http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Tue, 07 May 2013 09:20:09 +0000 http://www.hindawi.com/journals/art/2013/485715/ HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32–5.56), HIV education (aOR 3.28, 95% CI 1.92–6.83), and wait time (aOR 1.97 95% CI 1.03–3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06–3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33–8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction. Thomas A. Odeny, Jeremy Penner, Jayne Lewis-Kulzer, Hannah H. Leslie, Starley B. Shade, Walter Adero, Jackson Kioko, Craig R. Cohen, and Elizabeth A. Bukusi Copyright © 2013 Thomas A. Odeny et al. All rights reserved. Thu, 02 May 2013 09:15:26 +0000 http://www.hindawi.com/journals/art/2013/915923/ Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including misunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP training, and contraceptive shortages. Conclusions. These findings suggest the importance of considering issues such as patient flow, provider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing integrated FP/HIV services in high HIV prevalence areas. Sara J. Newmann, Kavita Mishra, Maricianah Onono, Elizabeth A. Bukusi, Craig R. Cohen, Olivia Gage, Rose Odeny, Katie D. Schwartz, and Daniel Grossman Copyright © 2013 Sara J. Newmann et al. All rights reserved. Tue, 30 Apr 2013 08:42:50 +0000 http://www.hindawi.com/journals/art/2013/861983/ This study explored barriers to and facilitators of using family planning services among HIV-positive men in Nyanza Province, Kenya. From May to June 2010, in-depth interviews were conducted with 30 men receiving care at 15 HIV clinics. The key barriers to the use of family planning included concerns about side effects of contraceptives, lack of knowledge about contraceptive methods, myths and misconceptions including fear of infertility, structural barriers such as staffing shortages at HIV clinics, and a lack of male focus in family planning methods and service delivery. The integration of family planning into HIV clinics including family planning counseling and education was cited as an important strategy to improve family planning receptivity among men. Integrating family planning into HIV services is a promising strategy to facilitate male involvement in family planning. Integration needs to be rigorously evaluated in order to measure its impact on unmet need for contraception among HIV-positive women and their partners and assure that it is implemented in a manner that engages both men and women. Rachel L. Steinfeld, Sara J. Newmann, Maricianah Onono, Craig R. Cohen, Elizabeth A. Bukusi, and Daniel Grossman Copyright © 2013 Rachel L. Steinfeld et al. All rights reserved. Mon, 29 Apr 2013 14:56:13 +0000 http://www.hindawi.com/journals/art/2013/736926/ Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV). We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya. Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups ( groups) and in-depth interviews () with healthcare workers and community members. Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37%) reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting. Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa. Janet M. Turan, Abigail M. Hatcher, Merab Odero, Maricianah Onono, Jannes Kodero, Patrizia Romito, Emily Mangone, and Elizabeth A. Bukusi Copyright © 2013 Janet M. Turan et al. All rights reserved. Sun, 28 Apr 2013 16:09:21 +0000 http://www.hindawi.com/journals/art/2013/715381/ This study considers social network interactions as a potential source of support for individuals living with HIV/AIDS in Iran. This cross-sectional study was conducted on 224 people with HIV/AIDS who refer to behavioral counseling centers. Participants were randomly selected among all people with HIV/AIDS from these centers. Relatives were more reported as sources of support than nonrelatives. They were closer to participants, but there was difference between the closest type among relative and nonrelative supporters . Mean of functional support with considering the attainable range 0–384 was low . Social support of participants has been found to be associated with CD4 cell count , sex , and network size after adjusted for other variables in the final model. Totally, in this study, many of participants had the static social support network that contained large proportions of family and relatives. The findings contribute to the evidence for promotion of knowledge about social support