Publics and their health: Historical problems and perspectives

The nature of the relationship between publics and their health has long been a concern for those seeking to improve collective and individual health. Attempts to secure the health of the population of any given place are one of the oldest forms of governmental action. Whether it be providing clean water or preventing the spread of disease, such efforts require the involvement of the publics these measures are designed to protect. Despite its importance, surprisingly little attention has been paid to who or what the ‘public' of public health consisted of. This collection addresses this gap by considering ‘who' the public of public health was in an array of places and around a variety of public health problems. Ranging across Europe and North and South America, and from the interwar period to the near present, this book explores the construction of ‘problem publics' to deepen our understanding of the ‘who' of public health. This book offers detailed case studies of the making of ‘problem' publics and public health problems in different places and at different times. By placing examples of the construction of problem publics in contexts as diverse as the USA in the interwar period, East Germany in the 1980s and contemporary Argentina, this collection identifies what is general and what is specific to the processes that make certain kinds of publics appear problematic. In the wake of the COVID-19 pandemic, this volume offers fresh insights into the nature of public health problems, practices and publics. © Manchester University Press 2023.

Public Health Legacies: Tuberculosis, HIV/AIDS, and SARS in Singapore

Tuberculosis, HIV/AIDS, and Severe Acute Respiratory Syndrome (SARS) are historically significant cases of infectious disease outbreaks that have posed economic, social, reputational, and moral challenges to Singapore and its much-vaunted model. Until only in recent years, Singapore's neoliberal public health system—focused on efficiency and optimal allocation—had neglected HIV/AIDS and thus the segments of society often associated with it. This neglect had been heightened by prevailing social stigmas and stereotypes. This may shed some light on the COVID-19 pandemic, which elicited rapid, responsive, robust, and inclusive government action where mainstream Singaporean community was concerned, but at the same time failed to recognize and deal with the marginalized and possibly stigmatized segments of society, such as migrant workers, whose badly infected dormitories became an international spectacle of crisis and social injustice. COVID-19 resembled tuberculosis and HIV/AIDS in terms of social stigmatization and even moral panic over the unhealthy elements in society. This resulted in the othering of—and disproportionate concern and hostility towards— teenage "spitters” who threatened to spread tuberculosis through their "defiant” behaviour, homosexuals who threatened to spread HIV/AIDS through their "immoral” behaviour and migrant workers in dormitories who were the foreign bringers of disease. The SARS crisis in 2003 was a "wake-up call” for a less-than-prepared Singapore. A subsequently more proactive government learnt key lessons from the crisis, which were systematically institutionalized in readiness for the next infectious disease outbreak. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

ANTIVIRAL HERBS.

Objective: Viruses are agents that can infect all kinds of living organisms, and the most important hosts are humans, animals, plants, bacteria and fungi. Viral diseases are responsible for serious morbidity and mortality worldwide, are a major threat to public health, and remain a major problem worldwide. The recently prominent Coronaviruses (CoVs) within this group belong to the Coronaviridae family, subfamily Coronavirinae, and are large (genome size 26-32 kb), enveloped, single-stranded ribonucleic acid (RNA ) viruses that can infect both animals and humans. The world has experienced three epidemics caused by betaCoVs in the last two decades: SARS in 2002-03, MERS in 2012, and COVID-19, first identified in 2019. COVID-19 continues to be our current health problem and studies on the subject continue. Result and Discussion: The term "antiviral agents" is defined in very broad terms as substances other than virus-containing vaccine or specific antibody that can produce a protective or therapeutic effect for the clearly detectable effect of the infected host. Nature has the potential to cure humanity's helplessness against viruses with many different plant species with strong antiviral effects. During the screening of plants with antiviral effects, focusing on plants used in folk medicine is of great importance in terms of maximizing the benefit to humanity - saving time and effort by dealing with valuable ancient knowledge on a scientific basis. In this review, viral diseases and the plants used in these diseases and determined to be effective are mentioned.Copyright © 2022 University of Ankara. All rights reserved.

