Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study

ABSTRACT Introduction: Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher's exact test, Kruskal-Wallis and ranksum test for comparisons. Results: We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system.

Efectos de la modalidad de presentación de un mensaje de educación entretenimiento de prevención del VIH

Introducción: Se presentan los resultados de un estudio experimental para contrastar el efecto de la modalidad de presentación de un mensaje de educación-entretenimiento (escrito versus audiovisual) en los procesos cognitivos de recepción, en función de la necesidad de cognición. Método: Participaron 109 hombres que tienen sexo con hombres (HSH), distribuidos aleatoriamente en dos condiciones experimentales (mensaje escrito versus mensaje audiovisual). Resultados: Se encontró que la necesidad de cognición moderó el efecto de la modalidad del mensaje sobre la elaboración cognitiva (el mensaje escrito incrementaba la elaboración cognitiva en participantes con baja necesidad de cognición) y sobre la contraargumentación (el formato escrito generó menor contraargumentación en participantes con alta necesidad de cognición), pero no sobre la reactancia. Conclusiones: La efectividad de un mensaje de educación-entretenimiento está determinada tanto por las características del mensaje (la modalidad de presentación) como por las diferencias individuales de las personas (la necesidad de cognición). De manera particular, la necesidad de cognición es una variable relevante para comprender los procesos cognitivos de recepción (la elaboración cognitiva y la contraargumentación) que desempeñan un papel fundamental en el estudio de la persuasión narrativa.

Introduction: This article presents the results of an experimental study that sought to contrast the effect of the entertainment education message (written versus audiovisual) on the cognitive processes of reception, as a function of the need for cognition. Method: 109 MSM participated, randomly distributed, in two experimental conditions (written versus audiovisual message). Results: We found that the need for cognition moderated the effect of message modality on cognitive elaboration and in contra-argumentation, but not on reactance. Data shows that written message increased cognitive elaboration in participants with low need for cognition and generated less contra-argumentation in participants with a higher need for cognition. Conclusions: The effectiveness of an entertainment-education message is determined by both the characteristics of the message (the modality of presentation) and the individual differences of people (the need for cognition). In particular, the need for cognition is a relevant variable for understanding the cognitive processes of reception (cognitive elaboration and contra-argumentation) that play a fundamental role in the study of narrative persuasion.

Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

Justicia distributiva, razón humanitaria y VIH-SIDA

Propósito/Contexto: este artículo analiza algunas injusticias que experimentan quienes viven con VIH-SIDA en la ciudad de Bogotá, Colombia. Metodología/Enfoque: se realiza una aproximación a la Bioética, buscando fundamentar el carácter distributivo de la justicia en relación con el VIH-SIDA; luego, a partir del trabajo académico de Didier Fassin, se aborda la categoría "razón humanitaria" para develar los desafíos que subyacen ante la ausencia de una política específica para el VIH-SIDA. Resultados/Hallazgos: se brindan recomendaciones que permiten transformar los espacios práctico-políticos de participación ciudadana para la toma de decisiones en salud, de tal manera que se asegure justicia política en el marco del VIH-SIDA. Discusión/Conclusiones/Contribuciones: el trabajo hace un aporte a la reflexión social de la bioética en América Latina y el Caribe porque expone un fenómeno moral concreto, el VIH-SIDA, desde un escenario cultural determinado (Bogotá), donde la vida, la dignidad y los derechos humanos están en juego por la ausencia de una política gubernamental que responda apropiadamente a la realidad serológica aquí enunciada.

Purpose/Background: This article analyzes some injustices experienced by those living with HIV-AIDS in the city of Bogotá (Colombia). Methodology/Approach: To this end, it makes an approach to bioethics seeking to support the distributive nature of justice in relation to HIV- AIDS; then, based on Didier Fassin's academic work, he addresses the humanitarian reason category to reveal the challenges that underlie the absence of a specific policy for HIV- AIDS. Results/Findings: It offers recommendations that allow transforming the practical-political spaces of citizen participation for decision-making in health, in such a way that political justice is ensured within the framework of HIV- AIDS. Discussion/Conclusions/Contributions: The work makes a contribution to the social reflection of bioethics in Latin America and the Caribbean because it exposes a concrete moral phenomenon (HIV-AIDS), from a certain cultural scenario (Bogotá), where life, dignity and human rights are at stake due to the absence of a specific government policy that responds appropriately to the serological reality stated here.

Objetivo/Contexto: este artigo analisa algumas das injustiças vivenciadas por pessoas que vivem com HIV-AIDS na cidade de Bogotá, Colômbia. Metodologia/abordagem: é feita uma abordagem da bioética, buscando fundamentar a natureza distributiva da justiça em relação ao HIV-AIDS; em seguida, com base no trabalho acadêmico de Didier Fassin, a categoria de "razão humanitária" é abordada para revelar os desafios subjacentes à ausência de uma política específica para o HIV-AIDS. Resultados/conclusões: São fornecidas recomendações para transformar os espaços práticos-políticos para a participação dos cidadãos na tomada de decisões de saúde a fim de garantir a justiça política no contexto do HIV/AIDS. Discussão/Conclusões/Contribuições: o trabalho contribui para a reflexão social da bioética na América Latina e no Caribe porque expõe um fenômeno moral concreto, o HIV-AIDS, a partir de um cenário cultural específico (Bogotá), onde a vida, a dignidade e os direitos humanos estão em jogo devido à ausência de uma política governamental que responda adequadamente à realidade sorológica aqui enunciada.