network and social support of people living with HIV/AIDS. Ameneh Setareh Forouzan, Zahra Jorjoran Shushtari, Homeira Sajjadi, Yahya Salimi, and Masoumeh Dejman Copyright © 2013 Ameneh Setareh Forouzan et al. All rights reserved. Mon, 15 Apr 2013 08:22:18 +0000 http://www.hindawi.com/journals/art/2013/235902/ With wider access to antiretroviral therapy, people living with HIV are reconsidering their reproductive decisions: remarrying and having children. The purpose of the paper is to explore sources of information for reproductive decision used by couples living with HIV in patrilineal and matrilineal districts of Malawi. Data were collected from forty couples from July to December 2010. Our results illuminate five specific issues: some of the informants (1) remarry after divorce/death of a spouse, (2) establish new marriage relationship with spouses living with HIV, and (3) have children hence the need for information to base their decisions. There are (4) shared and interactive couple decisions, and (5) informal networks of people living with HIV are the main sources of information. In addition, in matrilineal community, cultural practices about remarriage set up structures that constrained information availability unlike in patrilineal community where information on sexual and reproductive health, HIV, and AIDS was disseminated during remarriage counselling. However, both sources are not able to provide comprehensive information due to complexity and lack of up to date information. Therefore, health workers should, offer people living with HIV comprehensive information that takes into consideration the cultural specificity of groups, and empower already existing and accepted local structures with sexual and reproductive health, HIV, and AIDS knowledge. Belinda Chimphamba Gombachika, Ellen Chirwa, Address Malata, and Alfred Maluwa Copyright © 2013 Belinda Chimphamba Gombachika et al. All rights reserved. Mon, 18 Mar 2013 17:20:21 +0000 http://www.hindawi.com/journals/art/2013/350169/ AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA. Kathleen A. McManus, Carolyn L. Engelhard, and Rebecca Dillingham Copyright © 2013 Kathleen A. McManus et al. All rights reserved. Thu, 07 Mar 2013 12:02:46 +0000 http://www.hindawi.com/journals/art/2013/249171/ Mitochondrial damage is implicated in highly active antiretroviral therapy (HAART) toxicity. HIV infection also causes mitochondrial toxicity (MT). Differentiating between the two is critical for HIV management. Our objective was to test the utility of the Mitochondrial Disease Criteria (MDC) and the Enquête Périnatale Française (EPF) to screen for possible HAART related MT in HIV-infected children in Ghana. The EPF and MDC are compilations of clinical symptoms, or criteria, of MT: a (+) score indicates possible MT. We applied these criteria retrospectively to 403 charts of HIV-infected children. Of those studied, 331/403 received HAART. Comparing HAART exposed and HAART naïve children, the difference in EPF score, but not MDC, approached significance (). Young age at HIV diagnosis or at HAART initiation was associated with (+) EPF (). Adherence to HAART trended toward an association with (+) EPF (). Exposure to nevirapine, abacavir, or didanosine increased risk of (+) EPF (OR = 3.55 (CI = 1.99–6.33), 4.76 (2.39–9.43), 4.93 (1.29–18.87)). Neither EPF nor MDC identified a significant difference between HAART exposed or naïve children regarding possible MT. However, as indicators of HAART exposure are associated with (+) EPF, it may be a candidate for prospective study of possible HAART related MT in resource-poor settings. Allison Langs-Barlow, Lorna Renner, Karol Katz, Veronika Northrup, and Elijah Paintsil Copyright © 2013 Allison Langs-Barlow et al. All rights reserved. Mon, 04 Mar 2013 13:21:31 +0000 http://www.hindawi.com/journals/art/2013/108630/ This paper examines the association between female sex workers' (FSWs) noncommercial partnerships with risk of HIV in Andhra Pradesh, India. Data were drawn from a cross-sectional behavioral and biological survey conducted in 2009 among 3225 FSWs from Andhra Pradesh. Participants were asked about their sexual partnerships, condom use, and vulnerability factors and tested for HIV and sexually transmitted infections. The key independent variables considered were presence of a noncommercial sexual partner (no, yes) and the nature of such partnerships (regular, nonregular). FSWs who reported husband as noncommercial partner were considered to have a regular partner, while the rest were defined as having nonregular partners. