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AIDS: Stigma, PrEP and the ongoing crisis

 

This is the ninth column in “50 Years of Queer Anger,” a series examining LGBTQ+ issues in the United States since 1969.

On April 24, 1980, the CDC was informed that Ken Horne, a resident of San Francisco, was exhibiting Kaposi’s sarcoma, a type of cancer that, until that point, had mainly been found in old men. On June 5, 1981, the CDC’s “Morbidity and Mortality Weekly Report” included an article about five unexplained cases of Pneumocystis carinii pneumonia in five young gay men living in Los Angeles. The illness was then reported in San Francisco, and by 1984 at least 800 people had reported symptoms of what was originally called gay-related immune deficiency, or GRID. If you told any of those diagnosed that they had AIDS, none of them would have understood.

Almost 40 years later, it’s impossible to imagine a world without AIDS. HIV/AIDS education is required in 33 states and the District of Columbia. Events like World AIDS Day, organizations like (RED) and celebrity fundraisers like Magic Johnson, who has been living with HIV since 1991, have made AIDS a somewhat normalized part of the national American conversation about health.

However, recent events have made, at the very least, one realization necessary: The AIDS crisis is not over.

By no means is the AIDS crisis in America as devastating as it was in the 1980s and ’90s, but that does not mean it can be simply dismissed. In 2017, there were 38,739 new HIV diagnoses in the U.S. Black queer men made up 26 percent of those diagnosed, the most of any single group. This is due to a number of societal factors, including poverty, stigma and lack of access to health care.

Pre-exposure prophylaxis, a drug intended to stop HIV negative people from contracting the virus, has been making national headlines over the past few months due to its failure. As of October 2018, six cases of men on PrEP contracting HIV had been reported internationally. However, considering that 77,120 people were on PrEP in 2016 and that there was an average increase in users of 73 percent per year from 2-12 to 2016, these cases indicate a very small proportion of people on PrEP. Instead, it is crucial to talk about who has access to PrEP and other AIDS care.

Nearly 50 percent of people taking PrEP in 2016 lived in New York, California, Florida, Texas, and Illinois, but the Southern U.S. made up 52 percent of new HIV diagnoses and only 30 percent of PrEP users. Despite the renaming of AIDS, the stigma of it being a “gay-related” sexually transmitted disease has not faded.

Cost is an additional barrier to treatment. Truvada, the brand name of PrEP, is manufactured by Gilead Sciences, which charges $2000 per month or more for the medication —  despite it having a production cost of less then $6. People are afraid of outing themselves by getting treatment, are unaware of their status or simply don’t have the resources to be educated or protected against HIV. Since HIV/AIDS is still largely associated with gay people and sex workers, for some people being open about their status feels like admitting a moral failure. Anyone can contract HIV/AIDS, but societal stigma is very powerful.

The HIV/AIDS epidemic is far from over. Although an HIV diagnosis is no longer a death sentence, living with HIV/AIDS is still incredibly expensive, as well as physically and emotionally taxing. National and international stigma around HIV is still very real, and prevent people from getting the treatment they need. The fight against HIV and AIDS, both at home and abroad, must continue.

Author: A. Pallas Gutierrez

Source:

AIDS: Stigma, PrEP and the ongoing crisis

Same-sex marriage legalization associated with reduced anti-gay bias in the US

Bias declined more sharply in states where legislation was passed locally

A new study of evolving attitudes toward gay marriage across the U.S. suggests that state legislation has had a significant impact in reducing anti-gay bias in many parts of the country.

The findings, published in PNAS, provide evidence that public policy can shape social norms and alter individuals’ attitudes, says senior author Eric Hehman, a professor in McGill University’s Department of Psychology.

In 2004, Massachusetts became the first U.S. state to legalize same-sex marriage. In the following years, 34 other states and Washington, D.C., would follow suit before the Supreme Court ultimately ruled, in June 2015, that same-sex couples could marry nationwide. Since then, polls have suggested that support for same-sex marriage has steadily increased.

Eric Hehman, who specializes in how individuals perceive one another and how stereotypes and biases influence behaviour set out to measure whether and how state legislation had an impact on anti-gay bias.

“The idea that norms shape attitudes has been around in social psychology for many years,” says Hehman. “We wanted to measure if laws and policies can also act as norms and potentially change deeply rooted biases.”

Since same-sex marriage was legalized in different states over the course of 11 years, Hehman’s team was able to map trends in anti-gay bias during this period.

By geolocating responses at Project Implicit – a website launched in 2002 that measures biases of respondents – Eugene Ofosu, a graduate student working with Dr. Hehman, examined changing regional anti-gay biases of about 1 million respondents during a 12-year period. The researchers compared these trends before and after state-level legalization of gay marriage in each state.

Though implicit and explicit bias against the gay community was decreasing or stable prior to same-sex marriage legalization, the researchers found that legislation supportive of this marginalized population caused anti-gay bias to decline at roughly double the previous rate.

In the 15 states that did not pass same-sex marriage legalization locally by contrast, Hehman found a “backlash effect.” In those states, anti-gay bias increased in the immediate aftermath of the Supreme Court ruling making gay marriage legal nation-wide.

One possibility, Hehman says, is that — even though attitudes were shifting toward more acceptance of same-sex marriage, a tipping point of support had not yet been reached in those states for the majority to accept the federal ruling.

The study also suggests that attitudes and legislation may be mutually reinforcing: evolving attitudes toward same-sex marriage may have served as impetus for both state and federal legalization.

“In other words, representative governments can contribute to and/or intensify change in the attitude of citizens by passing legislation,” Hehman says. “We have some evidence that the laws caused this changed in bias, but it is possible the effect goes in both directions.”

 

Source: https://www.eurekalert.org/pub_releases/2019-04/mu-sml041019.php#.XLYeDyRt62Y.email

HIV-Positive People: It’s Time To Talk About Diarrhea

Let's Talk About Poop

A study presented at AIDS 2018 last November showed that the rate of noninfectious, HIV-related diarrhea hasn’t changed significantly over the past nine years — and continues to effect 17 percent of people living with HIV.

The results of this large clinical trial review are highly compelling because chronic HIV-related diarrhea not only has a direct physical effect, but it can also have severe consequences to one’s quality of life, mental well-being, drug effectiveness, and adherence to antiretroviral treatment. Unfortunately, even now, diarrhea is not well addressed as an important health concern in people living with HIV.

Researchers examined data from 38 HIV clinical trials, with a total of 20,000 participants, in studies posted on ClinicalTrials.gov from 2008 to 2017. Selected studies included over 100 participants each and were U.S.-based, though some included sites in additional countries. All studies looked at the efficacy of specific HIV antiretrovirals or ARV regimens, and reported incidences of diarrhea as an adverse event.

