Public Health Commons^™

High Hiv Incidence Among Persons Who Inject Drugs In Pakistan: Greater Risk With Needle Sharing And Injecting Frequently Among The Homeless., Rab Nawaz Samo, Arshad Altaf, Ajmal Agha, Omrana Pasha, Shafquat Rozi, Ashraf Memon, Saleem Azam, Meridith Blevins, Sten Vermund, Sharaf Ali Shah

Community Health Sciences

BACKGROUND:

The incidence of HIV among persons who inject drugs (PWIDU) has fallen in many nations, likely due to successes of clean needle/syringe exchange and substance abuse treatment and service programs. However in Pakistan, prevalence rates for PWID have risen dramatically. In several cities, prevalence exceeded 20% by 2009 compared to a 2003 baseline of just 0.5%. However, no cohort study of PWID has ever been conducted.

METHODS:

We enrolled a cohort of 636 HIV seronegative PWID registered with three drop-in centers that focus on risk reduction and basic social services in Karachi. Recruitment began in 2009 (March to June) …

The Influence Of Neurocognitive Impairment, Alcohol And Other Drug (Aod) Use, And Psychosocial Factors On Antiretroviral Treatment Adherence, Service Utilization And Viral Load Among Hiv-Seropositive Adults, Jennifer Attonito

FIU Electronic Theses and Dissertations

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL.

The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from …

Turning The Tide On An Epidemic: A Native Kentuckian Changes The Deadly Trajectory Of Hiv Infection, Dannette Smith Cook

Ex-Patt Magazine

Interview: Dr. Mina Hosseinipour did not know her research would positively change the trajectory of the worldwide HIV epidemic when she graduated with a bachelor’s degree from the University of Kentucky in the early 1990’s.

The Contribution Of Emotional Partners To Sexual Risk Taking And Violence Among Female Sex Workers In Mombasa, Kenya: A Cohort Study, Stanley Luchters, Marlise L. Richter, Wilkister Bosire, Gill Nelson, Nzioki Kingola, Xu-Dong Zhang, Marleen Temmerman, Matthew F. Chersich

Population Health, East Africa

Objectives: To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described.

Design: Cohort study with quarterly follow-up visit over 12-months.

Methods: Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing.

Results: Four or more …

Hiv-1 Autologous Antibody Neutralization Associates With Mother To Child Transmission, Elly Baan, Anthony De Ronde, Martijn Stax, Rogier W. Sanders, Stanley Luchters, Joseph Vyankandondera, Joep M. Lange, Georgios Pollakis, William A. Paxton

Population Health, East Africa

The HIV-1 characteristics associated with mother to child transmission (MTCT) are still poorly understood and if known would indicate where intervention strategies should be targeted. In contrast to horizontally infected individuals, exposed infants possess inherited antibodies (Abs) from their mother with the potential to protect against infection. We investigated the HIV-1 gp160 envelope proteins from seven transmitting mothers (TM) whose children were infected either during gestation or soon after delivery and from four non-transmitting mothers (NTM) with similar viral loads and CD4 counts. Using pseudo-typed viruses we tested gp160 envelope glycoproteins for TZM-bl infectivity, CD4 and CCR5 interactions, DC-SIGN capture …

Research Fatigue Among Injecting Drug Users In Karachi, Pakistan, Aysha Zahidie, Arshad Altaf, Adeel Ahsan, Tanzil Jamali

Community Health Sciences

Background

Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study …

Aids: An Overview, Loretta Mclaughlin

New England Journal of Public Policy

"We stand nakedly in front of a very serious pandemic, as mortal as any pandemic there ever has been," said Halfdan Mahler, director-general of the World Health Organization (WHO). "I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming. Everything is getting worse and worse with AIDS and all of us have been underestimating it, and I in particular. We're running scared. I cannot imagine a worse health problem in this century." When asked to compare AIDS to other epidemics, such as smallpox, that have infected and killed over the course …

Priority Interventions To Reduce Hiv Transmission In Sex Work Settings In Sub-Saharan Africa And Delivery Of These Services, Matthew F. Chersich, Stanley Luchters, Innocent Ntaganira, Antonio Gerbase, Ying-Ru Lo, Fiona Scorgie, Richard Steen

Population Health, East Africa

Introduction: Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery.

Methods: We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes.