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated to measure the associations between variables of interest. Almost three-fourths (74.8%) of FSWs reported having noncommercial partners (regular: 55.6%; nonregular: 19.3%). FSWs in nonregular partnerships were more likely to be HIV positive (13.1% versus 10.9%, adjusted OR: 1.4, 95% CI: 1.1–1.8), have syphilis (10.3% versus 4.2%, adjusted OR: 2.3, 95% CI: 1.6–3.3), use condoms inconsistently with occasional clients (21.0% versus 16.5%, adjusted OR: 1.5, 95% CI: 1.2–1.9), and report forced sex (25.1% versus 14.1%, adjusted OR: 1.9, 95% CI: 1.5–2.4) as compared to those in regular partnerships. HIV prevention programs need to emphasize safe sex behaviors, particularly among FSWs who have nonregular partners. Renuka Pulikallu Somanath, Ram Manohar Mishra, Niranjan Saggurti, and Prabhakar Parimi Copyright © 2013 Renuka Pulikallu Somanath et al. All rights reserved. Thu, 28 Feb 2013 08:16:57 +0000 http://www.hindawi.com/journals/art/2013/790154/ Women worldwide confront two frequently concurrent reproductive health challenges: the need for contraception and for protection from sexually transmitted infections, importantly HIV/AIDS. While conception and infection share the same anatomical site and mode of transmission, there are no reproductive health technologies to date that simultaneously address that reality. Relevant available technologies are either contraceptive or anti-infective, are limited in number, and require different modes of administration and management. These “single-indication” technologies do not therefore fully respond to what is a substantial reproductive health need intimately linked to pivotal events in many women's lives. This paper reviews an integrated attempt to develop multipurpose prevention technologies—“MPTs”—products explicitly designed to simultaneously address the need for both contraception and protection from sexually transmitted infections. It describes an innovative and iterative MPT product development strategy with the following components: identifying different needs for such technologies and global variations in reproductive health priorities, defining “Target Product Profiles” as the framework for a research and development “roadmap,” collating an integrated MPT pipeline and characterizing significant pipeline gaps, exploring anticipated regulatory requirements, prioritizing candidates for problem-solving and resource investments, and implementing an ancillary advocacy agenda to support this breadth of effort. P. F. Harrison, A. Hemmerling, J. Romano, K. J. Whaley, and B. Young Holt Copyright © 2013 P. F. Harrison et al. All rights reserved. Tue, 26 Feb 2013 07:57:55 +0000 http://www.hindawi.com/journals/art/2013/709810/ Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was years, and median CD4 count was 49 cells/mm3 (interquartile range (QR): 17–90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0–5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality. Henry Namme Luma, Benjamin Clet Nguenkam Tchaleu, Elvis Temfack, Marie Solange Doualla, Daniela Pamela Ntchankam Ndenga, Yacouba Njankouo Mapoure, Alfred Kinyuy Njamnshi, and Vincent-de-Paul Djientcheu Copyright © 2013 Henry Namme Luma et al. All rights reserved. Mon, 11 Feb 2013 15:31:10 +0000 http://www.hindawi.com/journals/art/2013/706191/ Introduction. There have been no scales specifically developed to assess physician-patient communication behaviors (PPCB) in the sub-Saharan population. Aim. We revised an existing PPCB scale and tested its psychometric properties for HIV patients in Kenya. Methods. 17 items (five-point scale) measuring PPCB were initially adopted from the Matched Pair Instrument (MPI). Between July and August 2011, we surveyed a convenient sample of 400 HIV adult patients, attending three Academic Model Providing Healthcare program (AMPATH) clinics in Eldoret, Kenya. Of these 400, eight also participated in cognitive interviews, and 200 were invited to return after one week for follow-up interviews; 134 (67%) returned and were interviewed. Construct and content validity were established using an exploratory factor analysis, bivariate analyses, internal consistency, test-retest reliability and cognitive interviews. Results. Construct and content validity supported a one-dimensional measure of 13 PPCB items. Items assessed physicians’ effort to promote a favorable