Impacto psicosocial del diagnóstico del VIH/sida en la familia / Psychosocial Impact of the HIV/AIDS Diagnosis on the Family

Introducción: En la historia de la humanidad nunca antes una pandemia había causado tanta desolación y tristeza ni destruido a tantas familias con un impacto psicosocial tan alarmante. Objetivo: Determinar el impacto psicosocial del diagnóstico del VIH/sida en las familias de pacientes con ese diagnóstico. Métodos: Se realizó un estudio observacional, descriptivo transversal en las familias de pacientes con el diagnóstico del VIH/sida en el policlínico Armando García Aspurú, de Santiago de Cuba, desde enero del 2018 a enero del 2019. El universo estuvo constituido por las 26 familias que tuvieran al menos un miembro enfermo. Resultados: Las vías más frecuentes de información por las que la familia se enteró fueron por el mismo paciente, seguido de la información por los servicios de salud. La reacción de la familia ante la noticia fue la esperanza de que no fuera cierto, seguido por la depresión y la angustia. En las creencias que manifiesta la familia sobre el VIH prevalecieron las opiniones de que la enfermedad la adquieren personas de vida desorganizada. Sobre las pérdidas laborales, académicas y/o sociales sufridas por la aparición del VIH, 84,6 por ciento refirió rechazo a nivel de la pareja. Ante la estigmatización, la familia determina no hablar de la enfermedad por miedo al rechazo y sensación de vergüenza. Conclusiones: La infección por VIH/sida trasciende con multiplicidad de consecuencias en variados niveles. Los grandes impactos se relacionan con la familia, donde la estigmatización juega un papel fundamental como intensificador de la conducta familiar y social(AU)

Introduction: Never before in the history of humankind had a pandemic caused so much desolation and sadness or destroyed so many families with such an alarming psychosocial impact. Objective: To determine the psychosocial impact of the HIV/AIDS diagnosis on the families of patients with this diagnosis. Methods: An observational, descriptive and cross-sectional study was carried out in the families of patients with the HIV/AIDS diagnosis in the Armando García Aspurú polyclinic, of Santiago de Cuba, from January 2018 to January 2019. The study universe was made up of the 26 families with at least one sick member. Results: The most frequent ways of information by which the family found out were from the patient herself/himself, followed by information from the health services. The family's reaction to the news was hope that it was not true, followed by depression and anguish. In the beliefs expressed by the family about HIV, there was a prevalence of opinions related to the idea that the disease is acquired by people with a disorganized life. Regarding occupational, academic or social losses suffered due to the appearance of HIV, 84.6 percent reported rejection from her/his couple. Before stigmatization, the family determines not to talk about the disease, due to fear of rejection and the feeling of shame. Conclusions: HIV/AIDS infection transcends with a multiplicity of consequences at various levels. The major impacts are related to the family, where stigmatization plays a fundamental role as an intensifier of family and social behavior(AU)

Vozes silenciadas: vivências de pessoas que convivem com HIV na província de Gaza, Moçambique / Silenced voices: experiences of people living with HIV in the province of Gaza, Mozambique / Voces silenciadas: experiencias de personas que viven con el VIH en la provincia de Gaza, Mozambique

OBJETIVO: No mundo, cerca de 16 milhões de mulheres vivem com HIV, muitas delas em idade reprodutiva. Esses níveis de infecção e as taxas de transmissão vertical ainda trazem grandes preocupações, devido à pouca intervenção terapêutica precoce em muitos países africanos. Em Moçambique, país da África Subsaariana, os índices de prevalência do HIV são de 13,2%, colocando o país em segundo lugar na conta de novas infecções, atrás apenas da África do Sul. OBJETIVO: Conhecer as experiências e as principais dificuldades vivenciadas pelas gestantes ou lactantes soropositivas e seus parceiros sexuais no contexto específico. METODOLOGIA: Estudo qualitativo realizado em Chókwè na província de Gaza- Moçambique. Foram realizadas entrevistas semiestruturadas com mulheres gestantes ou lactantes que vivem com HIV, com seus parceiros sexuais e com profissionais de saúde. Foram realizados grupos focais com mães mentoras e entrevista em grupo com pais mentores, as quais ocorreram no segundo semestre de 2021. As entrevistas e os encontros foram gravados com gravador de voz e transcritas na íntegra. As informações passaram pelo processo de análise temática. RESULTADOS: Participaram do estudo dez mulheres gestantes ou lactantes soropositivas e um parceiro sexual; treze mães mentoras e dois pais mentores; duas enfermeiras de Saúde Materno Infantil e uma psicóloga. Os achados revelam que as participantes associam o diagnóstico do HIV ao teste de gravidez ou ao parto, e o período da gestação e da amamentação é marcado pelo medo de infectar o filho com o vírus. As mulheres escondem seu estado sorológico do marido, da família e da comunidade por medo das consequências relacionadas com normas sociais rígidas e interferência de fatores culturais. Os resultados dos profissionais de saúde trouxeram aspectos similares aos das mulheres vivendo com HIV, entretanto, ressaltam a falta de profissionais para oferecer atendimento de qualidade. Constatou-se que na unidade de saúde e na comunidade utilizam palestras como única estratégia de educação em saúde, apesar da pouca eficácia. CONCLUSÕES: Observou-se que ainda existem muitas barreiras para prevenção da transmissão vertical em Moçambique, em especial, a qualidade do aconselhamento e dificuldades de acesso ao serviço, seja por falta de recursos ou pelas normas sociais e familiares que não reconhecem a autonomia da mulher. É necessario apoiar as mães que não desejam amamentar e aquelas que tem maior vulnerabilidade socioeconômica. Recomenda-se maior investimento nas estratégias de apoio psicossocial e envolvimento comunitário, utilizando alternativas como a Terapia Comunitária Integrativa (TCI) e Educação Popular. Sugere-se o envolvimento de lideranças comunitárias no processo de desenvolvimento de um programa de intervenção e promoção de saúde mental para mulheres gestantes ou lactantes soropositivas.

