Motivating HIV testing among MSM using internet and mobile phones

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Men who have sex with men (MSM) have the highest HIV prevalence in Peru, yet they are underserved by traditional preventive programs. In Peru, the Internet and mobile phones have emerged as an effective and convenient tool to reach this population. A study published in PLoS ONE identifies five key themes that should be considered when designing an effective campaign to motivate HIV testing.

  1. Overcome fear of getting tested for HIV. Previous studies identify “fear of the consequences of a positive test result” as the main barrier for not getting tested among MSM. Since the 1980s, HIV testing campaigns in Peru have focused on fear, stigmatizing the disease and causing people to avoid getting tested out of fear of being positive. Future campaigns need to counteract this by providing motivational messages that transmit calmness and explain that HIV is now a chronic and treatable disease.
  2. Increase risk perception. MSM with high-risk practices often do not perceive themselves at risk. A brief explanation on the modes of transmission along with messages that can prompt participants to remember common risk situations they may have experienced would be useful to better understand the risks.
  3. Explain logistics. A successful campaign should include the marketing of the personnel, the place, information about the process, including the test itself, and the price of testing. The personnel include the professionals who will perform the HIV test and who will provide the results. The place includes the physical location where the test will be conducted, the operating hours, general attractiveness, comfort and accessibility. The price refers not only to monetary cost but also intangible costs such as embarrassment and psychological strain.
  4. Avoid stigmatizing and stereotyping content. Avoid language that implies gay men are promiscuous or more likely to have HIV. Use neutral characters (not stereotyped caricatures of gay men), as well as neutral language (absence of gay-related jargon) because either they were considered stigmatizing for gay-identified MSM, or because they will not feel identified within the heterosexually-identified MSM.
  5. Use appropriate layout and language. Study participants recommended that all text based information, when possible, should always be presented with images. Language should be simple and colloquial but not vulgar. The Layout should avoid the use of red, dark or gloomy colors. When possible, use humor because it makes information easier to understand and to remember.

These results serve as the basis to design an effective campaign to motivate HIV testing among gay and non-gay identified MSM in Lima, Peru, the study concludes.

1. Blas MM, Menacho LA, Alva IE, et al. Motivating Men Who Have Sex with Men to Get Tested for HIV through the Internet and Mobile Phones: A Qualitative Study. PLoS ONE 2013; 8(1): e54012. (open access)

Stigma, discrimination against HIV-positive patients by healthcare providers

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Equipping healthcare providers with knowledge of HIV, through the provision of protocols and trainings, is of paramount importance in reducing stigma and discrimination against people living with HIV amongst healthcare providers, according to a study conducted in Southwest Ethiopia.

The healthcare providers who were aware of anti-stigma and anti-discrimination rules and regulations were less likely to contribute to stigma and discrimination.

The study also found that healthcare providers share stigma and discrimination not only related to their occupation but also present in their communities. This implies that community-based anti-stigma and anti-discrimination interventions may also be helpful.

The study makes the following recommendations for ministries/departments of health at the national, regional, or local levels, as well as healthcare institutions and non-governmental organizations working with HIV-positive patients:

  • Make available protocols related to HIV to each healthcare provider in healthcare settings.
  • Orient healthcare providers about the contents and relevance of the HIV-related policies.
  • Provide the opportunity for trainings on stigma and discrimination to healthcare providers from time to time.
  • Extend HIV-related care and support services and anti-discrimination interventions to local areas.
  • Involve people living with HIV and religious leaders in these activities.

And lastly, healthcare providers themselves should strive to update their knowledge on HIV/AIDS.

1. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012; 12: 522. (open access)

UNESCO HIV and AIDS Education Clearinghouse

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The United Nations Educational, Scientific and Cultural Organization (UNESCO) offers the UNESCO HIV and AIDS Education Clearinghouse to support education professionals, ministries of education, development agencies, civil society, researchers and other partners by providing a comprehensive knowledge base and information exchange service for the development of HIV/AIDS policies, programs and advocacy within the education sector.

The clearinghouse provides:

  • a trilingual (English, French and Spanish) website and database
  • a virtual library, updated monthly, currently containing over 4,000 references
  • alerts to scientific journal articles
  • a calendar of HIV/AIDS-related events
  • electronic newsletter subscriptions
  • an email discussion group for HIV/AIDS professionals (Asia Pacific region)
  • enquiry and literature search services

Click here to access the UNESCO HIV and AIDS Education Clearinghouse.

Sexual behavior changes reduce HIV rates in Malawi

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The HIV epidemic in Malawi has been on the decline. A study indicates that between 2000-2004 the prevalence of HIV dropped from 26 percent to 15 percent in urban areas among pregnant women and reduced by 40 percent among women aged 15-24 years. The study linked substantial positive changes in sexual behavior—such as increased condom use and fewer sex partners—to the decline.