atmosphere for interaction with HIV patients. Biases associated with encoding and comprehension of specific terms, such as “discussion, involvement or concerns,” were noted. Internal consistency (Cronbach’s alpha = .81) and one-week retest reliability scores (.82) supported the reliability of the 13-item scale. Discussion. The revised PPCB scale showed acceptable validity and reliability in Kenya. Juddy Wachira, Susan Middlestadt, Michael Reece, Chao-Ying Joanne Peng, and Paula Braitstein Copyright © 2013 Juddy Wachira et al. All rights reserved. Thu, 31 Jan 2013 14:50:28 +0000 http://www.hindawi.com/journals/art/2013/504792/ A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services established through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women's HIV testing and general utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants through strengthened referral and operational linkages amongst health facilities/services and community-based support interventions for PLHIV. The study was conducted in one operational district where the intervention was piloted and for comparative purposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved collaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing through integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued by families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering PLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision. Challenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst non-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission. Joanna White, Thérèse Delvaux, Chhorvann Chhea, Sarun Saramony, Vichea Ouk, and Vonthanak Saphonn Copyright © 2013 Joanna White et al. All rights reserved. Tue, 29 Jan 2013 10:03:46 +0000 http://www.hindawi.com/journals/art/2013/492831/ This observational analysis examined the clinical outcomes of patients receiving etravirine-(ETR-) based therapy, particularly with protease inhibitors (PIs) other than darunavir (DRV) and with raltegravir (RAL). Data included treatment-experienced adults in the HIV Research Network who began ETR-containing antiretroviral regimens in 2008–2010. The primary objective was to assess 6-month outcomes (durability, i.e., still on an ETR-containing regimen; change in CD4+ cell count and HIV-1 RNA <400 copies/mL). The cohort included 587 patients receiving ETR; 42% of ETR use was in patients not on DRV/ritonavir (r). Patients receiving ETR plus DRV/r had longer durability versus those on ETR plus a PI other than DRV/r at months 6 (91.2% versus 85.5%) and 12 (77.4% versus 65.2%), respectively. Patients on regimens with a PI other than DRV/r were the least likely to be receiving ETR at month 6 (85.5%) versus patients on other ETR-based regimens. Patients on regimens without a PI and without RAL had lower virologic suppression (month 6, 54.2%; month 12, 63.2%) versus patients on other ETR-based regimens. In a clinical care, nontrial setting, ETR was used in regimens without DRV/r. In this population, the 6-month response rates were similar and durable across all regimens, except when ETR was used without RAL and without a PI. Kelly Gebo, Cindy Voss, Joseph Mrus, and HIV Research Network Copyright © 2013 Kelly Gebo et al. All rights reserved. Mon, 28 Jan 2013 09:19:12 +0000 http://www.hindawi.com/journals/art/2013/362972/ Background. Clinical benefits of ART are well documented, but less is known about its effects on economic outcomes such as work status and income in sub-Saharan Africa. Methods. Data were examined from 482 adult clients entering HIV care (257 starting ART; 225 not yet eligible for ART) in Kampala, Uganda. Self-reported data on work status and income were assessed at baseline, months 6 and 12. Multivariate analysis examined the effects of ART over time, controlling for change in physical health functioning and baseline covariates. Results. Fewer ART patients worked at baseline compared to non-ART patients (25.5% versus 34.2%); 48.8% of those not working at baseline were now working at month 6, and 50% at month 12, with similar improvement in both the ART and non-ART groups. However, multivariate analysis revealed that the ART group experienced greater improvement over time. Average weekly income did not differ between the groups at baseline nor change significantly over time, among those who were working; being male gender and having any secondary education were predictive of higher income. Conclusions. ART was associated with greater improvement in work