Of the 38 trials reviewed, 21 had enrolled participants new to ARV treatment; 11 enrolled participants who had been on treatment for a while and seen their viral loads suppressed to undetectable levels, who then switched to different ARVs; and five enrolled those whose first antiretroviral regimen was failing to fully suppress their HIV (which is often indication of transmitted drug resistance). One study included participants who were both treatment naive and experienced. Participants in the comparative arms were also included in this study.

The point of treatment in those studied (naive, treatment-experienced, or treatment-failures) is important because possible side effects (including diarrhea) after starting new ARVs is somewhat expected. The body often adjusts to new medications so these side effects can ultimately diminish over time. However, long-term noninfectious diarrhea may indicate a different cause such as HIV-enteropathy or may represent a side effect of a specific ARV. In these cases, measures should be taken to diagnose the cause, and treatment or drug changes should be provided where possible.

Researchers found that the rate of diarrhea in the studies reviewed was approximately 17-18 percent and remained consistent over the past nine years, which runs against the common belief that the rates of diarrhea among HIV-positive patients has declined significantly in recent years. This rate was similar in both participants who were taking FDA-approved ARVs and those given experimental therapies. The average reported diarrhea incidence was significantly higher for participants who were treatment-naive versus those who were treatment-experienced at 19.72 percent vs 13.74 percent, respectively.

Researchers also analyzed adverse events reported data from specific ARVs and compared it to corresponding FDA-approved package inserts, and found that the rates of diarrhea reported by drug makers varied greatly from the rates of those in the clinical trials.

For example, the rate reported for Stribild on the package insert was 12 percent, however, the meta-analysis reported 20.6 percent. Similarly for Genvoya, the package insert reported half the rate of the meta-analysis at 7 percent versus 14 percent. For Triumeq, 1 percent (grade 2) versus 16.1 percent; Isentress, none versus 17.2 percent; and Evotaz 11 percent versus 22.1 percent.

This distinction is important since the package inserts report the rates of new or “treatment emergent” incidents of diarrhea attributed to a specific ARV, whereas the clinical trial adverse events (in this case diarrhea) reported in the studies reviewed on ClinicalTrials.gov represent the background rates of diarrhea and highlight the persistence of this important morbidity in the modern era.

“It remains consistent that patients who are living with HIV are still experiencing loose stools and diarrhea irrespective of being on the most current or older antiretroviral regimens. It is also paramount that clinicians not rely solely upon package insert reported rates of adverse events and instead seek the actual occurrence. Any and all efforts undertaken to enhance the quality of life for persons with HIV on antiretrovirals can only hope to improve outcomes, decrease transmissions, and move toward the end of the epidemic,” stated Patrick G. Clay, professor of Pharmacotherapy at the University of North Texas System College of Pharmacy and co-author of the study.

Chronic HIV-related diarrhea is rarely addressed during conversations between people living with HIV and their care providers, and thus can remain untreated. Living with this condition for years can create a sense of acceptance combined with a belief that there’s no point in complaining.

Author: Jeannie Wraight

Source: https://www.hivplusmag.com/treatment/2019/4/15/hiv-positive-people-its-time-talk-about-diarrhea

25 years on: MAC recreates iconic VIVA GLAM campaign to fight AIDS

The fight to cure HIV and AIDS is ongoing, and while science and medicine have now developed treatments to reduce the life-threatening velocity of the illnesses, an all-out cure has yet to be discovered.

One company who saw the necessity to support those living with AIDS, and the non-profits which provide for them, was M.A.C.

Back in 1994, M.A.C first released their VIVA GLAM range, 100% of the sale of which has contributed to the support of AIDS sufferers for a quarter of a century.

Related image

When VIVA GLAM was created, society was struggling to navigate the height of the HIV epidemic.

The first ever Viva Glam lipstick was launched, designed to get people talking about the epidemic – and the gorgeous Ru Paul fronted the campaign, showcasing the original bright red lip shade.

In the years since, big name celebrities have continued collaborating with the brand to create a shade.

In 1995, we saw fashion designers  Marc Jacobs, Vivienne Westwood and Katharine Hamnett participated in creating the couture 1995 colour collection, showcasing the shade of the original intense brownish red VIVA GLAM Lipstick we have come to know and love.

Throughout the years, the ambassadors have included Sia, Miley Cyrus, Elton John, Dita Von Teese, Mary J. Blige, Ariana Grande and Ricky Martin – and five staple shades now make up the collection.

So far, VIVA GLAM has raised $500 million for the global fight against HIV/AIDS, helping millions of people. The UK and Ireland alone have given 540 grants to over 100 charities including Positive East, HIV Ireland, National AIDS Trust, Terrence Higgins Trust and George House Trust in that time by buying a lippie each year.

This year, the brand are focused on recreating their original campaign, with the gorgeous Winnie Harlow fronting the throwback recreation – posing just as Ru Paul did in 1994.

‘I was inspired to recreate the original Viva Glam campaign after my hairdresser, Jay Brumant, showed me the beautiful images,’ Victorias Secret model Winnie said.

‘Working in fashion, I’m surrounded by many types of beauty, and I strongly feel that the contributions of the LGBTQ+ community are both prominent & embraced in the fashion world. I remember being invited to my first Vogue Ball. It was invigorating to see so many people from different walks of life come together and celebrate themselves freely.’

‘Ever since then, I have loved & always wanted to try to recreate a “drag moment”. I knew that if I was ever going to attempt it I would need to embrace an ICONIC look! Who is more iconic than RuPaul in the M·A·C Viva Glam campaign?’

‘So when I was in full “regalia” post Adam Burrell’s make-up magic, my friend & New York photographer, Gabriel Perez Silva, helped me recreate the images, and that’s how this costume came to be! I’m so honoured to follow in the footsteps of amazing artists like Lady Gaga, Elton John, and Ru celebrating Viva Glam’s 25th Anniversary alongside raising awareness for the MAC Viva Glam Fund.’

Each Viva Glam shade is €20.00 and can be purchased at any M.A.C. counter or store, and on maccosmetics.com.

Author: Sarah Magliocco

Source:

25 years on: MAC recreates iconic VIVA GLAM campaign to fight AIDS

Vu Q&A: Dr. Sylvie Naar on Individual Behavioral Interventions, Youth, and HIV

Sylvie Naar, Ph.D., Professor of Behavioral Sciences and Social Medicine at Florida State University and Principal Investigator for the Adolescent Medicine Trials Network for HIV/AIDS Interventions’ Scale It Up program

Q: You work on a wide variety of behavioral science projects. What is it about HIV among youth that drew you to work with this population?