In the 2000-2004 study period, the percentage of adolescents aged 15–19 years who first had sex before age 15 decreased from 29 percent to 18 percent among males and 17 percent to 14 percent among females. The proportion of men who had sex with multiple partners reduced from 15 percent to nine percent among men aged 15–49 years and from 12 percent to seven percent among young adults aged 15–24 years. Only one percent of women reported having two or more partners and this did not change between 2000-2004. The rate of men with multiple partners that used condoms increased from 14 percent to 20 percent among men aged 15–49 years and from 27 percent to 35 percent among young men aged 15–24 years.

“The declines in prevalence in urban areas were associated with the behaviour changes and…if the changes are maintained, this will have cumulatively averted 140,000 HIV infections by 2010,” the study concluded.

1. Bello G, Simwaka B, Ndhlovu T, et al. Evidence for changes in behaviour leading to reductions in HIV prevalence in urban Malawi. Sexually Transmitted Infections, published online 23 March 2011. (open access)

HIV among IDUs in Georgia

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A study shows that prevalence of HIV among injection drug users (IDUs) ranges between 2.5-4.5 percent in Georgia—similar to neighboring countries Turkey (1.5 percent) and Armenia (6.8 percent), but lower than former Soviet countries like Azerbaijan (10.3 percent) and Ukraine (22.9 percent).

HIV prevalence in Georgia is low, but increasing. In 2004, HIV rate in Tbilisi was 0.4 percent and 2.1 percent in Batumi. Close to 65 percent of IDUs tested in Tbilisi in 2006 were infected with hepatitis C.

Proximity to drug trafficking and distribution routes and exposure to war are known to influence risk of HIV acquisition, according to the study. Georgia is situated on the Silk Route (or North Route) of opiate trafficking from Afghanistan, and there are unresolved conflict areas in the northern parts of Georgia.

According to the World Drug Report, opiate seizures have been declining through the Silk Route, but at the same time, the Georgian Internal Services reports a substantial increase of illegal smuggling of buprenorphine from European countries. All of this re-emphasizes the need for structural HIV prevention interventions, according to the study.

1. Chikovani I, Goguadze K, Ranade S, et al. Prevalence of HIV among injection drug users in Georgia. Journal of the International AIDS Society 2011; 14: 9. (open access)

India: NNRTI drugs raise cholesterol in HIV patients with TB

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Studies have shown that the Indian population in general has a high risk of cardiovascular disease (because of genetic and other factors), and there is concern that HIV infection and treatment with antiretroviral therapy (ART) may increase that risk.

A study conducted in south India found that HIV-positive patients with tuberculosis (TB) who initiated once-daily nonnucleoside reverse-transcriptase inhibitor (NNRTI)–based ART under went complex changes in their cholesterol levels, highlighting the importance of screening and treating other cardiovascular disease risk factors. The patients were also treated with rifampicin-based thrice-weekly antituberculosis treatment.

After 12 months of receiving NNRTI-based ART, HDL, LDL and total cholesterol levels increased significantly. The results that around 25 percent of patients who received an NNRTI-based regimen had an abnormal lipid profile at one year should alert physicians to this outcome and encourage testing, the study authors said.

“Although the current World Health Organization guidelines do not recommend routine monitoring of lipid levels for patients receiving first-line antiretroviral treatment, patients would benefit from an assessment of lipid profiles and other cardiovascular risk factors followed by counseling on risk-reduction strategies,” the study said. “As patients continue to enjoy longer lives as a result of effective treatment, it is important to consider and minimize long-term adverse effects of the disease and its treatment.”

1. Padmapriyadarsini C, Kumar SR, Terrin N, et al. Dyslipidemia among HIV-infected patients with tuberculosis taking once-daily nonnucleoside reverse-transcriptase inhibitor–based antiretroviral therapy in India. Clinical Infectious Diseases 2011; 52(4): 540-546. (open access)

Reversing China’s HIV/AIDS epidemic by 2015

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In the past decade, tremendous efforts have been made and impressive achievements have been obtained in accelerating universal access for HIV prevention, treatment and care and support worldwide and in China. China is one of only a few low- and middle-income countries in which domestic funds account for the major proportion of their HIV/AIDS program funding.

The International Journal of Epidemiology December 2010 supplement issue entitled “China’s AIDS Policy Implementation,” has assembled and editorial and 11 papers describing the various aspects of China’s response to the HIV/AIDS epidemic. All articles in the issue are open access.

Editorial: China AIDS policy implementation: reversing the HIV/AIDS epidemic by 2015

1. Evolution of information-driven HIV/AIDS policies in China
China’s current national policies are increasingly information driven and responsive to changes in the epidemic. However, gaps remain in policy implementation, and new policies are needed to meet emerging challenges.

2. Contributions of international cooperation projects to the HIV/AIDS response in China
International cooperation projects have been an invaluable component of China’s response to HIV/AIDS, and China has now been able to take this information and share its experiences with other countries with the help of these same international programs.

3. Estimating the number of people living with HIV/AIDS in China: 2003–09
Repeated estimates have improved understanding of the HIV/AIDS epidemic in China. HIV estimates are a valuable tool for guiding national AIDS policies evaluating HIV prevention and control programs.

