The seemingly intractable problem of HIV-related stigma
Michelle Croston, Sarah Rutter in Psychological Perspectives in HIV Care, 2020
This chapter addresses how stigma is created and focuses on the creation and maintenance of HIV-related stigma. The introduction of antiretroviral therapy (ART) in the mid-1990s has saved the lives of millions of children with HIV. Due to the success of early identification of HIV and effective treatment with ART, most children and young people with HIV in the United Kingdom survive into adolescence and adulthood. Young people living with HIV, both in the UK and worldwide, experience the ordinary challenges of adolescence but may be also exposed to HIV-related stigma that interferes with their ability to adjust to and cope with their diagnosis. Most HIV-related stigma research and theory is based on Goffman’s work, which described stigma as a type of “spoiled identity” which occurs when a person or group possess a particular attribute that is viewed by others in society as an “undesirable difference”.
The changing narratives of HIV death and dying
Jose Catalan, Barbara Hedge, Damien Ridge in HIV in the UK, 2020
The association of HIV with death was inescapable from the early days of the epidemic. The experience of death and the responses of friends and partners, and also of health and charity workers facing the horror of high numbers of young people dying in unpleasant ways, had a powerful impact on all involved. A kind of ‘death literacy’ developed, with creative responses to living and dying emerging, where funerals often became celebrations of life. Death from HIV is now less frequent, but many who had lived through the earlier times continue to live under not only its shadow, but also its positive influences. Denial of death is possible again despite the ageing of the original players in the epidemic, as well as new deaths in people living with HIV from the use of recreational drugs.
Postscript: What can the HIV epidemic tell us about COVID-19?
Jose Catalan, Barbara Hedge, Damien Ridge in HIV in the UK, 2020
HIV and the coronavirus seemed to appear suddenly on the scene, although both were spreading in the community before they were recognised. Some argued that HIV could have been predicted, as Larry Kramer had in the US, and the likelihood of another flu-like pandemic had been anticipated by many. Prevention of coronavirus spread requires a combination of political and public health decisions, and the engagement of individuals from the populations at risk in responding positively to such recommendations. Testing, contact tracing, and isolation are clear examples of the political and public health actions needed. With HIV treatment success, marginalised people remained so, with ongoing health problems, little suitable work available, few savings, and poor mental health. With COVID-19, those with the least resources – including poorly paid key workers – are not able to work from home or self-isolate like many in the middle-classes can do to protect themselves.
Assessment of Vascular Function in HIV-Infected Patients
Published in HIV Clinical Trials, 2011
Juliana P. Borges, Eduardo Tibiriçá, Pedro Paulo S. Soares, Bruno Benedito, Dirce B. Lima, Marília B. Gomes, Paulo T.V. Farinatti
Purpose: The vascular function in HIV-infected persons under HAART and non-HIV-infected persons was investigated.Method: 18 HIV-positive patients and 23 HIV-negative subjects (14 younger group and 9 older group) were evaluated for microvascular vasodilatation during postocclusive reactive hyperemia (PORH) and during prolonged local thermal hyperemia; overall microvascular flux increase induced by iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNPDVP); Cutaneous vascular conductance (CVC) responses to ACh were lower in HIV patients compared to both HIV-negative groups (mean [SEM]) (HIV positive: 878.2 [99.5]; older HIV negative: 1129.3 [231.6]; younger HIV negative: 1366.5 [172.6] % baseline). Regarding SNP iontophoresis, HIV-positive and older HIV-negative groups showed lower CVC responses than younger HIV-negative group (HIV positive: 1043.0 [164.6]; older HIV-negative: 980.8 [108.3]; younger HIV-negative: 1757.3 [245.1] % baseline). Vasodilatation induced by thermal hyperemia (HIV positive: 1.63 [0.11]; older HIV negative: 1.48 [0.08]; younger HIV negative: 1.85 [0.27] perfusion units/mm Hg) and PORH (HIV positive: 0.374 [0.025]; older HIV negative: 0.326 [0.025]; younger HIV negative: 0.326 [0.037] PU/mm Hg) were similar between all groups. SIDVP was greater in HIV and older healthy groups than younger healthy group (HIV positive: 9.17 [0.42]; older HIV negative: 8.19 [0.43]; younger HIV negative: 6.42 [0.22] m/s).Conclusion: HIV-infected patients under HAART exhibited slight but nonsignificant lower microvas-cular reactivity to pharmacological stimuli and increased arterial stiffness compared to age-matched HIV-negative subjects. Comparison of both HIV-positive and older HIV-negative groups with younger HIV-negative subjects suggests that age plays a major role in microvascular reactivity regardless the HIV-infection.