status, even after controlling for change in physical health functioning, suggesting other factors associated with ART may influence work. Annet Nannungi, Glenn Wagner, and Bonnie Ghosh-Dastidar Copyright © 2013 Annet Nannungi et al. All rights reserved. Thu, 17 Jan 2013 14:52:54 +0000 http://www.hindawi.com/journals/art/2013/580974/ Background. Suboptimal adherence to antiretroviral therapy (ART) is still pervasive. The effect of using a mobile phone call intervention to improve patient adherence is currently not known. Objective. This study aims to investigate the effects of a phone call intervention on adherence to ART and quality of life (QOL) of treatment-naive and treatment-experienced patients. Methods. A randomized controlled trial was conducted in the three largest public hospitals. Adherence was measured by self-completed questionnaires. QOL was assessed by the WHOQOL-HIV BREF. Outcomes were assessed at day 15, at 1, 2, and 3 months after start of treatment for treatment-naive patients and at 3 months after study enrollment for treatment-experienced patients. Results. A total of 103 treatment-naive and 93 treatment-experienced HIV/AIDS patients were consecutively recruited. Results show that a phone call intervention could maintain high self-reported adherence among both treatment-naive and treatment-experienced patients. After three months, significant QOL improvements were observed in domains of physical health , level of independence , environment , and spirituality/religion/personal beliefs among treatment-naive patients. Conclusion. A mobile phone call intervention to patients could maintain high adherence rates although no statistically significant differences were found. A phone call could improve some domains of QOL among treatment-naive patients. Dongsheng Huang, Rassamee Sangthong, Edward McNeil, Virasakdi Chongsuvivatwong, Weibin Zheng, and Xuemei Yang Copyright © 2013 Dongsheng Huang et al. All rights reserved. Thu, 10 Jan 2013 09:44:17 +0000 http://www.hindawi.com/journals/art/2013/731983/ Giuseppe Ippolito, Jay A. Levy, Anders Sonnerborg, Ferdinand Mugusi, and Ferdinando Dianzani Copyright © 2013 Giuseppe Ippolito et al. All rights reserved. Wed, 09 Jan 2013 11:53:34 +0000 http://www.hindawi.com/journals/art/2013/878151/ Purpose. Little is known about the risky sexual behaviors of HIV-positive female sex workers (FSWs) in the developing world, which is critical for programmatic purposes. This study aims to shed light on their condom use with regular clients as well as husband/cohabiting partner, a first in India. Methods. Multivariate logistic regression analyses for consistent condom use with regular clients and husband/cohabiting partner are conducted for the sample of 606 HIV-positive FSWs. Results. Older FSWs are 90% less likely and nonmobile FSWs are 70% less likely to consistently use condoms. FSWs on ART are 3.84 times more likely to use condoms. Additionally, FSWs who changed their occupation after HIV diagnosis are 70% less likely to use condoms. FSWs who are currently cohabiting are more likely to consistently use condoms with repeat clients and are 3.22 times more likely to do so if they have felt stigma associated with being HIV-positive. FSWs who have multiple repeat clients, and who do not know the sexual behavior of these clients, are more likely to use condoms consistently. Conclusion. This study would help inform programs to target the following particularly vulnerable HIV-positive FSWs: those who are older, those who changed their occupation post-HIV diagnosis, and those who are nonmobile. Apoorva Jadhav, Parinita Bhattacharjee, T. Raghavendra, James Blanchard, Stephen Moses, Shajy Isac, and Shiva S. Halli Copyright © 2013 Apoorva Jadhav et al. All rights reserved. Sun, 30 Dec 2012 13:43:35 +0000 http://www.hindawi.com/journals/art/2012/842576/ Objective. To examine the reproductive health practices of female sex workers (FSWs) in the context of an HIV prevention program in Karnataka, India. Methods. Data obtained from a survey of 1,011 FSWs registered with an HIV prevention program. We examined reproductive health indicators, and performed multivariate logistic regression among primiparous FSWs to assess sex work during pregnancy and antenatal HIV testing. Results. Among primiparous FSWs (), 92.0% continued sex work during pregnancy, and 55.4% received antenatal HIV testing. A longer duration in sex work (AOR 2.7, 95% CI: 1.0–7.5), rural residence (AOR 3.3, 95% CI: 1.2–8.9), and antenatal