I was drawn to working with HIV among youth because of my training and personal experience. I am a pediatric psychologist by trade, so I had worked in chronic illness clinics with young people throughout my career, starting off with the Children’s Hospital of Michigan (CHM). At CHM, we were working on integrating mental health services into chronic illness care. On a personal note, I had a family member with hemophilia who contracted HIV early in life from tainted blood products and passed away in 1990. This was before the advent of highly active antiretroviral treatment, and he did not tell anybody in his family about having HIV until very close to his death. The stigma, even within a hemophilia setting, really bothered me. So that prompted me to get into health psychology versus traditional psychology. I started working in a pediatric clinic and really fell in love with the population.

The young people aspect is a part of my heart. It is the intersection of urban health, health psychology, minority health, substance abuse, sexual risk, and other behaviors. I slowly moved into more behaviorally impacted youth and the changing needs of the epidemic, which made me connected to the struggles of minority youth. Kids face an added stigma in the area of HIV, for being so young and the blame of catching something that is behaviorally infectious. They are often disconnected from their families for being HIV positive and a sexual minority, so they really need a lifeline from the clinic and our staff. These psychosocial needs are often overlooked for young people, and that’s the need I want to fill.

Q: As a professor of Behavioral Science and Social Medicine, how is your perspective on HIV among youth different than someone who is looking at it from an epidemiological or public health perspective?

I am attuned to the multiple systems that youth are embedded into and, in addition, to individual behavioral interventions in public health. My area of focus is translating basic behavioral and social science into new behavioral interventions and getting them into the community. My focus pairs well with those from epidemiological and public health backgrounds. Although we come from slightly different academic backgrounds, it is critical for me to partner with public health professionals in order to get the interventions successfully into the community.

Q: You are the Principal Investigator for the Adolescent Medicine Trials Network’s Scale It Up program. The program emphasizes self-management interventions to impact HIV among youth. What are self-management interventions and what are the main goals of the program?

Self-management interventions are based on motivational interviewing, which is a combination of motivational interventions with couples counseling, skills building, substance abuse prevention, and HIV testing for young people, in addition to a telehealth intervention for adherence to HIV therapy for positive youth. We have adapted motivational interviewing to be called TMI, for Tailored Motivational Interviewing, but also we jokingly call it Too Much Information because young people usually give us too much unnecessary information and often not the right information. From recordings of conversations with youth and providers, we’re combining all this information into the TMI framework to provide the right information into a variety of effective approaches.

The main goal of the Scale it Up program is to use a mixed methods approach, as described here, to understand the barriers for healthy lifestyles for these kids. Once we understand these barriers, we can then facilitate more efficacious programs and interventions.

Q: With the rise of the opioid epidemic, what trends are you seeing in new HIV infections from injection drug use among young people and how can we tailor interventions to target this method of transmission?

The trends in new HIV infections and injection drug use among young people are rising, but luckily, not alarming. In 2008, about 1% of HIV infections among youth were attributed to injection, as of 2016, it is 2.6%. The opioid epidemic tends not to be with injectables among young people, however, we know that those kinds of early opioid addictions can transition into IV drug use pretty quickly, and that is where people would be at risk for HIV, and other diseases. We have also seen that nonadherent kids, that is, kids that are not using condoms or PrEP in safe sex practices are also using more substances and overall, engaging in risky behaviors.

We have created a tailored Healthy Choices Intervention for these kids to help provide resources in clinical and community settings. This is to expand on the typical resources provided by research studies. This is an area we are keeping an eye on with the growing opioid epidemic, but not our biggest concern. 

Q: With National Youth HIV/AIDS Awareness Day around the corner on April 10, what is your message to youth?

My message to young people is to reach out and advocate for yourself. There are good services, support, and interventions out there that you can get connected with, both in person and through e-health/telehealth. Do not be afraid to get connected.

 

Source: https://aidsvu.org/vu-qa-dr-sylvie-naar-on-individual-behavioral-interventions-youth-and-hiv/

We need to reach men in HIV/AIDS drive, even in night clubs – Prof Mulenga

MEN, especially those under the age of 35, are not coming out to get tested for HIV and if they do get tested and are positive, they don’t get antiretroviral treatment, says Professor Lloyd Mulenga.

Prof Mulenga says by next year, HIV should not be a public nuisance and AIDS not a threat by 2030.

Officiating at the HIV/AIDS media workshop for Livingstone based journalists, he said the other challenge facing Zambia in ending new infections and AIDS was children living with HIV and

positive pregnant women who at risk of transmitting the infection to their unborn children.

“How do we end AIDS and which population is being affected? So we are looking at the populations that we are not reaching out to, especially men under the age of 35,” Prof Mulenga said. “I am a man and I really feel bad that we are the ones that are not coming out to be tested and those that get tested to be put on treatment.”

He added that linkages targeting men in HIV interventions were very low, especially in men below the age of 35.

Prof Mulenga noted that the other hard to reach groups were adolescent girls and young women, especially those under the age of 25.

“Also children and pregnant women not accessing treatment…. We can only end AIDS by coming up with a family oriented approach. We need to be innovative to reach men, even in night clubs,” he said. “…if it means getting to a night club and putting men on treatment, let’s do it. If it means getting to work places, let’s get there. We are on track to having HIV epidemic being controlled but we will have another surge if we go to sleep.”

Prof Mulenga said as at the end of February 9, about 980 of the over 1.2 million Zambians were on antiretroviral treatment adding that the

challenge now was to get the remaining over 200,000.

And USAID Discover Africa senior advisor Mwansa Njelesani-Kaira said people were living in a highly sexualised community.

Kaira, in her power-point presentation at New Fairmount Hotel, said with community concerted efforts and the support of the media it was possible to end AIDS in Zambia and also stop new HIV infections.

“People are living in a highly sexualised community, they enjoy sex, but feel ashamed of having sex outside marriage,” said Kaira.

Source:

We need to reach men in HIV/AIDS drive, even in night clubs – Prof Mulenga

Knowledge is power: Knowing your HIV status can lead to long, healthy life

 

Knowledge is power
The Berrien County Health Department and Community AIDS Resource and Education Services of Southwest Michigan offer free HIV testing daily with Rapid HIV test strips. Health officials say the sooner someone knows their HIV status, the better they can live a long and healthy life.

BENTON HARBOR — In 2019, managing HIV is easier than managing diabetes.

“With routine treatment, you can live a normal healthy life with HIV,” said Gillian Conrad, spokeswoman for the Berrien County Health Department. “If we change that stigma from the 1980s, and the face of AIDS that a lot of the adult population has in their mind, hopefully this next generation, millennials and younger, will kind of have a different idea of what living with HIV could look like.”

HIV stands for human immunodeficiency virus. It weakens a person’s immune system by destroying important cells that fight disease and infection. It is usually spread through sex, needle sharing during intravenous drug use and from pregnant women to their babies.

No effective cure exists for HIV, but with proper medical care, HIV can be controlled to a point where the virus can be suppressed so that it’s undetectable in someone’s blood, and untransmittable to others.