Trends in Tuberculosis Mortality Across India: Improvements Despite the COVID-19 Pandemic.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had significant health implications across the globe. India is a country that has faced a double burden of COVID-19 and tuberculosis (TB) since 2020. There is a need to understand the impacts of COVID-19 on tuberculosis control programs in India. Therefore, our study aimed to determine the changes in TB mortality across India between 2019 and 2021. METHODS: In our study, we described trends in TB and COVID-19 cases reported across India. Next, we compared death totals for TB between 2019, 2020, and 2021 in India at the national and state level. We considered total TB deaths, as well as deaths by TB for tribal populations, and for those living with human immunodeficiency virus (HIV). Percent changes were calculated. RESULTS: In 2020, compared to 2019, there was a 15.4% decrease in TB death totals, with 28 out of India's 36 states showing a decrease during this time period. While total deaths increased in 2021 compared to 2020, decreases did occur in 2021 compared to 2019. Deaths by TB for individuals living with HIV decreased by 16.0% across India. At a national level, there was a notable rise in TB deaths among tribal populations, though this was not universal across states. CONCLUSION: While the majority of the world has seen an increase in new TB cases and TB deaths annually since the start of the COVID-19 pandemic, there have instead been decreases in India during this time period. More research is required to understand the factors that have led to this decrease in TB deaths. Furthermore, additional allocation of resources is required to better support vulnerable populations in states where TB death totals have increased, especially among tribal populations.

Unexpected effects of COVID-19 outbreak: adaption of Anti-Retroviral Therapy (ART) delivery policies improved adherence in a population of People Living With HIV (PLWH).

Background: Adherence to Anti-Retroviral Therapy (ART) is crucial for People Living With HIV (PLWH). In Italy, ART is delivered by Hospital Pharmacies, on a renewable prescription from the hospital physician. The measurement of package-refill (the rate of ART packages actually collected out of those to be collected in order to comply with therapy) is an effective tool to evaluate the adherence.During COVID-19 outbreak, at "D. Cotugno" hospital in Naples, Italy, the ART delivery policies have been adapted, in order to reduce the number of patients' access. We analysed the impact of these changes on the pill-refill of ART in January-August 2020, compared with 2018-2019. Methods: "D. Cotugno" hospital is a mono-specialistic Infectious Diseases hospital, caring for about 2500 PLWH. Since February 2020, the hospital was almost entirely dedicated to COVID-19 patients. All out-patient activities were interrupted, except for those dedicated to HIV/AIDS patients.In this preliminary study we included all patients assigned to one of the three Medical Divisions dedicated to HIV, who were already under treatment since at least 2017. Rate of package-refill was obtained by the Hospital Pharmacy registry, demographic and clinical data were derived from clinical database.During COVID-19, many measures were adopted in order to increase safety of PLWH attending to hospital. Among these, medical prescription validity increased from 4 to 6 months, and number of packages to be collected increased from 2 to 4, adopting a multi-month dispensing strategy.Package-refill is adequate if at least 95% of ART have been actually collected; partial and inadequate if 75%-94% or less than 75% of ART, respectively, have been collected. Package-refill was measured during the first year of COVID-19 (March 2020 - February 2021), compared to the same period in the two years before. Results: A total of 594 PLWH were included. PLWH with optimal pill-refill significantly increased in 2020-21 compared to 2018-2020 (62% vs 55%, p 0.013). Discussion: Due to COVID-19, we would have expected a reduction in ART deliveries. Surprisingly, the opposite occurred. The increase of pill-refill rates may be due to different reasons, but we hypothesized that the adaption of delivery policies, with a higher number of packages allowed to be collected, strongly contributed to this result. This study suggests that multi-month dispensing policies may contribute to the improvement of adherence among PLWH.

Field Testing the "Avoid the Needle" Intervention for Persons at Risk for Transitioning to Injecting Drug Use in Tallinn, Estonia and New York City, USA.