Results: We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for …

Effectiveness Of A Community-Based Positive Prevention Intervention For People Living With Hiv Who Are Not Receiving Antiretroviral Treatment: A Prospective Cohort Study, Avina Sarna, Stanley Luchters, Eustasius Musenge, Jerry Okal, Matthew Chersich, Waimar Tun, Sabine Mall, Nzioki Kingola, Sam Kalibala

Population Health, East Africa

Background: We report effectiveness of an HIV-prevention intervention delivered by community health workers (CHWs) in Mombasa, Kenya, to PLHIV who have not initiated or who have discontinued ART-an often difficult-to-reach population because they fall outside the ambit of health care and prevention services.

Methods: A 2-arm cohort study assessed a structured risk-reduction intervention involving at least 4 one-to-one counseling sessions and personalized support. The control group received standard prevention services. CHWs recruited treatment-naïve people living with HIV (PLHIV) or those who had previously taken antiretroviral drugs. Data were analyzed using a Propensity Score Matched (PSM)-sample to control for baseline differences …

Sociodemographic Profile Of Older Adults With Hiv/Aids: Gender And Sexual Orientation Differences, David J. Brennan, Charles A. Emlet, Sarah Brennenstuhl, Sergio Rueda

Charles Emlet

Hiv Testing Practices Among Black Primary Care Physicians In The United States, Eric Y. Wong, Wilbert C. Jordan, David J. Malebranche, Lori L. Delaitsch, Rebecca Abravanel, Alisha Bermudez, Bryan P. Baugh

David J Malebranche

Background: The Centers for Disease Control and Prevention recommends routine HIV testing in all healthcaresettings, but it is unclear how consistently physicians adopt the recommendation. Making the most of each interaction between black physicians and their patients is extremely important to address the HIV health disparities that disproportionately afflict the black community. The goal of this survey-based study was to evaluate the perceptions and practices of black, primary care physicians regarding HIV testing.

Methods: A physician survey was administered at the 2010 National Medical Association Annual Convention, via online physician panels, and by email. Physician eligibility criteria: black race; practicing …

Condom Negotiation Across Different Relationship Types By Young Women Engaged In Sex Work In Phnom Penh, Cambodia, Lisa Maher, Julie Mooney-Somers, Pisith Phlong, Marie-Claude Couture, Serey Serey Kien, Ellen Stein, Anna Juong Bates, Neth Sansothy, Kimberly Page, Young Women's Health Study Collaborative

Nursing and Health Professions Faculty Research and Publications

Cambodia’s 100% Condom Use Programme is credited with an increase in consistent condom use in commercial sexual interactions and a decrease in HIV prevalence among female sex workers (FSWs). There has been little improvement in condom use between FSWs and non-commercial partners, prompting calls for more innovative approaches to increasing condom use in these relationships. To understand why condoms are used or not used in sexual interactions involving FSWs, we examined condom negotiation across different types of relationships. We conducted 33 in-depth interviews with young (15 to 29 years) women engaged in sex work in Phnom Penh. There was an …

Linkage Politics And The Persistence Of National Policy Autonomy In Emerging Powers: Patents, Profits, And Patients In The Context Of Trips Compliance, Aseema Sinha, Tricia Olsen

CMC Faculty Publications and Research

The Trade Related Intellectual Property Agreement (TRIPS) has had a profound effect on industrialization and innovation, as well as access to medicines in cases of public health crisis such as HIV/AIDS. However, compliance with TRIPS has varied in developing countries, despite heightened international pressure. For instance, Brazil has pursued a coherent approach to its HIV/AIDS health crisis, while India has failed to take care of its HIV patients despite late compliance with the TRIPS agreement and the presence of business firms that produce the generic medicines for HIV/AIDS. This article suggests that divergence in TRIPS compliance is the result of …

Mother- To - Child Transmission Of Hiv And Congenital Syphilis: A Snapshot Of An Epidemic In The Republic Of Panama, Lorna Elizabeth Jenkins

USF Tampa Graduate Theses and Dissertations

ABSTRACT

Background: Worldwide HIV is going through a feminization and rejuvenation as more women are living with HIV/AIDS, increasing the risk of vertical transmission. Despite the efforts in Latin America and the Caribbean (LAC) by 2010, Panama was the third most affected country in the region with HIV/AIDS, with females aged 15-24 twice as affected as men.

Methods: This descriptive epidemiological study of HIV vertical transmission in Panama reviewed clinical charts to identify health care personnel's practices during pregnancies in 2008. This study also examines the impact of interventions comparing the HIV outcome of the children at the end of …

Experiences Of Kenyan Healthcare Workers Providing Services To Men Who Have Sex With Men: Qualitative Findings From A Sensitivity Training Programme, Elise M. Van Der Elst, Evans Gichuru, Anisa Omar, Jennifer Kanungi, Zoe Duby, Miriam Midoun, Sylvia Shangani, Susan M. Graham, Adrian D. Smith, Eduard J. Sanders, Don Operario

Community & Environmental Health Faculty Publications

Introduction

Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients.