“You’re a person,” Conrad said. “You continue treatment. You’re living your life and your partner is on PrEP (pre-exposure medication) and you’re fine. There’s no reason why everyone (living with HIV) in Berrien County can’t be virally suppressed sometime in the near future.”

Living with HIV

“When I was first diagnosed, I didn’t know about medication and about living a long, healthy life,” said Levi Berkshire, non-medical case manager with CARES. “That was the biggest thing. I was really worried about dying.”

CARES, which stands for Community AIDS Resource and Education Services of Southwest Michigan, helps connect people with HIV care and other services in a 10-county area, with locations in Benton Harbor and Kalamazoo.

Berkshire started working for CARES in 2015, after his HIV diagnosis in 2014.

“I’m 35 now. I am old enough to remember what HIV/AIDS used to be,” the Kalamazoo resident and native said. “I thought I was going to die, but once I started finding everything out, I wanted to do a service to my community: the LGBT community. And I realized other people should know about it too.”

Berkshire has worked with people all over Southwest Michigan, including getting newly diagnosed people linked to care, talking to groups about sex and drugs and just being a resource for people.

He said because of the stigma around HIV, when he was first diagnosed he was really worried about going to his doctor in Kalamazoo, so he started his treatment in Grand Rapids. But once his education on the topic changed, his mindset changed.

“Going to state HIV trainings for my job at CARES really educated me,” Berkshire said. “I don’t have a degree, I have a cosmetology license, so I knew you could get infected and I knew it was possible to pass it along, but there was no LGBT sex education. I had to listen to older gay men and they told me to get an STD test every six months.”

He said that was his routine, but he just knew that he was going to get HIV sooner or later.

“With me being able to get my diagnosis early and get into care, I haven’t had to live with the hard things that a lot of people sometimes have to go through,” Berkshire said.

Treatment

HIV, if not treated, can lead to AIDS, also known as HIV Stage 3. When a person with HIV gets certain infections, called opportunistic infections, or specific cancers, they will get diagnosed with AIDS, according to the Centers for Disease Control.

Up until 1996, when combination drug therapy became available, an HIV diagnosis almost always advanced to full-blown AIDS and was a death sentence.

The available medications were highly toxic and didn’t suppress the virus very well. People had to take several pills every couple of hours, through the day and night, and endured side effects such as nausea, vomiting and nerve pain, according to the CDC.

Berkshire said now he simply takes medication once a day and has regular doctors visits where his blood is tested.

“Living with HIV is not what it used to be. It’s much more manageable than managing diabetes. It’s come a long way,” he said.

Virgil Hatcher, case management director for CARES, said as soon as someone is referred to them they try to get them health insurance.

“Then they would meet with the (health care) provider and they’d usually want to do some tests before they prescribe medication, but once they do, that treatment can happen very quickly,” he said. “People can become undetectable fairly quickly after starting retro-viral medication.”

Hatcher said health providers can usually get people in pretty quickly in Berrien County, while some other areas can be backed up a month or more.

Kelly Doyle, CARES executive director, said getting people in as quickly as possible is the key.

“That keeps them a lot more healthy because the virus is so low in their body. It’s like tamping down an infection – tamping down the inflammation in them so they’re not getting other things,” she said. “And once they become undetectable, even having unprotected sex, they can’t transmit the disease.”

Starting treatment quickly can happen only if a person knows they have HIV.

The Michigan Department of Health and Human Services (MDHHS) estimates that in 2017, there were about 2,500 people in Michigan living with HIV and not diagnosed.

Testing and prevention

CARES and the Berrien County Health Department (BCHD) offer free HIV testing.

Kim Wilhelm, BCHD clinical and community health services manager, said they have six nurses who are trained to do HIV tests and usually can accommodate people on a walk-in basis.

CARES does testing during walk-in hours from 2-4 p.m. every Wednesday and by appointment.

Wilhelm said the BCHD is trying to reach nontraditional populations through testing in their family planning clinic.

“We’re maybe not getting the young men that are deemed ‘a man who has sex with men,’ although we still do a lot of that in our STD clinic, but we’re trying to get more women tested,” she said.

While gay and African American men are disproportionately affected by HIV, African American women have some of the highest rates of HIV too.

Doyle said these are women who are exposed to sexually transmitted diseases through commercial sex work, or have a partner who is positive.

“When you look at the statistics, that group here is higher than in some other areas,” she said.

There were 238 people in Berrien County reported with HIV in 2017, according to the MDHHS. In Van Buren County there were 57, while in Cass County there were 23.

Doyle said based on population size, Berrien County has one of the highest prevalence rates for HIV in the state. Because of the higher risk, CARES has an office in Benton Harbor and spends a little bit more time and energy in the county.

Hatcher said Berrien County is disproportionately affected because it is disproportionately affected by most health problems.

“Berrien County population being as African American as they are, that’s the biggest challenge for us: getting that population that have been diagnosed or are HIV positive in for treatment,” he said. “It continues to be a challenge and I think that’s probably true in all African American communities.”

Doyle said it’s also because racism, homophobia and stigma are cofactors in the transmission of the disease.

“Part of that is that we have a problem with health equity,” she said. “African Americans often have a mistrust of the medical system for lots of good reasons. They were tested on; there hasn’t been a lot of outreach from the medical community to the African American community of like, let’s feel trusted; and you don’t often see providers that are African American, so they’re not going to walk in and see someone who looks like them to make them more comfortable.”

So going after and reaching out to vulnerable populations is a big part of what the BCHD and CARES does.

Doyle said CARES often goes into the apartment complexes in Benton Harbor, like River Terrace, to offer testing days.

“The health department will do STD testing, we’ll do HIV testing and we’ll have the access to the people in the apartments – usually through incentive, like food – to come and test,” she said. “A lot of our work is going to where people are at. We’re meeting people in the community where they’re most comfortable and we literally work on their goals and what they want to work on.”

Wilhelm said another side of prevention is partner follow up.

“We contact the sexual partners and have them come in for testing,” she said. “A lot of the time they’re in different states and we have to work with other health departments in different states to get those names along.”

Conrad said this is a challenge in this day and age, but that’s where a lot of new HIV diagnoses come from.

“Anonymous social media, like Grindr, that are out there are specifically designed for hookups,” she said. “If you’re diagnosed with HIV or any STD, being asked, ‘Well, who have you been with recently?’ That can sometimes be difficult for folks to even know the names or contact information when you met someone through these apps. That has been a particular challenge around the country.”

The stigma around HIV is so strong that it can be hard to get people to come in to get tested.

“We’d like to end the stigma of even going and having an STD test,” Conrad said. “Getting tested is especially important if you’re going to be with a new partner. It might not sound romantic, but being well informed is sexy.”