This study aimed to field tested the "Avoid the Needle" (AtN) intervention to reduce transitions from non-injecting to injecting drug use in two different epidemiological settings. Respondent driven sampling was used to recruit current non-injecting drug users (NIDUs) in Tallinn, Estonia in 2018-19 and in New York City (NYC) in 2019-20. Both persons who had never injected and persons who had previously injected but not in the last 6 months were eligible; a structured interview was administered, a blood sample collected, and the intervention administered by trained interventionists. We recruited 19 non-injectors from Tallinn and 140 from NYC. Participants in Tallinn were younger and had begun using drugs at earlier ages than participants in NYC. The primary drugs used in Tallinn were amphetamine, fentanyl, and opioid analgesics, while in NYC they were heroin, cocaine, speedball, and fentanyl. Six-month follow-up data were obtained from 95% of participants in Tallinn. The study was interrupted by COVID-19 lockdown in NYC, but follow-up data were obtained from 59% of participants. There were minimal transitions to injecting: 1/18 in Tallinn and 0/83 in NYC. There were significant declines in the frequencies of using readily injectable drugs (fentanyl, amphetamine, heroin, cocaine) from baseline to follow-up in both sites (Cochran-Armitage tests for trend, χ2 = 21.3, p < 0.001 for New York City; and χ2 = 3.9, p = 0.048 for Tallinn). Reducing transitions into injecting is a potentially very important method for reducing HIV transmission and other harms of drug use. Further investigation and implementation of AtN type interventions is warranted.

COVID-19 Infection as an Exacerbated Factor of Oral Candidiasis in HIV/AIDS Patient.

Introduction: Oral candidiasis is an oral mucosal infection caused by Candida sp. This infection can appear in patients with HIV/AIDS associated with immunodeficiency. Another factor that can aggravate the occurrence of oral candidiasis is the COVID-19 infection caused by the SARS-CoV-2 virus as a current pandemic condition. This case report aims to explain the mechanism of COVID-19 infection as a factor that can aggravate the condition of oral candidiasis in HIV/AIDS patients. Case: A 56-year-old male patient was consulted from the COVID-19 isolation unit to the Department of Oral Medicine with complaints of sore and uncomfortable mouth related to white plaque covering the surface of the tongue. The patient was diagnosed with HIV/AIDS and had a COVID-19 infection. The management instructions were to maintain oral hygiene, administration of antifungal drugs such as nystatin oral suspension and fluconazole, chlorhexidine gluconate 0.2% mouthwash, and vaseline album. Discussion: Generally, HIV/AIDS patient has dysregulation of the immune system which can suppress host immunity to fight pathogens, making it easy for opportunistic infections such as oral candidiasis. The COVID-19 infection can cause lymphopenia conditions that further reduce the host's ability to fight pathogens. The SARS-CoV-2 virus can also directly attack various tissues in the oral mucosa which can contribute to exacerbating the severity of oral candidiasis in HIV/AIDS patients. Conclusion: The COVID-19 infection is a factor that can exacerbate the condition of oral candidiasis in HIV/AIDS patients by further decreasing the host's immunity and damaging various tissues in the oral mucosa.

Mental health and adherence to antiretroviral therapy among Mexican people living with HIV during the COVID-19 pandemic.

BACKGROUND: The mental health and medical follow-up of people living with HIV (PLWH) have been disrupted by the COVID-19 pandemic. The objectives of this study were to assess anxiety, depression and substance use in Mexican PLWH during the pandemic; to explore the association of these symptoms with adherence to antiretroviral therapy (ART), and to compare patients with and without vulnerability factors (low socioeconomic level, previous psychological and/or psychiatric treatment). METHODS: We studied 1259 participants in a cross-sectional study, PLWH receiving care at the HIV clinic in Mexico City were contacted by telephone and invited to participate in the study. We included PLWH were receiving ART; answered a structured interview on sociodemographic data and adherence to ART; and completed the psychological instruments to assess depressive and anxiety symptoms and substance use risk. Data collection was performed from June 2020 to October 2021. RESULTS: 84.7% were men, 8% had inadequate ART adherence, 11% had moderate-severe symptoms of depression, and 13% had moderate-severe symptoms of anxiety. Adherence was related to psychological symptoms (p < 0.001). Vulnerable patients were more likely to be women, with low educational level and unemployed (p < 0.001). CONCLUSIONS: It is important to address mental health of PLWH during the COVID-19 pandemic, with special attention to the most vulnerable individuals. Future studies are needed to understand the relationship between mental health and ART adherence.