Clinical presentation and opportunistic infections in HIV-1, HIV-2 and HIV-1/2 dual seropositive patients in Guinea-Bissau
Published in Infectious Diseases, 2016
Allan Sørensen, Sanne Jespersen, Terese L Katzenstein, Candida Medina, David da Silva Té, Faustino Gomes Correira, Cecilie Juul Hviid, Alex Lund Laursen, Christian Wejse
Background: Better understanding of HIV-2 infection is likely to affect the patient care in areas where HIV-2 is prevalent. In this study, we aimed to characterize the clinical presentations among HIV-1, HIV-2 and HIV-1/2 dual seropositive patients. Methods: In a cross-sectional study, newly diagnosed HIV patients attending the HIV outpatient clinic at Hospital Nacional Simão Mendes in Guinea-Bissau were enrolled. Demographical and clinical data were collected and compared between HIV-1, HIV-2 and HIV-1/2 dual seropositive patients. Results: A total of 169 patients (76% HIV-1, 17% HIV-2 and 6% HIV 1/2) were included in the study between 21 March 2012 and 14 December 2012. HIV-1 seropositive patients were younger than HIV-2 and HIV-1/2 seropositive patients, but no difference in sex was observed. Patients with HIV-1 and HIV-1/2 had a lower baseline CD4 cell count than HIV-2 seropositive patients (median CD4 cell count 185, 198 and 404 cells/μl, respectively (p value 0.001 and 0.05). HIV-1 seropositive patients had a lower BMI and a higher prevalence of weight loss, skin rash and productive cough than HIV-2 seropositive patients (p value 0.03, 0.002, 0.03 and 0.04). Only four cases (2%) of pulmonary tuberculosis (TB) were diagnosed. One patient (1/96, 1%) was tested positive for cryptococcal antigen. Conclusion: HIV-1 and HIV-1/2 seropositive patients have lower CD4 cell counts than HIV-2 seropositive patients when diagnosed with HIV with only minor clinical and demographic differences among groups. Few patients were diagnosed with TB and cryptococcal disease was not found to be a major opportunistic infection among newly diagnosed HIV patients.
The need to know: HIV status disclosure expectations and practices among non-HIV-positive gay and bisexual men in Australia
Published in AIDS Care, 2015
Dean A. Murphy, John B.F. de Wit, Simon Donohoe, Philippe C.G Adam
Although there is evidence of increasing overall rates of HIV status disclosure among gay and bisexual men, little is known about men's disclosure expectations and practices. In this study, we investigate the importance non-HIV-positive men in Australia vest in knowing the HIV status of their sexual partners, and the extent to which they restrict sex to partners of the same HIV status, and their HIV disclosure expectations. Data were collected through a national, online self-report survey. Of the 1044 men included in the study, 914 were HIV negative and 130 were untested. Participants completed the assessment of socio-demographic characteristics, HIV status preferences, and disclosure expectations and practices. Participants also completed reliable multi-item measures of perceived risk of HIV transmission, expressed HIV-related stigma, and engagement with the gay community and the community of people living with HIV. A quarter (25.9%) of participants wanted to know the HIV status of all sexual partners, and one-third (37.2%) restricted sex to partners of similar HIV status. Three quarters (76.3%) expected HIV-positive partners to disclosure their HIV status before sex, compared to 41.6% who expected HIV-negative men to disclose their HIV status. Less than half (41.7%) of participants reported that they consistently disclosed their HIV status to sexual partners. Multivariate linear regression analysis identified various covariates of disclosure expectations and practices, in particular of disclosure expectations regarding HIV-positive men. Men who expected HIV-positive partners to disclose their HIV status before sex more often lived outside capital cities, were less educated, were less likely to identify as gay, perceived more risk of HIV transmission from a range of sexual practices, were less engaged with the community of people living with HIV, and expressed more stigma towards HIV-positive people. These findings suggest that an HIV-status divide is emerging or already exists among gay men in Australia. HIV-negative and untested men who are most likely to sexually exclude HIV-positive men are less connected to the HIV epidemic and less educated about HIV risk and prevention.