OBJECTIVE: In the world, about 16 million women are living with HIV, many of them in reproductive age. These levels of infection and vertical transmission rates are still of great concern, due to the lack of early therapeutic intervention in many African countries. In Mozambique, a country in sub-Saharan Africa, HIV prevalence rates are 13.2%, placing the country in second place in terms of new infections, behind only South Africa. OBJECTIVE: To know the experiences and the main difficulties experienced by HIV-positive pregnant or lactating women and their sexual partners in the specific context. METHODOLOGY: Qualitative study carried out in Chókwè in the province of Gaza - Mozambique. Semi-structured interviews were conducted with pregnant or lactating women living with HIV, with their sexual partners and with health professionals. Focus groups were held with mentor mothers and group interviews with mentor fathers, which took place in the second half of 2021. The interviews and meetings were recorded with a voice recorder and transcribed in full. The information went through the thematic analysis process. RESULTS: Ten seropositive pregnant or lactating women and one sexual partner participated in the study; thirteen mentor mothers and two mentor fathers; two Maternal and Child Health nurses and a psychologist. The findings reveal that the participants associate the HIV diagnosis with the pregnancy test or childbirth, and the period of pregnancy and breastfeeding is marked by the fear of infecting the child with the virus. Women hide their serological status from their husband, family and community for fear of consequences related to rigid social norms and interference of cultural factors. The results of health professionals brought similar aspects to those of women living with HIV, however, they highlight the lack of professionals to offer quality care. It was found that the health unit and the community use lectures as the only health education strategy, despite its low effectiveness. CONCLUSIONS: It was observed that there are still many barriers to preventing mother-to-child transmission in Mozambique, in particular, the quality of counseling and difficulties in accessing the service, whether due to lack of resources or social and family norms that do not recognize women's autonomy. . It is necessary to support mothers who do not wish to breastfeed and those who are more socioeconomically vulnerable. Greater investment in psychosocial support and community involvement strategies is recommended, using alternatives such as Integrative Community Therapy (ICT) and Popular Education. It is suggested the involvement of community leaders in the process of developing a program of intervention and promotion of mental health for seropositive pregnant or lactating women.

OBJETIVO: En el mundo, alrededor de 16 millones de mujeres viven con el VIH, muchas de ellas en edad reproductiva. Estos niveles de infección y tasas de transmisión vertical siguen siendo motivo de gran preocupación, debido a la falta de una intervención terapéutica temprana en muchos países africanos. En Mozambique, un país del África subsahariana, las tasas de prevalencia del VIH son del 13,2%, lo que coloca al país en el segundo lugar en términos de nuevas infecciones, solo por detrás de Sudáfrica. OBJETIVO: Conocer las vivencias y las principales dificultades vividas por mujeres embarazadas o lactantes seropositivas y sus parejas sexuales en el contexto específico. METODOLOGÍA: Estudio cualitativo realizado en Chókwè en la provincia de Gaza-Mozambique. Se realizaron entrevistas semiestructuradas con mujeres embarazadas o lactantes que viven con el VIH, con sus parejas sexuales y con profesionales de la salud. Se realizaron grupos focales con madres mentoras y entrevistas grupales con padres mentores, que se realizaron en el segundo semestre de 2021. Las entrevistas y encuentros fueron grabados con una grabadora de voz y transcritas en su totalidad. La información pasó por el proceso de análisis temático. RESULTADOS: Participaron del estudio diez mujeres embarazadas o lactantes seropositivas y una pareja sexual; trece madres mentoras y dos padres mentores; dos enfermeras de Salud Materno Infantil y una psicóloga. Los hallazgos revelan que las participantes asocian el diagnóstico de VIH con la prueba de embarazo o el parto, y el período de embarazo y lactancia está marcado por el miedo a contagiar al niño con el virus. Las mujeres ocultan su estado serológico a su esposo, familia y comunidad por temor a las consecuencias relacionadas con las normas sociales rígidas y la interferencia de factores culturales. Los resultados de los profesionales de la salud trajeron aspectos similares a los de las mujeres que viven con el VIH, sin embargo, destacan la falta de profesionales para ofrecer una atención de calidad. Se constató que la unidad de salud y la comunidad utilizan las charlas como única estrategia de educación en salud, a pesar de su baja efectividad. CONCLUSIONES: Se observó que todavía existen muchas barreras para prevenir la transmisión maternoinfantil en Mozambique, en particular, la calidad de la consejería y las dificultades para acceder al servicio, ya sea por falta de recursos o por normas sociales y familiares que no reconocer la autonomía de la mujer. Es necesario apoyar a las madres que no desean amamantar ya aquellas que son más vulnerables socioeconómicamente. Se recomienda una mayor inversión en estrategias de apoyo psicosocial y participación comunitaria, utilizando alternativas como la Terapia Comunitaria Integrativa (TIC) y la Educación Popular. Se sugiere involucrar a los líderes comunitarios en el proceso de desarrollo de un programa de intervención y promoción de la salud mental para mujeres embarazadas o lactantes seropositivas.

Seroprevalencia y factores de riesgo de Toxoplasma gondii en Personas que Viven con VIH/SIDA (PVVS) en el departamento de Cochabamba, Bolivia

Objetivo: determinar la seroprevalencia y los factores de riesgo de infección crónica por T. gondii en personas que viven con VIH/SIDA (PVVS) en el departamento de Cochabamba. Metodología: estudio observacional-descriptivo de corte transversal. Se emplearon 325 muestras de plasma/suero proveniente de pacientes que asistieron a LABIMED entre Julio y agosto del año 2016. La recopilación de datos se realizó en un formulario sociodemográfico. Se emplearon ensayos serológicos cualitativos de Hemaglutinación Indirecta (HAI) e Inmunoflorecencia Indirecta (IFI), este último para confirmación de casos positivos. Adicionalmente se realizó el recuento de Linfocitos T CD4+ por citómetria de flujo para determinar el estado inmunológico de los pacientes que sirve de guía en el tratamiento clínico. Los datos fueron analizados con el programa/software SPSS versión 20. Resultados: la seroprevalencia global de infección crónica por T. gondii en la población de estudio fue del 40%. El consumo de carne poco cocida (OR: 2,85; 95%IC: 1,56-5,22) y la actividad de agricultura/jardinería (OR: 1,7; IC del 95%: 1,07-2,70) fueron factores de riesgo para adquirir la infección crónica por T. gondii. El 45.6% de las PVVS positivos para toxoplasmosis tiene un recuento de Linfocitos T CD4+ < a 200 células/mm3, equivalente a una inmunodeficiencia severa. Conclusión: El estudio muestra una seroprevalencia significativa de infección crónica por T. gondii, además de presentar una inmunodeficiencia severa en PVVS