Characterizing the Impact of the COVID-19 Pandemic on HIV PrEP care: A Review and Synthesis of the Literature.

The global COVID-19 pandemic and associated lockdown measures have caused disruptions to sexual health services and created additional barriers to the continuity of HIV pre-exposure prophylaxis (PrEP) among key populations. This review provides an examination of the influences of the pandemic on engagement in the PrEP care continuum. Using the PRISMA guideline, 46 studies were included in this review and the synthesis. Most of the studies were conducted in high-income settings through quantitative analysis. A majority of studies examining the changes in PrEP use suggested a decline or discontinuation in PrEP uptake during the pandemic. The most common reasons for stopping using PrEP were perceived barriers to PrEP-related care, having reduced sexual behaviors and fewer sexual partners, and reduced perceived risk of HIV infection. Limited studies documenting an increase in PrEP uptake were all in specific PrEP optimizing programs. During the pandemic, there is also an emerging trend of switching to on-demand PrEP from daily oral PrEP. Future studies should understand the mechanism of strategies that facilitated the improvements during the pandemic. PrEP implementation programs should consider alternative PrEP modalities and provide consistent and comprehensive knowledge about correct information.

Some clinical and epidemiological aspects of the course of COVID-19 in people living with HIV

Objective. To describe the clinical and epidemical characteristics of a new coronavirus disease 2019 (COVID-19) in people living with HIV, for HIV infection implies the development of an immunosuppressive condition that may exacerbate the course of COVID-19. Material and methods. The research is based on retrospective and current epidemiological situation of HIV and SARS-CoV-2 infections in the Southern Russia regions during 2020 and survey of the patients with the co-infections concerning epidemiological, clinical, and laboratory diagnostic information. We collected all data from 15 regional centers for AIDS prevention and control in the Southern and North Caucasus Federal Districts. The survey sample consists of 121 patients. Statistical computation is done with Microsoft Office Excel 2010. Results and discussion. HIV patients of various age and social characteristics are involved in the COVID-19 epidemic process. Within registered HIV and SARS-CoV-2 co-infections all patients have apparent clinical symptoms. Asymptomatic cases are not presented. Mild cases prevail in the sample (48.8%). The frequency of severe and extremely severe was significantly higher in people living with HIV/AIDS on ART more than 2 months against naive PLHIV or using ART up two one month (p<0.05).Copyright © 2022 by the authors.

Institutional moral analysis of a global injustice: The case of access to antiretroviral drugs in the global South

The global health challenges highlighted by Covid-19 invigorate the interest in the legal instruments related to public policies on access to medicines, in a way that highlights the dialogue between the local and the global and the ambiguous role of global institutions in reducing inequalities in this access, as they themselves legitimize some of the causes of the problem. To guide this discussion, this study aims to question the institutional dimensions of unequal access to antiretroviral drugs between Global North and South, comparing the dialogue between international and domestic law in the field of health and intellectual property, as well as the challenges in terms of policies imposed on Brazil and India to deal with the impact of global decisions at the local level. It is concluded that, in relation to global health crises, the big question is not about the need to modify laws and institutions to face them, but about what combination of reforms would alleviate the problems arising from them in a more fair and efficient way. The study is operationalized by dialectical reasoning and carried out through documental, jurisprudential and bibliographic analysis. As for its originality, it consists in bringing to the debate this topic that is so pertinent in the global pandemic context from a comparative perspective and under the prism of global justice, an institutional approach that departs from egalitarian liberalism to defend that the mitigation of injustices comes from of an intelligent redesign of norms and institutions. © 2022 Centro Universitario de Brasilia. All rights reserved.

HIV and AIDS prevention: knowledge, attitudes, practices and health literacy of older persons in the Western Cape and KwaZulu-Natal Provinces, South Africa and in Lesotho.

BACKGROUND: Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years. METHODS: A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants' KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level. RESULTS: The baseline survey comprised 1163 participants. The median age was 63 years (range 50-98 years); 70% were female, and 69% had ≤ 8 years' education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2-2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5-2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4-3.4); (High school: AOR = 4.4; 95% CI = 2.7-7.0); (University/college: AOR = 9.6; 95% CI = 4.7-19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention. CONCLUSIONS: The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.

