stimuli and leisure time activities are having a strong association with hypermasculinity of the youth in Mumbai. As expected, high positive condom attitude is less and low condom attitude is more among the hypermasculine group than those having low masculinity. Exposure to mass media is negatively and leisure time activities, relational satisfaction with girlfriend/wife as well as sexual satisfaction are positively associated with hypermasculinity among the youth.

Objectives: Regular and quality CD4 testing is essential to monitor disease progression in people living with HIV. In Haiti, most laboratories have limited infrastructure and financial resources and have relied on manual laboratory techniques. We report the successful implementation of a national specimen referral network to rapidly increase patient coverage with quality CD4 testing while at the same time building infrastructure for referral of additional sample types over time.

Method: Following a thorough baseline analysis of facilities, expected workload, patient volumes, cost of technology and infrastructure constraints at health institutions providing care to HIV patients, the Haitian National Public Health Laboratory designed and implemented a national specimen referral network. The specimen referral network was scaled up in a step-wise manner from July 2011 to July 2014.

Results: Fourteen hubs serving a total of 67 healthcare facilities have been launched; in addition, 10 healthcare facilities operate FACSCount machines, 21 laboratories operate PIMA machines, and 11 healthcare facilities are still using manual CD4 tests. The number of health institutions able to access automated CD4 testing has increased from 27 to 113 (315%). Testing volume increased 76% on average. The number of patients enrolled on ART at the first healthcare facilities to join the network increased 182% within 6 months following linkage to the network. Performance on external quality assessment was acceptable at all 14 hubs.

Conclusion: A specimen referral network has enabled rapid uptake of quality CD4 testing, and served as a backbone to allow for other future tests to be scaled-up in a similar way.

Introduction: Three randomized controlled trials involving over 11,000 men have demonstrated that male circumcision reduces female to male transmission of HIV. It is recommended by the World Health Organization as part of a HIV prevention program. Adult male circumcision is associated with significant complications while neonatal male circumcision (NMC) has few risks and may be a preferred prevention strategy. Internationally, NMC is seldom performed except as a religious ritual. So, introducing NMC in Thailand needs to determine its acceptability among mothers. Therefore a study was conducted among postpartum Thai mothers to determine their perceptions of, concerns about and acceptability of NMC.

Methods: A survey was conducted of 593 postpartum mothers from 16 hospitals in 4 provinces in Thailand. Data were analyzed using descriptive statistics, univariate analysis and binary logistic regression.

Results: 70 % of the participants reported that they knew or have heard about MC. Safety and pain were the major concerns of the mothers towards NMC. One-third would chose to have their infants circumcised after receiving the information about NMC, an additional third were undecided and 34.5% would not allow their sons to undergo NMC. Mothers (44.0 %) were the most influential person when it comes to the decision on NMC followed by fathers (37.9 %). In a multiple regression, having 9 years or greater of formal education (OR 1.64; 95% CI 1.01-2.66), having a circumcised husband (OR 2.88; 95% CI 1.11-7.50), and knowing of at least one circumcised child (OR 1.97; 95% CI 1.22-3.18) were independent predictors of acceptability to NMC among postpartum mothers.

Conclusions: The results suggest that NMC may be culturally neutral with evidence that even modest educational efforts can impact mothers’ decisions in favor of NMC. However, this study and a previous study suggest that both parents and health professionals need to be educated about the benefits of NMC.