HIV testing (AOR 6.3, 95% CI: 2.0–20.1) were associated with continued sex work during pregnancy. Older FSWs (age >25 years, AOR 0.12, 95% CI: 0.05–0.33), who delivered at home (AOR 0.14, 95% CI: 0.09–0.34), were least likely to receive antenatal HIV testing. Antenatal HIV testing was associated with awareness of methods to prevent vertical HIV transmission (AOR 3.9, 95% CI: 1.9–14.1). Conclusions. Antenatal HIV testing remains low in the context of ongoing sex work during pregnancy. Existing HIV prevention programs are well positioned to immediately integrate reproductive health care with HIV interventions targeted to FSWs. Marissa Becker, Satyanarayana Ramanaik, Shiva Halli, James F. Blanchard, T. Raghavendra, Parinita Bhattacharjee, Stephen Moses, Lisa Avery, and Sharmistha Mishra Copyright © 2012 Marissa Becker et al. All rights reserved. Sun, 30 Dec 2012 09:34:21 +0000 http://www.hindawi.com/journals/art/2012/371482/ HIV prevalence in India remains high among female sex workers. This paper presents the main findings of a qualitative study of the modes of operation of female sex work in Belgaum district, Karnataka, India, incorporating fifty interviews with sex workers. Thirteen sex work settings (distinguished by sex workers' main places of solicitation and sex) are identified. In addition to previously documented brothel, lodge, street, dhaba (highway restaurant), and highway-based sex workers, under-researched or newly emerging sex worker categories are identified, including phone-based sex workers, parlour girls, and agricultural workers. Women working in brothels, lodges, dhabas, and on highways describe factors that put them at high HIV risk. Of these, dhaba and highway-based sex workers are poorly covered by existing interventions. The paper examines the HIV-related vulnerability factors specific to each sex work setting. The modes of operation and HIV-vulnerabilities of sex work settings identified in this paper have important implications for the local programme. Raluca Buzdugan, Shiva S. Halli, Jyoti M. Hiremath, Krishnamurthy Jayanna, T. Raghavendra, Stephen Moses, James Blanchard, Graham Scambler, and Frances Cowan Copyright © 2012 Raluca Buzdugan et al. All rights reserved. Mon, 24 Dec 2012 12:45:13 +0000 http://www.hindawi.com/journals/art/2012/187890/ Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men’s and women’s attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. We used data from the RESPECT study, a randomized controlled trial that evaluated an intervention to prevent sexually transmitted infections in a cohort of young Tanzanian men and women, to examine the relationship between couples’ attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women’s reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline. Over time, participants’ attitudes tended to become more equitable and women’s reports of IPV declined substantially. Multivariable logistic regression analyses suggested that inequitable attitudes and couple discordance were associated with higher risk of IPV. Our findings point to the need for a better understanding of the role that perceived or actual imbalances in relationship power have in heightening IPV risk. The decline in women’s reports of IPV and the trend towards gender-equitable attitudes indicate that concerted efforts to reduce IPV and promote gender equity have the potential to make a positive difference in the relatively short term. Suneeta Krishnan, Divya Vohra, Damien de Walque, Carol Medlin, Rose Nathan, and William H. Dow Copyright © 2012 Suneeta Krishnan et al. All rights reserved. Thu, 20 Dec 2012 08:52:56 +0000 http://www.hindawi.com/journals/art/2012/478065/ Using the PEN-3 model, the purpose of this qualitative study was to understand the factors responsible for the childbearing decisions of women living with HIV/AIDS (WLHA) in Lagos, Nigeria. Sixty WLHA who sought care at a teaching hospital in Lagos were recruited to participate in in-depth interviews. The average age of the participants was 30 years, and 48 participants were receiving antiretroviral therapy. Healthcare and spiritual practices, healthcare provider-patient communication about childbearing, and husband/partner support emerged as factors that contribute to the childbearing decisions of WLHA. The findings reveal the importance of discussing sexual reproductive health and childbearing issues with WLHA in the healthcare context prior to pregnancy. Y. A. Sofolahan and C. O. Airhihenbuwa Copyright © 