Experiences of HIV/AIDS women in planning their pregnancies during the COVID-19 pandemic

Introduction: HIV/AIDS has become a public health problem in many countries along with the increasing number of reported cases and the high mortality rate due to the HIV virus. The HIV virus can infect pregnant women, where pregnant women are at high risk of transmitting the virus to their babies. Transmission of HIV/AIDS from mother to child can be prevented by planning a pregnancy for HIV/AIDS women who want to get pregnant through the PMTCT (Prevention Mother to Child Transmission) program. In the midst of implementing the PMTCT program, the government is faced with the COVID-19 pandemic which causes the public to be advised to postpone pregnancy until the pandemic ends and counseling or consultation regarding family planning is done via telephone. The study aimed to determine the experiences of HIV/AIDS women in planning their pregnancies during the Covid-19 pandemic. Methods: This research is a Qualitative research with a phenomenological approach which was conducted in March-April 2022 at the Victory Plus Foundation Yogyakarta. Data collection using in-depth interviews. The sampling technique used was purposive sampling. Participants in this study were women with HIV/AIDS who were pregnant during the Covid-19 pandemic and women with HIV/AIDS who had given birth with a maximum age of 6 months. Results: Researchers found 4 themes, which are the experience of women when diagnosed with HIV/AIDS, planning for pregnancy during the Covid-19 pandemic, the condition of pregnancy for women with HIV/AIDS, and social support for women with HIV/AIDS during pregnancy. Conclusion: Based on the results of the study, it can be concluded that some women with HIV/AIDS plan their pregnancies during the COVID-19 pandemic by discussing with their husbands, regularly taking ARVs, using the Calendar application to calculate the fertile period, and checking viral load and CD4 levels. © 2023, Sanglah General Hospital. All rights reserved.

Consequences of COVID-19 Among Adult HIV Patients Versus Non-HIV Patients: Two-Year Data From the Primary Isolation Centre in Sudan.

Background The COVID-19 pandemic remains to have a global impact despite the great efforts in prevention. Controversy persists regarding the outcomes of SARS-CoV-2 among HIV patients versus non-HIV individuals. Objective This study aimed to assess the impact of COVID-19 among adult patients with HIV versus non-HIV in the chief isolation centre in Khartoum state, Sudan. Methods This is an analytical cross-sectional, comparative single-centre study conducted at the Chief Sudanese Coronavirus Isolation Centre in Khartoum from March 2020 to July 2022. Data were analysed using SPSS V.26 (IBM Corp., Armonk, USA). Results This study included 99 participants. The overall age mean was 50±1 years old, with a male predominance of 66.7% (n=66). 9.1% (n=9) of the participants were HIV cases, 33.3% of whom were newly diagnosed. The majority, 77.8%, reported poor adherence to anti-retroviral therapy. The most common complications included acute respiratory failure (ARF) and multiple organ failure, 20.2% and 17.2%, respectively. The overall complications were higher among HIV cases than non-HIV cases; however, statistically insignificant (p>0.05 ), except for acute respiratory failure (p<0.05). 48.5% of participants were admitted to the intensive care unit (ICU), with slightly higher rates among HIV cases; however, this was statistically insignificant (p=0.656). Regarding the outcome, 36.4% (n=36) recovered and were discharged. Although a higher mortality rate was reported among HIV cases compared to non-HIV cases (55% vs 40%), it was statistically insignificant (p=0.238). Conclusion The mortality and morbidity percent proportion among HIV patients with superimposed COVID-19 infection was higher than in non-HIV patients but statistically insignificant aside from ARF. Consequently, this category of patients, to a large extent, should not be considered highly susceptible to adverse outcomes when infected with COVID-19; however, ARF should be closely monitored for.

The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study.

BACKGROUND: Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran. METHODS: In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software. RESULTS: Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors. CONCLUSION: Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.

Does COVID-19 Vaccination with BNT162b2 Influence HIV-Related Immunological and Virological Markers? Data from 235 Persons Living with HIV at Cotugno Hospital, Naples, Italy: Immune Response After Second and Third Doses, and Influence on Immunovirological Markers.