Berkshire, who also serves as co-chair for the Michigan HIV/AIDS Community Council, said his diagnosis made him stronger. He said being able to incorporate STD and HIV testing into your yearly doctor’s appointment, or for women, their pap smear, is good for you as a person.

“You don’t have to tell the person you’re dating. This is for yourself. It’s OK to get a test. People live a long, healthy life,” he said. “Being able to talk about it is great. Just be empowered to know your status. It’s a positive thing. You’re taking your health in your own hands. If you don’t know how to do that, just be able to advocate for yourself and the things you want and need. If you struggle, take someone with you.”

A group effort

Wilhelm said the BCHD is one of the few health departments in Michigan that has an early intervention program. The employee gets a list of any new person with HIV that comes into Berrien County.

“She follows up with them to get them re-engaged in care,” Wilhelm said. “She’ll help them find a provider and, through that state funding, she will actually physically take them to their first two appointments to make sure they’re getting there.”

She said they also work with newly diagnosed people to get them connected with CARES for more case management and long-term help.

The first thing CARES does is get the person health insurance through Medicaid or whatever their situation calls for. The state also has a medication assistance program for HIV drugs that covers everything.

Berkshire said it’s more than $3,000 a month for his HIV medicine. He pays nothing, because what isn’t covered through his employer’s health insurance is picked up by Michigan.

Hatcher said CARES is just there to help.

“We’re here to facilitate and make it as easy as possible for people to be treated and treated effectively,” he said. “Anyone with HIV can be treated and not have to worry about the expense of medicine. We have things in place that will help anyone do that without being burdened by it.”

The future of HIV

While it was announced last month that doctors cured someone of HIV through bone marrow transplants, local officials say they are hopeful, yet cautious.

“I think there’s always hope when you’re talking about science and them doing innovative things and treatments that work better because there has been improvement in treatment over the years. It’s much better than it has ever been,” Hatcher said. “There’s hope, but we don’t focus on the cure, we focus on the treatment. We don’t sell a cure to anyone as a motivator. We do sell treatment because they can reach an undetectable viral load.”

Doyle said bone marrow transplants wouldn’t become the standard because the cost is so high and the science is still so new.

She said America’s eroding health care system offers another problem.

“We had a lot of movement with the Affordable Care Act and expanded Medicaid,” Doyle said. “We’re very lucky to have expanded Medicaid in Michigan. We’ve gotten a ton of people on insurance because of that. We’re seeing that continue to be eroded with the Medicaid work requirements bills, and also just the chipping away at the ACA. That’s really going to affect the communities that are disproportionately affected by HIV.”

Another factor is that President Donald Trump’s administration has cut funds for HIV research.

“Even though he’s declared he was going to end the epidemic in 10 years, he’s cut funds to research on HIV and cancer and other things,” she said. “That’s not moving us forward. That’s not moving us toward ending the epidemic. And he’s also cut funds for outside the United States. People have sex beyond borders.”

Author:

Source: https://www.heraldpalladium.com/news/local/knowledge-is-power-knowing-your-hiv-status-can-lead-to/article_21144f29-3abf-5ded-9988-327548dfd2ae.html

Intensify Civic Education On HIV/AIDS, Medic Tells AIDS’ Body

 

A retired Medical expert Dr. Milton Ouma has appealed to the National Aids Control Council to upscale HIV/AIDS campaign activities along the Lake Region and gold mining areas in Migori County to help reduce infection rate in the region.

Dr. Ouma who spoke to the Kenya News Agency in Migori town said that serious and sustained civic education was required in Nyatike gold mine areas and in the entire shores of Lake Victoria to help create awareness on the dreaded disease.

“We admit that a lot has been done to create awareness on the disease but much is still needed to ensure that the people are well acclimatized with the danger of the disease,” he stressed.

He said human lifestyle within the areas presented a good recipe for more infections and required that medical experts and organisations charged with the disease control to come out in full throttle to face the challenge at all cost.
Dr. Ouma said that most HIV/AIDs civic education conducted in the county
has not been reaching these HIV-prone areas effectively and it was high time NACC seriously took up its responsibilities.

He said efforts to reduce the spread of the disease in the county would only be achieved if more efforts was directed towards Sori, Muhuru bay and Osiri gold mines where people seem to be living in denial of the existence of the disease.

Meanwhile, Dr. Ouma advised expectant mothers to deliver in hospital to prevent mother to child HIV infection.

He said most expectant mothers have been delivering at home hence the higher chances of disease transmission to their new born babies.
Dr. Ouma who served in the government in various capacities till the year 2015 also appealed to the youths living with the virus to shun deliberate infection of their partners, saying it was criminal.

He said that those who were living with the disease should also strive to keep off re-infection by abstaining from sex or engaging in limited sex with one known partner.

Author: George Agimba

Source:

Intensify civic education on HIV/AIDS, medic tells AIDS’ body

Arizona lawmakers move to repeal HIV/AIDS instruction law

HIV-AIDS ribbonA person holds a red ribbon symbolizing awareness for HIV-AIDS. (wavebreakmedia/shutterstock.com)

PHOENIX — Arizona lawmakers were poised Wednesday to begin the process of repealing a 1991 law that bars HIV and AIDS instruction that “promotes a homosexual lifestyle” following the filing of a lawsuit by LGBT groups.

The planned action in the state House comes a day after Republican Attorney General Mark Brnovich declined to join in defending the lawsuit filed last month against the state’s Board of Education and state’s top schools official, Democratic Superintendent of Public Instruction Kathy Hoffman.

The 1991 law also prohibits HIV and AIDS instruction that “portrays homosexuality as a positive alternative lifestyle” or “suggests that some methods of sex are safe methods of homosexual sex.”

The lawsuit says the law stigmatizes lesbian, gay, bisexual and transgender students and is discriminatory.

Republican state Rep. T.J. Shope plans to carry the repeal and calls the 1991 law “antiquated.” He said Republicans who hold majorities in both chambers of the Legislature were split, with some critical of Brnovich’s decision and others believing as he did that the law was outdated.

Shope will use an existing bill as a vehicle for a full repeal of the 1991 law by adding an amendment.

Hoffman had called for the repeal of the law in February, before the lawsuit was filed. She had indicated she had no plans to mount a defence, and Brnovich’s decision left it up to the Legislature or the Board of Education to defend it.

“For nearly three decades the effects of these policies have harmed Arizona’s students and families,” she said in a statement Wednesday. “As I have previously stated, I believe this law is indefensible and its repeal is long overdue. I urge the legislature to take immediate action and remove this law from statute.”

The lawsuit, filed on behalf of Equality Arizona, alleges the 1991 law constitutes unconstitutional discrimination and restricts educational opportunity for LGBT students. It says it enshrines in state law that LGBT students can only be discussed in a negative light and communicates to students and teachers “that there is something so undesirable, shameful, or controversial about ‘homosexuality’ that any positive portrayals of LGBTQ people or same-sex relationships must be explicitly barred.”