Objective: To determine the seroprevalence and risk factors for chronic infection by T. gondii in people living with HIV/AIDS (PLHA) in the department of Cochabamba. Methods: observational-descriptive cross-sectional study. 325 samples (n=325) of plasma/serum from patients who attended LABIMED between the months of July to August of the year 2016 were used. Data (age, gender and risk factors) were collected in the sociodemographic form. Qualitative serological tests of Indirect Hemaglutination (HAI) and Indirect Immunoflorescence (IFI) were used the latter for confirmation of positive cases. Additionally, the count of CD4+ T lymphocytes was performed by flow cytometry to determine the immunological status of the patients that serves as a guide in clinical treatment. The data were analyzed with the program/software SPSS version 20. Results: the global seroprevalence of chronic infection by T. gondii in the study population was 40%. Consumption of undercooked meat (AOR: 2.85; 95% CI: 1,56-5,22) and farming/gardening activity (AOR: 1,7; 95% CI: 1,07-2,70) were risk factors for chronic T. gondii infection. 45,6% of people living with the HIV/AIDS virus who are positive for toxoplasmosis have a CD4+ T lymphocyte count <200 cells/ml, equivalent to severe immunodeficiency. Conclusions: the study shows a significant seroprevalence of chronic infection by T. gondii, as well as presenting a high severe immunodeficiency in patients with the HIV/AIDS virus.

Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro, Brazil

ABSTRACT Background: Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. Methods: We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. Results: Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. Conclusion: We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.

Por uma decolonização do HIV e interseccionalização das respostas à aids / For an HIV Decolonization and intersectionalization of AIDS responses

Resumo Com o advento da aids, uma articulação discursiva jornalística-biomédica-midiática contribuiu para acentuar a estigmatização sobre determinadas populações implicando uma colonização do HIV em que o vírus atingiria algumas pessoas enquanto outras estariam livres. Através de uma Análise do Discurso Crítica (ADC) realizou-se uma análise de retórica de algumas rupturas e continuidades discursivas nas áreas acadêmica-jurídica-midiática a partir de uma revisão narrativa de literatura (RNL). Os referenciais teóricos, éticos e políticos dos estudos decoloniais foram utilizados para a presente análise por entenderem que a colonialidade se reproduz em uma tripla dimensão: a do poder, do saber e do ser. Estes estudos foram articulados à uma crítica interseccional em que múltiplas formas de discriminação podem se sobrepor e serem experimentadas em intersecção tendo a contextualização sobre o que representou a aids, no Haiti, como eixo central comparativa para análise. Interessou-nos pensar a contribuição dessas perspectivas para lançar algumas provocações às respostas ao HIV/aids numa tentativa de superação de uma visão reducionista propagada por discursos morais e criminalizantes que, ao se posicionarem através de uma suposta neutralidade, dissimulam a interseccionalidade de gênero, classe, raça e sexualidade, levantando barreiras para as políticas e estratégias de promoção da saúde e prevenção ao HIV/aids.

Abstract With the advent of AIDS, a discursive journalistic-biomedical-mediatic articulation contributed to accentuate stigmatization on certain populations, implying a colonization of HIV in which the virus would reach some people while others would be free. Through a Critical Discourse Analysis (CDA), a critical literature review was carried out in some academic-legal-media areas from a narrative literature review (NLR). The theoretical, ethical and political references of decolonial studies were used for the present analysis because they understand that coloniality is reproduced in a triple dimension: that of power, knowledge and being. These studies were linked to an intersectional criticism in which multiple forms of discrimination can overlap and be experienced in intersection having the contextualization about what aids represented, in Haiti, as a comparative central axis for analysis. We were interested in thinking about the contribution of these perspectives to launch some provocations to the responses to HIV/AIDS in an attempt to overcome a reductionist view propagated by moral and criminalizing discourses that, by positioning themselves through supposed neutrality, conceal the intersectionality of gender, class, race and sexuality, raising barriers to health promotion and HIV/AIDS prevention policies and strategies.

"Tô tranquila, estou com meus exames indetectáveis": as relações afetivo-sexuais de mulheres jovens vivendo com HIV com carga viral indetectável / "I'm calm, I have my undetectable exams": the affective-sexual relationships of young women living with HIV with an undetectable viral load / "Estoy tranquila, tengo mis exámenes de laboratorio indetectables": las relaciones afectivo-sexuales de mujeres jovenes viviendo con VIH con carga viral indetectable

Resumo Neste artigo, discutimos de que modo o discurso biomédico sobre carga viral indetectável (re)organiza as trajetórias afetivas e sexuais de mulheres jovens vivendo com HIV. Realizamos entrevistas semiestruturadas com cinco jovens vivendo com HIV/aids, com idade entre 18 e 30 anos, tanto pela internet, como em um serviço de saúde especializado (SAE) em Salvador-Ba, no período entre 2015 e 2017. As interações online aconteceram através do Whatsapp e Facebook. As jovens vivenciam a necessidade de negociar o prazer e a prevenção. Posicionam-se como sujeitos de "risco" e adotam a noção de carga viral indetectável como forma de sentirem-se seguras na prevenção. Os novos discursos biomédicos são incorporados em seus cotidianos, e os sentimentos de medo, rejeição e a "possibilidade" de "perigo" para o outro (soronegativo) contribuem para a reorganização de suas vidas e de seus relacionamentos.