Few data are available on the impact of COVID-19 vaccination on CD4 counts and HIV-RNA in persons living with HIV (PLWH). We present the data of 235 PLWH who were vaccinated with BNT162b2 in March 2021-February 2022 at the "Cotugno" hospital in Naples. PLWH treated at the "Cotugno" hospital, who were vaccinated at the hospital vaccination center, without prior COVID-19 and for whom immunological/virological data were available in the last 12 months and in the 6 months after vaccination were included. Antispike Ab were available for 187 and 64 PLWH after the second and third doses: PLWH with antispikes >33 binding antibodies units (BAU)/mL increased from 91% to 98%. Antinucleocapsid Ab performed in 147 and 56 patients identified 19 (13%) asymptomatic/paucisymptomatic COVID-19 infections after the second dose and an additional 15 (27%) after the third dose. Immunological/virological data were collected before vaccination (T0), after the second dose (T1), and after the third dose (T2). The absolute number of CD4 increased after the third dose (median 663, 657, and 707 at T0, T1, and T2; p < 0.000 T0 vs. T2). The proportion of patients with HIV-RNA <50 copies/mL increases significantly after the second dose (73%; 85.7%; 87.7%; p < 0.000 T0 vs. T2). The presence of COVID-19 asymptomatic/paucisymptomatic infections (demonstrated by the presence of antinucleocapsid Ab) significantly increases SARS-CoV-2 antispike Ab after second dose, but not after third dose. Asymptomatic/paucisymptomatic COVID-19 infections do not have influence on CD4 cell number and HIV-RNA level. Similarly, the presence of not-controlled HIV-RNA (HIV-RNA >50 copies/mL) does not influence antispike Ab response. According to our data, the response to SARS-CoV2 vaccination is effective in people living with HIV. Vaccination against COVID-19 appears to positively affect immunological and virological levels in people living with HIV.

Comprehensive HIV/AIDS knowledge and HIV testing among men in sub-Saharan Africa: a multilevel modelling.

This study investigated the association between comprehensive HIV/AIDS knowledge and HIV testing among men in sub-Saharan Africa (SSA). Data were taken from the most recent (2010-2019) Demographic and Health Survey men's recode files of 29 countries in SSA. A total of 104,398 men who had complete information on all the variables of interest were included in the study. The outcome variable was HIV testing. A multilevel logistic regression analysis was conducted to determine the association between comprehensive HIV/AIDS knowledge and HIV testing. The results of the fixed effects model were presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The average prevalences of HIV testing and comprehensive HIV/AIDS knowledge among men in SSA were 53.5% and 50.8% respectively. Rwanda and Niger recorded the highest (93.6%) and lowest prevalences (9.8%) respectively. The prevalence of comprehensive HIV/AIDS knowledge among men in the 29 countries was 50.8%, with the highest in Rwanda (76.4%) and the lowest in Benin (31.1%). Men who had no comprehensive HIV/AIDS knowledge were less likely to test for HIV compared with those who had comprehensive HIV/AIDS knowledge (AOR=0.59, CI: 0.57-0.60). Men who were older than 20 years, married or cohabiting, with at least secondary education, in the richest wealth quintile, exposed to mass media, used condoms and with multiple sexual partners were more likely to test for HIV. To improve HIV testing among men in SSA, this study recommends that policymakers and stakeholders step up comprehensive HIV/AIDS knowledge sensitization and education using effective tools such as mass media.