Arizona is one of seven states with laws prohibiting the promotion of homosexuality. Critics say such laws stigmatize lesbian, gay, bisexual and transgender students and create a state-sanctioned climate of discrimination.

Lambda Legal filed the lawsuit along with the National Center for Lesbian Rights in U.S. District Court in Tucson. Shannon Minter, legal director for the National Center for Lesbian Rights, said repealing the law would end the lawsuit.

“We just realized and recognized that the law was blatantly unconstitutional,” Minter said. “And when a similar law was challenged in Utah, the Utah Legislature also took action to repeal it.”

Author: Bob Christie

Source: https://www.ctvnews.ca/world/arizona-lawmakers-move-to-repeal-hiv-aids-instruction-law-1.4374303

Feasibility and yield of HIV screening among adult trauma patients presenting to an urban emergency department of a tertiary referral hospital in Tanzania

Abstract

Background

The World Health Organization and Tanzanian National Guidelines for HIV and AIDS management, recommends provider initiated testing and counseling for HIV at any point of health care contact. In Tanzania, over 45% of people living with HIV are unaware of their HIV positive status. We determine the feasibility and yield of HIV screening among otherwise healthy adult trauma patients presenting to the first full-capacity Emergency Department in Tanzania.

Methods

This was a prospective cohort study of consecutive adult trauma patients presenting to Emergency Medicine Department at Muhimbili National Hospital (EMD-MNH) in Dar es Salaam, from March 2017 to September 2017. Eligible patients provided informed consent, pre and post-test counseling was done. Structured case report forms were completed, documenting demographics, acceptance of testing, results and readiness to receive results. Outcomes were the proportion of patients accepting testing, proportion of positive tests, readiness of the patient to receive the results, and proportion of patients who had an HIV test ordered as part of care.

Results

We screened 2848 trauma patients, and enrolled 326 (11.5%) eligible patients. Median age was 33 (IQR 25–42 years), and 248 (76.0%) of participants were male. Of those enrolled, 250 (76.7%) patients accepted testing for HIV, and among them 247 (98.8%) were ready to receive their test results. Of those tested, 14 (5.6%) were found to be HIV positive and 12 were ready to receive results. Two months post hospital discharge 6 (50%), of those who were informed of positive results had visited Care and Treatment Clinics (CTC) for HIV treatment. Three additional patients had not yet attended and three could not be reached. The treating ED physician tested none of the enrolled patients for HIV as part of their regular treatment.

Conclusions

In our cohort of adult trauma patients presenting to ED, routine HIV screening for unrelated reason, was feasible and acceptable. The yield is sufficient to warrant an on-going program and superior to having physicians choose which patients to test. Future studies should focus on factors affecting the linkage to CTC among HIV positive patients identified at the ED.

 

Background

Human Immunodeficiency Virus (HIV) continues to be a major world public health problem, having claimed more than 35 million lives so far. In 2017, approximately 940,000 people died from HIV-related causes globally [1]. Sub-Saharan Africa is the most affected region, with 25.8 million people living with HIV in 2017. It accounts for two-thirds of the global total of new HIV infections [234].

Tanzania has about 1.4 million people living with HIV, with adult prevalence of 4.7%. In 2015, 54,000 people were newly infected with HIV mainly between the age group between 15 and 49 years, and 36,000 people died from an AIDS-related illness in the same year [56]. Of all people living with HIV at the moment globally, it is estimated that only 60% know their status. The remaining 40% or over 14 million people need to access HIV testing services [7]. The World Health Organization (WHO), and Tanzanian National Guideline for Management of HIV and AIDS recommend routine HIV testing in all health facilities [89]. Through provider initiated testing and counselling, people living with HIV might be identified early and can then be enrolled into the management system [10].

Routine HIV screening testing at the emergency department (ED) provides an opportunity for early recognition of HIV positive patients [1112]. Identifying them early will provide the possibility of initiating treatment early so as to stop the progression to AIDS. Further more, the identification of HIV negative individuals will provide an opportunity of linkage to HIV prevention services. Studies in other countries have shown that the routine HIV testing at the ED is feasible with a very good acceptance rate and with good yield [1213]. Those diagnosed HIV positive have been enrolled in ongoing follow-up for their continuous care [14]. However, as a emergency medicine is very new field in Tanzania, there has been no study done in Tanzania looking the feasibility of routine HIV testing and its yield in emergency departments. The first full capacity Emergency Department was opened in 2010 in at the main referral hospital in Dar es salaam. In this ED, HIV testing occurs on a provider-initiated basis, but it is generally performed only on medically ill patients for the diagnostic purpose, and not as part of the routine ED Screening. The study aimed to determine the feasibility and yield of HIV screening among otherwise healthy adult trauma patients as these trauma patients present non-medically ill individuals who would otherwise not have attended hospitals and would therefore not have opportunity to have an ED provider initiated testing. With the goal towards assessing the possibility of creating an ED protocol that would allow every patient attending the ED in Tanzania to be counseled for taking the HIV test.

Methods

Study design

This was a prospective cohort study of adult trauma patients presenting to the Emergency Medicine Department of Muhimbili National Hospital from March 2017 to September 2017.

Study area

Muhimbili National Hospital (MNH) is a tertiary referral hospital located in Dar es salaam, Tanzania. The hospital has a bed capacity of 1500 with around 1000 to 1200 admissions per week, operating 24 h in 7 days of the week. The MNH-EMD is the first public ED in the country and was opened in 2010. It is staffed with emergency physicians, postgraduate students in emergency medicine training program, medical officers, critical care nurses and nursing officers. The MNH-EMD is the first entry point to the hospital for most of the patients attending MNH, and sees around 200 patients daily. Acutely ill patients are received at ED, resuscitated and stabilized before being disposed to the appropriate ward. Currently HIV testing at the ED is based on physician discretion and is usually done on only sick medical patients.

Participants

All adult (≥ 18 years old) trauma patients attending the EMD-MNH were eligible for the study. Patients were excluded if they had altered mental status, could not speak English or Kiswahili, those who are known to have HIV infection as evidenced by an HIV treatment card, pregnant women already attending Antenatal clinics, and hemodynamic instability—as defined by the treating physician.

Study procedures

The research assistant frequently and actively went through the entire department (resuscitation rooms and low acuity areas) during 12 h of day clinical shifts of week days to identify trauma patients with the help of nurses in the respective area. The patient registry was also reviewed to identify trauma patients present the department.

All adult trauma patients meeting the inclusion criteria were offered a chance to participate in the study after they had received initial treatment and stabilization. The research assistant explained the study, and patients reviewed and signed a consent form to be involved in the study (Consent for the study did not mean consent for testing.) Participants then received pre- testing HIV counseling provided by an EMD nurse who had training in HIV counseling and testing. Participants were informed that no extra charges would be incurred for the test, and that their treatment plan will not be affected by their decision to be tested. Patient privacy and confidentiality were carefully observed before and after testing regardless of the test results.