Abstract In this article, we discuss how the biomedical discourse of undetectable viral load reorganises the affective and sexual trajectories of young women living with HIV. We conducted semi-structured interviews with five young women living with HIV/AIDS, aged between 18 and 30 yo, on the internet and at a specialized health service (SAE) in Salvador-Ba, between 2015 and 2017. The online interactions occurred through Whatsapp and Facebook. Young women experience the need to negotiate pleasure and prevention. They position herself as at "risk" subjects and adopt the notion of undetectable viral load as a way to feel safe in prevention. The new biomedical discourses are incorporated into their daily lives, and the fear, rejection and "possibility" of "danger" for another (seronegative) contributed to the reorganization of their lives and relationships.

Resumen En este artículo, discutimos cómo el discurso biomédico sobre la carga viral indetectable (re)organiza las trayectorias afectivas y sexuales de las mujeres jovens que viven con el VIH. Realizamos entrevistas semiestructuradas con cinco jovenes que viven con VIH/ SIDA, con edades entre 18 y 30 años, tanto en línea como en un servicio especializado de salud (SAE) en Salvador-Ba, entre 2015 y 2017. Las interacciones en línea ocorrieron través de Whatsapp y Facebook. Las mujeres jóvenes experimentan la necesidad de negociar el placer y la prevención. Se posicionan como sujetos de "riesgo" y adoptan la noción de una carga viral indetectable como forma de sentirse seguras en la prevención. Los nuevos discursos biomédicos se incorporan a su cotidianidad, y los sentimientos de miedo, rechazo y "posibilidad" de "peligro" para el otro (seronegativo) contribuyen a la reorganización de sus vidas y relaciones.

"A Ballroom é um arquivo de pessoas negras que viveram a epidemia de aids": narrativas sobre o arquivo negro da prevenção / "The Ballroom is an archive of black people living an Aids epidemic": narratives about the black archive of prevention

Resumo O objetivo deste artigo é apresentar as narrativas da Comunidade Ballroom de São Paulo, para situar como as práticas de prevenção combinada ao HIV se dão em pessoas negras LGBTQIAPN+, identificando como as estratégias se conformam, com que elementos e influências, ausências e restrições. Trata-se de uma pesquisa qualitativa no campo da Saúde Coletiva que utiliza entrevistas semiestruturadas com lideranças dessa comunidade para reconstruir as narrativas sobre HIV, abrindo um arquivo negro sobre prevenção. Tal perspectiva, alinhado ao trabalho de Saidiya Hartman pela perspectiva do pensamento negro radical, debruça-se sobre as histórias que não foram e ainda serão contadas: uma forma de imaginar radicalmente o futuro da negridade. Enquanto força analítica, o arquivo negro da prevenção tem a função de reparação, ampliando narrativas pela ótica racial, ocluindo uma história única da epidemia de HIV/Aids.

Abstract This article aims to present the narratives of the Ballroom Community in São Paulo to situate how combined HIV prevention practices are carried out in these people, identifying how the strategies conform, with what elements and influences, absences and restrictions. This is a qualitative research in the field of Collective Health that uses semi-structured interviews with Ballroom leaders to reconstruct narratives about HIV, opening a black archive on prevention. Such a perspective, in line with Saidiya Hartman's work from the perspective of radical black thought, focuses on the stories that have not been and will still be told: a way of radically imagining the future of blackness. As an analytical force, the black archive has the function of reparation, expanding narratives from a racial perspective, occluding a unique history of the HIV/Aids epidemic.

Sobre o presente e o futuro da epidemia HIV/Aids: a prevenção combinada em questão / On the present and future of the HIV/Aids epidemic: combination prevention in question

Resumo Muito se discute sobre o atual estágio da epidemia de HIV/Aids no Brasil. Dados oficiais do Ministério da Saúde apontam para estabilização da epidemia; no entanto, pesquisadores e organismos internacionais apontam para sua reemergência. Em nível mundial, a ONU afirma ser possível erradicar a epidemia até 2030. Neste artigo apresentamos o trabalho de tradução de práticas que abrange diálogos entre as narrativas oficial, global e nacional. Foram adotadas duas estratégias metodológicas centrais: entrevistas e pesquisa documental. A análise e discussão dos resultados foram realizadas com base nos procedimentos sociológicos: sociologia das emergências e ecologia de saberes, referenciados em Boaventura de Sousa Santos, para identificar o que emerge na diversidade de experiências, globais, nacionais e locais, como resposta à epidemia de HIV/Aids, com o recorte sobre as análises e reflexões sobre a prevenção combinada. Identificamos que a prevenção foi a etapa mais negligenciada do cuidado, e que há divergências entre as expectativas das instituições e dos atores locais sobre as possibilidades de erradicação da epidemia. Concluímos pela insuficiência do modelo de Prevenção Combinada proposto pelo Ministério da Saúde no diagrama "Mandala de Prevenção Combinada" e propomos uma representação gráfica alternativa, a partir das possibilidades que emergiram do trabalho de tradução.