Methods

Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in …

Knowledge, Perceptions, Discrimination, Health Self-Efficacy, And Risky Behaviors For Hiv/Aids And Its Association With Migration Time Among Mixtec And Zapotec Men Who Migrate, 2012, Sandra Iveth Bejarano

Open Access Theses & Dissertations

BACKGROUND AND SIGNIFICANCE: Historically, there has been a transnational migration flow from Mexico to the United States. There are many reasons for which people make the decision to migrate; the most common ones are unemployment and economic hardship. Currently, Oaxaca is considered one of the states with the highest poverty levels in Mexico. As a result of extreme poverty groups of indigenous people, such as Zapotec and Mixtec, are forced to migrate out of their communities in order to find jobs. Migration has been associated with various health outcomes, including diabetes, high blood pressure, and heart disease as well as …

Bmi At Diagnosis And Its Association With Markers Of Hiv Disease Progression And Cardiovascular Disease Risk., Kelly Deshon Johnson

Theses and Dissertations

Highly active antiretroviral treatment (HAART) has transformed the state of human immunodeficiency virus (HIV) from acute to chronic. As a result, the long-term effect of HAART has caused weight gain among HIV-infected individuals, leading to an increased prevalence of overweight and obesity. Increased Body Mass Index (BMI) has been associated with adverse health outcomes in non-HIV and HIV populations, yet among HIV-infected individuals, a higher BMI at diagnosis offers a slower progression from HIV to AIDS. Pre-HAART, studies reported that obese HIV-infected individuals have higher increases in CD4 count over time. However post-HAART, some report that overweight HIV-infected individuals with …

Tuberculosis Screening And Treatment Outcomes In Zambia, Jennifer Harris

All ETDs from UAB

Zambia is a country in Southern Africa with dual HIV and tuberculosis (TB) epidemics. The annual TB incidence is 444/100,000 and 64% of TB patients are co-infected with HIV. Accurate screening and diagnosis for TB is challenging since it often presents with non-specific signs and symptoms and the available diagnostics are neither sensitive nor specific. Papers one and two of this dissertation focus on the derivation of TB screening rules to more accurately identify high-risk persons in two Zambian populations: inmates and HIV clinic patients. Among inmates, being HIV positive and having a body mass index < 18.5 most strongly predicted HIV disease. Chest pain was also strongly associated, but this may have been a chance finding. For HIV clinic patients, we developed four rules with increasing complexity of clinical tools used for screening. Sensitivity was very high with all rules; the addition of vital signs and pulmonary exam findings to symptom-based screening rules greatly increased the rules' specificity. Furthermore, a rule incorporating pulmonary exam findings performed similarly to a rule with chest radiography suggesting pulmonary exam may be an inexpensive alternative to x-ray. The final paper looks at TB incidence, mortality and intermediate clinical outcomes in a cohort of HIV clinic patients with and without TB during their first 12 months of HIV care. TB incidence was very high during this time period, despite thorough screening at baseline. Mortality was elevated in both culture-confirmed and clinically-diagnosed TB patients, with much of the elevated risk concentrated in TB patients who had culture-confirmed but clinically-unapparent disease. Looking at intermediate outcomes among patients who started anti-retroviral therapy, the change in CD4 cell count was similar for patients with and without TB. TB patients started off with lower mean body weights and hemoglobin concentrations but also showed greater increases over 12 months, thus `catching up' with the TB-negative patients. If these findings are replicable in other cohorts they could have substantial impact on TB screening and diagnostic procedures in resource limited, high burden countries like Zambia.

Host Genetic Factors Associated With Cervical Human Papillomavirus Clearance, Staci Lynn Sudenga

All ETDs from UAB

This dissertation research focuses on how variants in various host genes are associated with clearance of HPV in three longitudinal cohorts from the United States. I first examined the definition of the intermediate phenotype to cervical cancer, HPV persistence and then I incorporated this phenotype in all my three aims by examining variations in xenobiotic metabolism genes in HIV-1 negative and immune-related genes in HIV-1 positive females and how these contribute to HPV infection outcomes. Several significant variants were associated with HPV clearance for the three aims. For the first aim, in ALTS assessing functional variants within xenobiotic metabolism genes …

The Potential For Bridging : Hiv Status Awareness And Risky Sexual Behavior Of Injection Drug Users Who Have Non-Injecting Permanent Partners In Ukraine, Alyona Mazhnaya

Legacy Theses & Dissertations (2009 - 2024)

Abstract