Anxiety Levels of People Living with HIV and Problems in Accessing Healthcare Services and Drugs During the COVID-19 Pandemic

Introduction: Since its emergence in December 2019, COVID-19 has caused severe morbidity and mortality. Access to healthcare services for individuals with chronic diseases including people living with HIV was disrupted due to many factors such as the density in hospitals and social closure strategies to stop the spread of the pandemic. The aim of this study was to determine whether HIV status and social and medical problems faced by people living with HIV caused anxiety during the COVID-19 pandemic. Materials and Methods: Between October 2021 and February 2022, the Beck anxiety scale and a 16-item questionnaire including questions on demographic information was completed by 100 people living with HIV who visited our Cukurova University Infectious Diseases and Clinical Microbiology outpatient clinic and gave consent to be included in the study. Results: Overall, 93 (93%) participants were male and seven (7%) were female, with a mean age of 36 +/- 10 years. Among all participants, 44% reported a decrease in their general quality of life, 42.4% reported an increase in the level of anxiety, 33% reported a decrease in access to resources such as money and food, and 13% reported that they had difficulty in paying the rent of their own house. During the pandemic, 11.3% of the participants lost their jobs and 9.1% lost their health insurance;8.1% reported that they became homeless and moved to live with someone else. Access to antiretroviral treatment decreased in 7.2% of the participants, the number of hospital visits were reduced in 33.3%, and 26% reported a reduction in monitoring tests such as HIV RNA. The mean Beck anxiety score, which was used to evaluate the patients' anxiety level, was 12.32 +/- 12.35 (min-max= 0-54) and suggested mild anxiety symptoms. Conclusion: The difficulties and problems in the daily lives of individuals living with HIV have deepened with the COVID-19 pandemic. The data we obtained in our study helps us understand the difficulties and anxiety levels of people living with HIV in receiving healthcare.

Migration and spread of infectious diseases: From the origin of Homo sapiens up to the Anthropocene

A typifying characteristic of Homo sapiens is its ability to walk upright, which allowed humans to move about in grasslands, enabling them to leave the forests of central Africa and populate the rest of Africa and later the world, a success story like no other. Africa is the place of origin of Homo sapiens. The first major migration of anatomically modern humans, known as the Out-of-Africa migration, was the first of many migratory events of Homo sapiens that continue up to the current era that shaped the world and society. This article aims to describe the defining role of human migration in spreading infectious diseases from pre-history to the present. In future, infectious diseases will continue to spread through migration. However, by contrast, the spread of diseases will be exacerbated due to the opportunities provided in the Anthropocene epoch and will become progressively more challenging. Migration is a term that encompasses the simultaneous movement of large numbers or groups of people away from their original place of living and for a specific reason. The main reasons for migration are emigration/immigration, forced displacement, slavery, migrant labour, asylum seeking and refugees. In addition, war, conflict, and environmental disasters such as droughts, famine and overpopulation are other common causes of migration. Migration is usually unplanned;it happens without warning or advanced planning and is accompanied by a large-scale disruption in the socio-economic structure, health, and well-being of the migrants and/or other affected groups. Such major disruptions to individuals' normal living can weaken the immune system, leading to increased susceptibility to infectious diseases. In addition, temporary housing during migration can often also result in humanitarian disasters that increase opportunities for the transmission of infectious diseases. Migrants are also at risk of contracting new or previously-unencountered diseases prevalent in their chosen resettlement area. Conversely, migrants can carry with them microorganisms absent in the resettlement area. An example of this is the smallpox virus that was brought to South America by the Spanish colonisers. At that stage, poxvirus was absent in this continent, and the indigenous populations had no immunity to the pathogen. The transmission of the poxvirus by colonizers to indigenous populations almost destroyed the indigenous populations of the time. A form of migration that emerged more recently is travel. Travel migration is defined as the large number of unrelated individuals who travel simultaneously across the globe for work or pleasure. Travel migration has been enabled by advances in the speed by which air and train travel takes place. This results in large numbers of individuals being transported across the globe in a short period and over long distances. Travel by water, air and land resulted in the world's population being highly interconnected through the mingling of large numbers of people from geographically remote places but in a relatively short period. Travelling connects people and diseases across the globe. Examples of pathogens that spread through migration and that cause major infectious diseases include the smallpox virus, the human immuno-deficiency virus (HIV), and coronaviruses that cause Middle Eastern respiratory syndrome (MERS), coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS). Mycobacterium tuberculosis, the cause of tuberculosis, and Helicobacter pylori, which can cause gastric ulcers, are among the oldest known bacteria that infect humans and were already present in humans when the Out-of-Africa migration occurred. These two pathogens were carried with humans as they migrated and populated new areas of the world, and both have been present in large numbers of humans over millennia. These two organisms can only spread through very close contact between humans and have no host outside the body;therefore, they are great examples of how migration distributes infectious diseases across the world. Mycobacterium tuberculosis is exceptionally well-adapted to spread and cause disease among individuals with lower immunity, such as migrants. Poor housing conditions and crowding, which invariably result from migration due to humanitarian disasters, advance the transmission of pathogens such as tuberculosis. Major lifestyle changes of humans occurred from the Paleolithic to the Neolithic after the Out-of-Africa migration, which directly or indirectly benefited the transmission of diseases. During the Neolithic, animals were domesticated, and agriculture started, allowing people to settle down and establishing the first towns and cities. The domestication of animals created an opportunity for pathogens to cross from animals to humans and adapt to the new host to cause new infectious diseases in humans, called zoonosis. The Anthropocene dawned when deforestation, mining, farming, and other human activities left their mark. As a result, the Anthropocene offers unique opportunities for the emergence and spread of infectious diseases: firstly, by zoonosis or the transmission of diseases from animals to humans, and secondly, the spread of the diseases through migration. Furthermore, changes in the weather and climate can lead to environmental migration. This occurs when people need to abandon their normal place of living because of severe weather events such as droughts and ice ages. Labour migration was responsible for the spread of HIV from its place of origin in Africa. This virus initially landed in humans through inter-species cross-over from primates to humans in the 1950s from eating semi-cooked bush meat. As a result, it became established in the indigenous populations of Africa. HIV is a sexually transmitted disease amongst humans, and migratory labourers from Haiti were infected with the virus while working in the Congo, where they transmitted the virus to people in Haiti upon their return. The MERS and SARS coronaviruses became human pathogens due to bat-human species cross-over, probably due to eating bush meat. However, the rapid distribution of these two viruses to other areas of the world was enabled through travel migration and the highly connected world population. Similarly, the extremely rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) upon its discovery in December 2019 was partly due to travel migration. In future, the negative impact of infectious diseases can be prevented by having disaster preparedness plans to protect the health and well-being of migrants and resident populations. However, events that can potentially be disastrous are difficult to pre-empt: the world was largely unprepared on how to respond to the rapid spread of SARS-CoV-2 and how to control the ensuing pandemic. Other recent examples of similar unforeseen events are the Ukraine-Russian conflict that started in March 2022, which caused many people from Ukraine to flee to other countries for safety. The second example is the heavy rain of April 2022 in the KwaZulu-Natal Province of South Africa, which caused massive destruction of houses and infrastructure, resulting in affected people being displaced. In both cases, the reasons for migration can have a detrimental impact on the health of the affected people, which renders them susceptible to disease transmission.