Abstract Much is discussed about the current stage of the HIV/Aids epidemic in Brazil. Official data from the Ministry of Health points to the stabilization of the epidemic; however, researchers and international organizations point to its reemergence. At a global level, the UN claims that it is possible to eradicate the epidemics by 2030. In this article, we present the work of translating practices that encompasses dialogue between the official, global and national narratives. Two central methodological strategies were adopted: interviews and documentary research. The analysis and discussion of the results were carried out based on sociological procedures: sociology of emergencies and ecology of knowledge, referenced in Boaventura de Sousa Santos, to identify what emerges in the diversity of experiences, global, national and local, as a response to the epidemics of HIV/Aids, with a focus on analysis and reflections on combined prevention. We identified that prevention was the most neglected stage of care, and that there are divergences between the expectations of institutions and local actors about the possibilities of eradicating the epidemics. We conclude that the Combined Prevention model proposed by the Ministry of Health in the "Combined Prevention Mandala" diagram is insufficient and we propose an alternative graphic representation, based on the possibilities that emerged from the translation work.Resumo: Muito se discute sobre o atual estágio da epidemia de HIV/Aids no Brasil. Dados oficiais do Ministério da Saúde apontam para estabilização da epidemia; no entanto, pesquisadores e organismos internacionais apontam para sua reemergência. Em nível mundial, a ONU afirma ser possível erradicar a epidemia até 2030. Neste artigo apresentamos o trabalho de tradução de práticas que abrange diálogos entre as narrativas oficial, global e nacional. Foram adotadas duas estratégias metodológicas centrais: entrevistas e pesquisa documental. A análise e discussão dos resultados foram realizadas com base nos procedimentos sociológicos: sociologia das emergências e ecologia de saberes, referenciados em Boaventura de Sousa Santos, para identificar o que emerge na diversidade de experiências, globais, nacionais e locais, como resposta à epidemia de HIV/Aids, com o recorte sobre as análises e reflexões sobre a prevenção combinada. Identificamos que a prevenção foi a etapa mais negligenciada do cuidado, e que há divergências entre as expectativas das instituições e dos atores locais sobre as possibilidades de erradicação da epidemia. Concluímos pela insuficiência do modelo de Prevenção Combinada proposto pelo Ministério da Saúde no diagrama "Mandala de Prevenção Combinada" e propomos uma representação gráfica alternativa, a partir das possibilidades que emergiram do trabalho de tradução.

Uptake of HIV voluntary counseling and testing and associated factors among students in the Higher Institutions of Learning in Kigali, Rwanda: A cross-sectional study

Background HIV/AIDS remains a significant global public health challenge with youth bearing the brunt of the burden. One essential method for preventing and accessing AIDS care is through Voluntary Counselling and Testing (VCT). Regardless of this, youth population continues to have low utilization of VCT services. Objective To assess the uptake of HIV VCT services and associated factors among university students in Kigali. Methods A cross-sectional study among 374 students recruited using stratified sampling was conducted. A structured questionnaire was used to gather information. A multivariable logistic regression analysis was used to assess the independent factors associated with VCT uptake. Results The prevalence of VCT uptake was 59.9%. The logistic regression revealed that being Catholic (AOR = 11.99, 95%CI: 5.44-26.41) and Moslem (AOR = 37.34, 95%CI: 2.67-128.36) compared to Protestant, as well as availability of VCT services (AOR = 5.15, 95%CI: 3.11 - 8.541) favored the use VCT. On the other hand, being aged 20 to 24 years (AOR = 0.112, 95%CI: 0.04 - 0.29) had low likelihood of using VCT than those more than 24 years of age. Conclusion VCT uptake was significantly positively associated with religion and VCT services availability, and negatively associated with age 20-24 years in the campus. Therefore, targeted actions of disseminating information on benefits of VCT and enhancing accessibility of VCT services among students are necessary for the increased VCT uptake to be attained.

Profil hématologique des patients VIH/SIDA à l'hôpital régional de Nzérékoré / Hematological profi le of HIV/AIDS patients at the Nzérékoré Regional Hospital

Introduction. Le VIH/SIDA est à l'origine d'un grand nombre de manifestations biologiques à titre de troubles hématologiques graves pouvant atteindre toutes les lignées sanguines. L'objectif de cette étude était de mettre en évidence les anomalies de l'hémogramme chez les PVVIH à Nzérékoré afi n de contribuer à une meilleure prise en charge. Méthodes. Il s'agissait d'une étude prospective de type descriptif à visée analytique d'une durée de 6 mois allant du 25 février au 25 août 2021 sur les PVVIH dans le service de médecine générale de l'Hôpital régional de Nzérékoré. Résultats. Durant notre étude, la prévalence hospitalière du VIH au service de médecine générale de l'hôpital régional de Nzérékoré était de 20,34%. L'âge moyen était de 36,98 ans, le sexe féminin prédominait avec un sex-ratio de 0,74 ; majoritairement mariés (53,33%) et ménagères (41,66%). Les anomalies hématologiques les plus représentées étaient l'anémie (95%) et la lymphopénie (77,5) dont la majorité était au stade III et IV. Conclusion. Le VIH/SIDA reste un problème de santé publique. Son évolution est liée à des anomalies aussi cliniques que biologique imposant un suivi régulier et adéquat

Introduction. HIV/AIDS is the cause of a large number of biological manifestations as serious hematological disorders that can affect all blood lines. The objective of this study was to highlight blood count abnormalities in PLWHA in Nzérékoré in order to contribute to better management. Methods. This was a prospective descriptive study with an analytical aim, lasting 6 months from February 25 to August 25, 2021, on PLHIV in the general medicine department of the Nzérékoré regional hospital.. Results. During our study, the hospital prevalence of HIV in the general medicine department of the regional hospital of Nzérékoré was 20.34%. The average age was 36.98 years, the female sex predominated with a sex ratio of 0.74; the majority were married (53.33%) and housewives (41.66%). The most common hematological abnormalities were anemia (95%) and lymphopenia (77.5), the majority of which were stage III and IV. Conclusion. HIV/AIDS remains a public health problem. Its evolution is linked to both clinical and biological abnormalities requiring regular and adequate follow-up.