4. Scaling up the national methadone maintenance treatment program in China: achievements and challenges
This article documents the steps China made in overcoming the many barriers to success of its methadone program. These lessons might be useful for other countries in the region that are scaling-up their methadone programs.

5. Scaling up prevention programmes to reduce the sexual transmission of HIV in China
Prevention programs for reducing sexual transmission of HIV have reasonable coverage, but can still improve. The quality of intervention needs to be improved in order to have a meaningful impact on changing behaviour to reducing HIV sexual transmission. Systematic evaluation of the policies, guidelines and intervention programmes needs to be conducted to understand their impact and to maintain adherence.

6. Design and implementation of a China comprehensive AIDS response programme (China CARES), 2003–08
China CARES has facilitated AIDS prevention, treatment and care in resource-poor, rural and ethnic minority areas of China.

7. Changing baseline characteristics among patients in the China National Free Antiretroviral Treatment Program, 2002–09
Limited treatment resources can be focused on areas with more patients. Greater emphasis needs to be placed on earlier HIV diagnosis and treatment. New strategies must be identified to bring HIV-infected injection drug users into treatment. Routine HIV testing would identify those at risk earlier.

8. From spectators to implementers: civil society organizations involved in AIDS programmes in China
Civil society organizations (CSOs) have significantly increased their participation and contribution to HIV/AIDS programs in China. Policies for registration and financial support to CSOs need to be developed to enable them to play an even greater role in HIV/AIDS programs.

9. Quality assurance in the HIV/AIDS laboratory network of China
China has made significant progress in establishing a well-coordinated HIV laboratory network and quality assurance systems. However, the coverage and intensity of HIV testing and quality assurance programs need to be strengthened so as to ensure that more infected persons are diagnosed and that they receive timely prevention and treatment services.

10. Development of a unified web-based national HIV/AIDS information system in China
China’s new unified, web-based HIV/AIDS information system has improved the efficiency of data collection, reporting, analysis and use, as well as data quality and security. It is a powerful tool to support policy making, program evaluation and implementation of the national HIV/AIDS program and, thus, may serve a model for other countries.

11. Quantitatively monitoring AIDS policy implementation in China
Setting targets for core indicators and monitoring performance has facilitated implementation of the national AIDS program in China.

HIV decline in Zimbabwe due to reductions in risky sex

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A study has found convincing evidence of an HIV decline accelerated by changes in sexual behavior in Zimbabwe, an African country ravaged by HIV/AIDS.

HIV prevalence fell in Zimbabwe over the past decade—from 29.3 percent in 1997 to 15.6 percent in 2007. Reductions in the proportions of men and women with non-regular sexual partners and sustained high levels of condom use during this period likely contributed to the decline in HIV prevalence.

Estimates indicated that HIV incidence may have peaked in the early 1990s and fallen during the 1990s; and multiple local and national surveys showed substantial rises in AIDS-related deaths during the 1990s leveling off after 2000.

However, AIDS-related deaths in Zimbabwe remained at crisis levels in the mid-2000s, according to the study.

1. Gregson S, Gonese E, Hallet TB, et al. HIV decline in Zimbabwe due to reductions in risky sex? Evidence from a comprehensive epidemiological review. International Journal of Epidemiology 2010; 39(5): 1311-1323. (open access)

Men and women in sub-Saharan Africa have equal chance of having an HIV-positive partner

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Women and men in sub-Saharan Africa are equally likely to be the index partner in a couple where only only partner is HIV-positive, according to a systematic review published in the November 2010 issue of The Lancet Infectious Diseases. These results have important implications for prevention strategies.

Although most social marketing aimed at reducing extramarital relationships is targeted at men, efforts should also take into account the role of women, review authors said. Similarly, both men and women in relationships should be informed about the need for condom use when HIV status is unknown. Although the man’s role in infecting the female partner has been the dominant focus in prevention strategies, the emphasis should be revised in the context of stable couples, since uninfected men and women seem to have an equal chance of having a stable partner who has HIV.

1. Eyawo O, de Walque D, Ford N, et al. HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Infectious Diseases 2010; 10(11): 770-777 (open access; free registration required)

Routine HIV testing helps prevent mother-to-child transmission

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A policy change from voluntary HIV testing to routine HIV testing for pregnant women led to a dramatic and sustained increase in the number of mothers tested for HIV in Mbale, Uganda. The findings are from a seven-year study published on 14 October 2010 in the journal BMC Health Services Research.

The percentage of pregnant women who were tested for HIV increased from 22 percent during the period when HIV testing was recommended on a voluntary basis to more than 87 percent when HIV testing was routine and initiated by health care providers. The study also indicated that the prevalence of HIV-positive prenatal patients at Mbale Regional Referral Hospital over the seven-year study period was 6.1 percent.

Read more at Suite101.

1. Byamugisha R, Tylleskar T, Kagawa MN, et al. Dramatic and sustained increase in HIV-testing rates among antenatal attendees in Eastern Uganda after a policy change from voluntary counselling and testing to routine counselling and testing for HIV: a retrospective analysis of hospital records, 2002-2009. BMC Health Services Research 2010; 10: 290. (open access)

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