Structured case report forms were completed, documenting demographics, acceptance of testing, results and readiness to receive results.

Testing

Testing was done as per the 2016 National Guidelines for HIV and AIDS Management in Tanzania. Finger prick blood sample was collected then tested in the EMD for HIV using rapid immunochromatographic assay (SDBIOLINE HIV1/2 Alere, Abbott Laboratories, Illinois USA) as the first testing tool. Those with a negative SD BIOLINE test were considered free of HIV. If the SDBIOLINE HIV1/2 test positive, a second gold standard immunochromatographic (UniGold™ HIV, Trinity Biotech Plc, Ireland) test was used as the confirmatory test. Those with UniGold HIV test positive were considered to have HIV infection. A negative UniGold HIV test was considered inconclusive; in this case the blood sample was taken to the central pathology laboratory for HIV antibody and antigen testing and results were received the same day.

Post testing counseling

Post testing counseling was done before test results were provided. Patients were asked about their readiness to receive the test result. For those who were ready to receive test results, the results were provided. Those who were not ready to receive the test results were counseled to come back to the department at any moment that they felt ready to receive the test results, and were also told they can always go to the nearby health facility of their choosing to be tested for HIV again whenever they are ready. Those who were willing to receive their results and were positive for HIV were provided a special referral form and instructed to attend Counseling and Treatment Centers (CTC) and other HIV treatment centers for further assessment and care after their discharge from the hospital.

Provider-selected testing

For each enrolled patient, the Wellsoft electronic health record (Wellsoft Corporation, Somerset, USA) was reviewed to determine if the treating physician had ordered an HIV test. The proportion of individuals tested for HIV, and positive cases detected by the EMD physician, were compared with that detected by routine testing during the study.

Feasibility

Feasibility was assessed by noting any problems with availability of the test, difficulty of administering the test or assessing results, or any adverse events.

Follow up

HIV positive patients were contacted by telephone 2 months after their discharge to ask if they had made a visit to CTC as they were instructed.

Data analysis

Data from REDCap (Version 7.2.2, Vanderbilt, Nashville, TN, USA) was exported to Statistical Package for Social Science (SPSS version 22.0 IBM Ltd, Carolina, USA) for analysis. Descriptive statistics; median, proportion, interquartile range [IQR] and counts are reported. Proportion of trauma patients accepting HIV testing was calculated as enrolled adult trauma patients who accepted testing divided by the total number of adult trauma patients enrolled in the study. The yield was the proportion positive tests among those who accepted testing and was calculated by dividing the adult trauma patients who tested positive for HIV by the total number of adult trauma patients who accepted testing.

Results

During the study period 2848 trauma patients presented to the EMD, among them 326 (11.45%) met the inclusion criteria, gave written consent and hence enrolled in the study (Fig. 1).

Fig. 1
Fig. 1

Study Enrollment

Demographic characteristics

A total of 326 adult trauma patients were enrolled, Median age was 33 (IQR 25–42 years) and 248 (76%) were male. Total of 136 (48%) were referred from other hospitals to MNH. Approximately half of patients (160) were married, 173 (53%) were unemployed and 224 (69%) had no formal education beyond primary school Table 1.

Table 1

Demographic characteristics of trauma patients approached for an opt out HIV screening attending at EMD of MNH

Variable

Frequency, N (%)

Sex

 Male

248 (76%)

 Female

78 (24%)

Age groups

 Median age (IQR)

33 (25–42)

  18–31

145 (44%)

  32–41

100 (31%)

  42–53

51 (16%)

  54–66

19 (6%)

  > 66

11 (3%)

Referral status

 Referred

136 (48%)

 Not referred

190 (58%)

Marital status

 Married

160 (49%)

 Single

154 (47%

 Divorced

5 (2%)

 Widowed

7 (2%)

Occupation

 Public or private servant

102 (31%)

 Unemployed

173 (53%)

 Petty trader

32 (10%)

 Student

15 (5%)

 Others

4 (1%)

Education level

 Primary education

224 (69%)

 Secondary education

73 (22%)

 College/University education

21 (6%)

 No formal education

8 (3%)

Acceptance and readiness to receive test results

Of 326 patients enrolled and counseled for HIV testing, 250 patients (77%) accepted testing; 69% of all males accepted testing while all females (100%) accepted testing. Married and single patients were similar in their willingness to be tested. Acceptance was high (79%) among those with primary education.

Among the 250 patients tested, 247 (98.8%) were ready to receive their test results. One male and two females were not ready to receive their HIV test results; all 3 were single, and had not gone beyond primary school. All three had been referred from other hospitals to MNH (Tables 2 and 3).

Table 2

Distribution by gender, age, marital status and referral status of trauma patients who accepted HIV screening and were ready to receive the test results

Variable

Number

Accepted Testing for HIV

Ready to receive test results

Test results positive

Overall

N

n/N (%)

n/N (%)

n/N (%)

Total

346

250 (77.0%)

247 (98.8%)

14 (5.6%)

Sex

 Male

248

172 (69.0%)

171 (99.0%)

9 (5.2%)

 Female

78

78 (100%)

76 (97.0%)

5 (6.4%)

Age group

 18–31

145

109 (76%)

107 (98%)

5 (4.6%)

 32–41

100

78 (78%)

77 (99%)

5 (6.4%)

 42–53

51

41 (80%

41 (100%)

1 (2.4%)

 54–66

19

15 (79%)

15 (100%)

2 (13.3%)

 > 66

11

7 (64%)

7 (100%)

1 (14.3%)

Marital status

 Married

160

127 (79%)

127 (100%)

5 (3.9%)

 Single

154

115 (75%)

112 (97%)

8 (7.0%)

 Divorced

5

3 (60%)

3 (100%)

0

 Widowed

7

5 (71%)

5 (100%)

1 (20.0%)

Referral status

 Referred

190

152 (80%)

149 (98%)

12 (7.9%)

 Not referred

136

98 (72%)

98 (100%)

2 (2.0%)

Table 3

The distribution by occupation and education level of trauma patients who accepted the HIV screening and were ready to receive the test results

Number

Accepted testing for HIV

Ready to receive test results

Test results positive

Occupation

Public or private servant

102

77 (75%)

75 (97%)

6 (7.8%)

Unemployed

173

137 (79%)

136 (99%)

6 (4.4%)

Petty trader

32

24 (75%)

24 (100%)

2 (8.3%)

Student

15

8 (53%)

8 (100%)

0

Others

4

4 (100%)

4 (100%)

0

Education level

Primary education

224

176 (79%)

173 (98%)

14 (8.1%)

Secondary education

73

57 (78%)

57 (100%)

0

College/university education

21

12 (57%)

12 (100%)

0

No formal education

8

5 (63%)

5 (100%)

0

Yield

Out of 250 patients who agreed to be tested, 14 (5.6%) tested positive for HIV 9 (5.23%) were male and 5 (6.41%) were female (Fig. 1, Tables 2 and 3).