Assessment of COVID-19 vaccine hesitancy among people living with HIV/AIDS: a single-centered study

Introduction: as the coronavirus disease 2019 (COVID-19) vaccines are distributed and administered globally, hesitancy towards the vaccine hinders the immunisation of a significant number of vulnerable populations, such as people living with HIV/AIDS. Hence, this study aims to assess COVID-19 vaccine hesitancy among people living with HIV/AIDS (PLHIV) attending clinicaloutpatient follow-up at State Specialist Hospital Maiduguri (SSHM), Borno State, Nigeria. Methods: a hospital-based cross-sectional study design was conducted to assess COVID-19 vaccine hesitancy among 344 PLHIV receiving antiretroviral therapy (ART) at the United States President´s Emergency Plan for AIDS (PEPFAR) clinic in SSHM from 4 th January to 25th February 2022. Data were collected using a structured and pretested interviewer-administered questionnaire. The results were presented using frequencies and percentages. The factors that are associated with COVID-19 vaccine hesitancy were identified using the Chi-square statistical test. Results: among the 344 respondents of the study, only 88 (26.6%) received the COVID-19 vaccine. Out of the 256 respondents that did not receive the vaccine, only 10.5% (27/256) are willing to be vaccinated, while the majority; 57.8% (148/256) are not willing to be vaccinated and 31.7% (81/256) of the respondents are uncertain, thus resulting in a hesitation rate of 89.45%. There was no statistically significant association between COVID-19 vaccine hesitancy and the study´s independent variables; where p-value is greater than 0.05. Conclusion: hesitancy towards COVID-19 vaccine is high among PLHIV and there is no any statistically significant association between COVID-19 vaccine hesitancy and the independent variables of the study where p-value is greater than 0.05. Hence, it is necessary to develop targeted strategies to boost vaccine uptake among this vulnerable population.

Adolescents infectés par le VIH au cours de la transition des soins pédiatriques aux soins pour adultes dans un hôpital de référence à Abidjan (Côte d'Ivoire). Etudes des caractéristiques cliniques / Hiv-infected adolescents during the transition from paediatric to adult care in a referral hospital in abidjan (cote d'ivoire). Clinical characteristics study

Les adolescents vivant avec le VIH ont de moins bons résultats que les adultes en matière de soins, en particulier lors de la transition entre les soins pédiatriques et les soins aux adultes. L' Objectif était de décrire les particularités socio familiales, cliniques, para cliniques et thérapeutiques des adolescents au cours de cette phase charnière de leur prise en charge. Méthodes. Il s'agissait d'une étude rétrospective à visée descriptive qui s'est déroulé du 1er au 31 mars 2020 (1 mois) sur la cohorte d'enfants vivant avec le VIH suivi au CHU de Cocody (Abidjan) de novembre 2005 à mars 2020 (15 ans). Résultats. Trente-huit adolescents en phase de transition ont été inclus. L'âge moyen était de 17 ans avec des extrêmes de 15 et 20 ans. Le sex ratio était de 1,37. La majorité des enfants étaient scolarisé (81,57%) avec un retard scolaire chez plus de la moitié (58%). Près de la moitié des cas était orphelin d'un ou des 2 parents (47,4%). Les conditions socioéconomiques étaient modestes ou défavorable (73,7%). Près de la moitié des adolescents était suivi depuis plus de 10 ans (42%). Un surpoids a été retrouvé dans 21% des cas. On notait un échec immunologique dans 10,5% des cas et un échec virologique dans un tiers des cas (31,6%). L'observance était moyenne ou mauvaise chez près de la moitié des adolescents (44,7%). La majorité des adolescents (94,7%) n'avait jamais eu de contact avec un médecin d'adulte. Conclusion. La transition des soins pédiatriques aux soins pour adulte est un processus au cours duquel l'adolescent est confronté à des diffi cultés socio familiale et scolaire, a l'inobservance avec échec thérapeutique qui doit être repéré de façon précoce. Le succès de cette étape nécessite également le rapprochement entre pédiatres et médecins d'adultes pour une prise en charge optimal des patients.

Trends in incidence of HIV/AIDS in China from 1990 to 2019 based on an age-period-cohort mode / 预防医学

Objective@#To investigate the trends in incidence of HIV/AIDS in China from 1990 to 2019 and to examine the effect of age, period and cohort on the incidence of HIV/AIDS, so as to provide insights into the improvements of the HIV/AIDS control measures. @*Methods@#Data pertaining to incidence of HIV/AIDS in China from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 (GBD 2019) datasets, and the trends in incidence of HIV/AIDS in China from 1990 to 2019 was analyzed with annual percentage change (APC) and average annual percentage change (AAPC) using a jointpoint regression model. The effects of age, period and cohort on the incidence of HIV/AIDS in China were examined with an age-period-cohort model. @*Results@#The age-standardized incidence of HIV/AIDS appeared an overall tendency towards a rise in China from 1990 (0.80/105) to 2019 (2.21/105) (AAPC=3.209%, P<0.05), and the incidence of HIV/AIDS showed a tendency towards a rise from 1990 to 1997 (AAPC=9.044%, P<0.05) and from 1997 to 2003 (AAPC=17.598%, P<0.05), a decline from 2006 to 2014 (AAPC=-8.412%, P<0.05) and remained relatively stable from 2003 to 2006 and from 2014 to 2019 (both P>0.05). The incidence of HIV/AIDS appeared a tendency towards a rise with age, and peaked among patients at ages of 25 to 29 years (4.93/105) and 75 to 79 years (7.38/105). The risk of HIV/AIDS appeared a tendency towards a rise followed by a decline with time, and a reduced risk of HIV/AIDS was found from 1990 to 1994 (RR=0.297), from 1995 to 1999 (RR=0.523), from 2005 to 2009 (RR=0.737), from 2010 to 2014 (RR=0.412) and from 2015 to 2019 (RR=0.351) in relative to the period from 2000 to 2004. The risk of HIV/AIDS appeared a tendency towards a rise with the cohort, and a higher risk of HIV/AIDS was found in the 1930-1934 cohort (RR=1.880) and 2000-2004 cohort (RR=2.978) in relative to the 1955-1959 cohort. @*Conclusions@#The incidence of HIV/AIDS appeared a tendency towards a rise followed by a decline in China from 1990 to 2019, and remained at a low level since 2014. The adolescents and elderly were high-risk groups of HIV/AIDS. A variety of health education interventions and intensified active HIV/AIDS screening are recommended.