The Impact of the COVID-19 Pandemic on Sexual Behavior and HIV Prevention and Treatment Services Among U.S. Men Who Have Sex With Men in the Post-Lockdown Era.

Early in the COVID-19 pandemic, disruptions to sexual health services and changes to sexual behavior due to the first COVID-19 lockdowns were common among U.S. gay, bisexual, and other men who have sex with men (GBMSM). Less is known about the persistence of these changes after this initial lockdown period. These changes have long-term implications for HIV prevention for current and future pandemic periods. This study collected information on COVID-related impacts on sexual behavior and HIV-related health service disruptions from a cohort of U.S. GBMSM at three time points during the COVID-19 pandemic. We observed that COVID-related disruptions to sexual behavior continued from early lockdown periods through December 2020. Although early interruptions to pre-exposure prophylaxis (PrEP) access resolved in later 2020 and interruptions to antiretroviral therapy (ART) adherence were minimal, extended disruptions were observed in HIV testing, sexually transmitted infection (STI) testing, HIV care clinical visits, and HIV viral load testing. Although sexual behavior did not return to prepandemic levels in late 2020, the reduced access to HIV prevention, testing, and treatment services during this period could result in an overall increased HIV transmission rate, with long-term impacts to the trajectory of the U.S. HIV epidemic. Additional resources and programs are needed to address challenges created by the COVID-19 pandemic, as well as prepare for future potential pandemics and other disruptive events.