Self-reported CTC attendance

Among the 12 HIV positive patients that received results, 6 patients (50%) reported having made visits to CTC and were on ARVs; 3 patients (25%) reported to have not gone to CTC. The remaining 3 (25%) were could not reached; either their phone number were not reachable, or the person answering stated it was the wrong number (Fig. 1).

HIV testing as part of regular ED care

Of 250 patients tested for HIV during the study, none were tested for HIV as part of their regular care in the emergency department. Therefore, all 14 HIV positive patients would not have been identified by the physician who was providing care for these trauma patients.

Feasibility

During the entire period of study, all patients who agreed to be tested received the test as per National guidelines. The testing kits were available whenever needed, results were provided on time and there were no adverse events throughout study period.

Discussion

In this study we found that routine HIV testing in an emergency department in Tanzania is feasible and acceptable, majority of patients in the study were willingly tested and ready to receive their results. We found an overall HIV positivity rate of 5.6% among patients who participated in the study.

The majority of enrolled patients were young. This was due to the fact that the study was confined to trauma patients. Younger age people are at greater risk of having trauma because of their daily activities [1516]. Previous studies have also shown that younger age groups are also more likely to have HIV [1317]. However, we chose trauma patients for this study primarily because we wanted to test the feasibility and acceptability of a routine HIV testing in an otherwise healthy population and compare the results with what providers in our department normally do regarding HIV testing in such patients.

We found that routine HIV screening at the EMD for diagnosing people living with HIV, but unaware of their status is feasible, as evidenced by more than 75% of those counseled agreeing to be tested. Mass education and training has helped to raise the awareness of HIV and AIDS in Tanzania and that likely contributed to a good acceptance rate. While a previous emergency department study in the US have shown a high overall acceptance rate as in our study [23], this is not always the case. A study done in Singapore showed a very low acceptance rate which was 21% [18]. All female trauma patients approached for routine HIV testing accepted; similar studies done in different health care settings in different parts of the world have shown that the acceptance rate tends to be higher in women [17]. In our study, the unanimous acceptance rate by women may be due to the fact that women have more visits to health facilities, including antenatal and postnatal clinics where HIV education is commonly provided.

Almost all trauma patients who accepted testing were ready to receive their test results. This is similar to studies in other sub-Saharan countries: In Uganda, only 4% of patients did not appear for their HIV test result [19]. Another study from Zambia showed that all patients who accepted HIV testing were ready to receive their test results [17]. A study done in Uganda showed that of all those who agreed to be tested, only one person did not return for test results [14]. Even among those that tested positive, we found that more than 85% of those tested positive for HIV were ready to receive their test results. Similarly, studies done in Uganda did not show any difference in readiness to receive test results among those who tested positive for HIV and those who tested negative [1920]. This readiness found in all these studies, including ours, was probably due to proper pre- and post-test counseling.

Of those patients that accepted HIV screening, almost 6% tested positive which is similar to HIV prevalence in the country; the Tanzanian National Guidelines for HIV and AIDS management reports the HIV prevalence to be 4.8% [21]. The yield was much higher than in similar studies done in emergency departments in USA [1322]. Another study done in Singapore showed the yield to be much lower than in the this study (0.18%) [18]. And a study in the USA found that routine testing identified 1.9% new cases of HIV [23].

In our study, the proportion of positive HIV tests was slightly higher nationally the prevalence of HIV infection in Tanzania in women is 6.3% and 3.9% for men [8]. The higher prevalence of HIV in females is thought to be due to biological differences, which increase the chance of females acquiring the virus. This study did not show a very large difference between males and females, but not all males agreed to be tested.

One of the important goals for ED HIV screening is to link newly HIV diagnosed patients to specialized HIV centers (CTC) for continuous care. In this study, 50% of those who were HIV positive and received their results went to CTC, and at follow up reported they were already on treatment. Three others who were reached (25% of positive results) did not go to CTC. This may be due to the fact that the study enrolled trauma patients and they might not have recovered fully, preventing them from attending CTC. However, similar findings were reported in the study done in United States; only 56% of newly HIV diagnosed patients attended the specialized centers for HIV [13]. Other studies in similar settings in Uganda, Zambia and in Singapore have shown that most of the patients who have tested positive in routine HIV or PITC adhered to instructions to enroll in a clinic [141718].

In our department, most HIV screening is done to assist with diagnosis of a medical disease, and so non-suspicious patients rarely get tested. In this study we found that none of the patients that were included in the study would have been tested by the treating physician and so none of the new cases would have been identified. A study of routine HIV testing done in Emergency Department in USA showed that out 9 patients diagnosed with HIV, only 2 of them would have been diagnosed by the physician [13]. In another study conducted in USA most patients with newly diagnosed cases of HIV identified in the ED through routine testing were not admitted to the hospital, and thus would not be identified in a regular hospital care [23].

Limitations

This was a single center study, which reduces its generalizability. The study excluded children, pregnant women, unconscious patients and those with hemodynamic instability. Three of the positive patients were could not be reached, and three did not receive result limiting the ability to determine compliance with follow up care.

Conclusion

Routine HIV screening among adult trauma patients being seen in an ED in Tanzania is feasible, acceptable and helps to identify new cases of HIV positive patients who can then enroll for continuous HIV and AIDS care. Future studies should focus on factors that can increase acceptance of testing, and improve the linkage to CTC among HIV positive patients identified at the ED.

Declarations

Authors’ contributions

Conceptualization: JR HS SK EW. Data curation: JR HS SK. Formal analysis: JR HS SK. Funding acquisition: JR. Methodology: JR HS SK EW. Project administration: JR. Supervision: HS SK. Validation: JR HS SK. Writing-original draft: JR. Writing review and editing: JR HS SK EW. All authors read and approved the final manuscript.

Acknowledgements

The author would like to thank Dr. Brittany L. Murray, our research assistant, and study participants for making this project a success.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

The dataset supporting the conclusions of this article is available from the authors on request.

Consent to publication

Not applicable.

Ethics approval and consent to participate

This study was conducted after approval from the MUHAS IRB and permission from MNH. All patients consented to participate in the study.

Funding

This was a non-funded project; the principal investigators used their own funds to support the data collection and logistics.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

 

Authors:

  • Juma Ramadhani
  • Hendry R. Sawe,
  • Said S. Kilindimo,
  • Juma A. Mfinanga and
  • Ellen J. Weber

Source: https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-019-0223-5