Immunological CD4+ T-cell recovery and prognostic influencing factors in elderly HIV/AIDS patients of different genders after antiviral therapy / 中国热带医学

@#Objective　To investigate the prognostic influencing factors and recovery of CD4+ T lymphocytes in elderly HIV/AIDS patients after antiviral therapy by analyzing basic data and clinical follow-up data of elderly HIV/AIDS patients. Methods　The clinical data of 3 618 elderly AIDS patients aged ≥50 yeas who received antiretroviral therapy (ART) at HIV ART sites in Liuzhou City from 2005-2015 were collected. The data, including basic information, CD4+ T cell count, WHO clinical stage, infection route and follow-up, were retrospectively analyzed. Kaplan-Meier method was used to compare the differences in patient survival, multivariate Cox regression to analyze the independent influencing factors influencing the risk of death, and to compare the recovery of CD4+ T cell counts during follow-up of patients of different genders. Results　During the follow-up period, the 5-year cumulative survival rate up to the observation endpoint was 0.82 (female) and 0.66 (male). Multivariate logistic regression analysis showed that the risk factors affecting the effect of antiviral treatment were age (OR=1.909, 95%CI:1.474-2.464, P<0.001), body mass index (BMI) (OR=0.744, 95%CI: 0.574-0.965, P=0.026), opportunistic infections (OI) (OR=1.223, 95%CI:1.028-1.454, P=0.023), gender (OR=0.692, 95%CI:0.503-0.952, P=0.023) and baseline CD4+ T lymphocytes count (OR=0.563, 95%CI:0.429-0.739, P<0.001). Recovery of CD4+ T lymphocyte counts showed when baseline CD4+ T lymphocyte counts were less than 200 cells/mm3, older women with HIV/AIDS had higher CD4+ T lymphocytes than men at all times of ART treatment (P<0.05). Conclusions　Older women have a higher survival rate than older men after five years of antiviral therapy. Age, BMI, gender, OI and baseline CD4+T lymphocyte count may be important indicators that affect the survival of elderly HIV/AIDS patients. Older women showed better recovery of CD4+ T lymphocytes than older men during the 4-year follow-up period after ART.

Demand and influencing factors of non-occupational post-exposure prophylaxis for AIDS among men who have sex with men in Wuhan / 中国热带医学

@#Abstract: Objective　To investigate the drug demand and related influencing factors of AIDS non-occupational post-exposure prophylaxis (nPEP) among men who have sex with men (MSM) in Wuhan, and to provide a scientific basis for the development of subsequent intervention policies for MSM. Methods　With the assistance of social organizations in Wuhan, MSM was recruited by the snowball method to carry out an online questionnaire survey to collect information on demographics, AIDS-related knowledge, high-risk behaviors, and the need for nPEP medication. The χ2 test and unconditional Logistic regression were used to analyze the related factors of the demand for nPEP medication. Results　A total of 308 valid subjects were included in this study, with predominantly 18-29 years old (78.57%, 242/308). The self-reported sexual orientation was mainly homosexuality (82.47%, 254/308), and the awareness rate of AIDS knowledge was high (89.29%, 275/308). Among the survey respondents, 35.06% (108/308) did not know the situation of HIV infection among MSM population in Wuhan; 55.19% (170/308) had two or more same-sex sexual partners in the last six months; 90.91% (280/308) had heard of nPEP before participating in this survey. After passing nPEP and informing the protective effect of nPEP, 59.42% (183/308) of them needed nPEP. After HIV exposure, 73.38% (226/308) were willing to spend money to buy nPEP drugs, and 88.64% (273/308) were willing to take nPEP drugs because of the known side effects. Logistic regression analysis showed that in the last six months, the needs for taking nPEP medication in those who had 2 or more same-sex sexual partners (OR=2.121, 95%CI: 1.329-3.386) and who had received peer education (OR=1.740, 95%CI: 1.088-2.781) were higher than those of those who had a same-sex sexual partner in the last six months and who had not received peer education. Conclusions　The MSM population in Wuhan has a great demand for nPEP drugs, and peer education is an important way to carry out nPEP publicity and promotion. At the same time, we should continue to strengthen warning publicity and education and behavioral intervention to reduce MSM risky sexual behaviors and reduce new HIV infections.

Immunological effect and influencing factors of HAART on HIV/AIDS with baseline CD4 below 350 cells/mm3 / 公共卫生与预防医学

Objective To analyze the immunological effect and its influencing factors of HAART on HIV/AIDS with a baseline CD4 of less than 350 cells/mm3 in Hubei Province during 2011-2020. Methods The treatment information of people living with HIV/AIDS (PLWH) was collected through China Disease Control and Prevention Information System, and the change of CD4 mean value was analyzed by Wilcoxon sign rank sum test. Chi square test and multivariate logistic regression were used to analyze the factors influencing the immunological effect. Results The mean value of CD4 cell count at baseline was (172.78±107.65) cells/mm3 before treatment and (398.85±206.71) cells/mm3 in the fifth year after treatment. Patients with baseline CD4<50 /mm3 had the largest increase in CD4 mean value after treatment (P<0.05). Multivariate logistic regression analysis showed that Age ≥35 years, heterosexual transmission, time interval from diagnosis to treatment≥1 month, baseline CD4<50 /mm3, treatment time 7-<18 months, and drug failure were the risk factors for the success of antiviral therapy(P<0.05). Conclusion The immunological effect of HIV/AIDS antiviral therapy in Hubei Province is affected by many factors. It is necessary to strengthen the implementation of early detection and early treatment strategy and promote treatment compliance education for patients aged ≥35 years.