2012 Y. A. Sofolahan and C. O. Airhihenbuwa. All rights reserved. Tue, 18 Dec 2012 07:55:17 +0000 http://www.hindawi.com/journals/art/2012/802389/ HIV-positive women have abortions at similar rates to their HIV-negative counterparts, yet little is known about clinical outcomes of abortion for HIV-positive women or the best practices for abortion provision. To fill that gap, we conducted a literature review of clinical outcomes of surgical and medication abortion among HIV-positive women. We identified three studies on clinical outcomes of surgical abortion among HIV-positive women; none showed significant differences in infectious complications by HIV status. A review of seven articles on similar gynecological procedures found no differences in complications by HIV status. No studies evaluated medication abortion among HIV-positive women. However, we did find that previously expressed concerns regarding blood loss and vomiting related to medication abortion for HIV-positive women are unwarranted based on our review of data showing that significant blood loss and vomiting are rare and short lived among women. We conclude that although there is limited research that addresses clinical outcomes of abortion for HIV-positive women, existing data suggest that medication and surgical abortion are safe and appropriate. Sexual and reproductive health and HIV integration efforts must include both options to prevent maternal mortality and morbidity and to ensure that HIV-positive women and women at risk of HIV can make informed reproductive decisions. Ruth Manski, Amanda Dennis, Kelly Blanchard, Naomi Lince, and Dan Grossman Copyright © 2012 Ruth Manski et al. All rights reserved. Mon, 17 Dec 2012 08:16:17 +0000 http://www.hindawi.com/journals/art/2012/367604/ Contraception can reduce the dual burden of high fertility and high HIV prevalence in sub-Sahara Africa, but significant barriers remain regarding access and use. We describe factors associated with nonuse of contraception and with use of specific contraceptive methods in HIV positive and HIV negative Rwandan women. Data from 395 HIV-positive and 76 HIV-negative women who desired no pregnancy in the previous 6 months were analyzed using univariate and multivariate logistic regression models to identify clinical and demographic characteristics that predict contraceptive use. Differences in contraceptive methods used were dependent on marital/partner status, partner’s knowledge of a woman’s HIV status, and age. Overall, condoms, abstinence, and hormonal methods were the most used, though differences existed by HIV status. Less than 10% of women both HIV+ and HIV− used no contraception. Important differences exist between HIV-positive and HIV-negative women with regard to contraceptive method use that should be addressed by interventions seeking to improve contraceptive prevalence. Adebola A. Adedimeji, Donald R. Hoover, Qiuhu Shi, Mardge H. Cohen, Tracy Gard, and Kathryn Anastos Copyright © 2012 Adebola A. Adedimeji et al. All rights reserved. Mon, 10 Dec 2012 07:34:43 +0000 http://www.hindawi.com/journals/art/2012/402403/ We used a grounded theory approach to explore how a sample of caregivers of children on antiretroviral treatment (ART) experience HIV disclosure to their infected children. This paper explores caregivers' barriers to disclosing HIV to infected children. Caregivers of children aged 6–13 years who were receiving ART participated in four focus-group interviews. Three main themes, caregiver readiness to tell, right time to tell, and the context of disclosure, emerged. Disclosure was delayed because caregivers had to first deal with personal fears which influenced their readiness to disclose; disclosure was also delayed because caregivers did not know how to tell. Caregivers lacked disclosure skills because they had not been trained on how to tell their children about their diagnosis, on how to talk to their children about HIV, and on how to deal with a child who reacts negatively to the disclosure. Caregivers feared that the child might tell others about the diagnosis and would be discriminated and socially rejected and that children would live in fear of death and dying. Health care providers have a critical role to play in HIV disclosure to infected children, considering the caregivers' expressed desire to be trained and prepared for the disclosure. Sphiwe Madiba and Kebogile Mokwena Copyright © 2012 Sphiwe Madiba and Kebogile Mokwena. All rights reserved. Mon, 26 Nov 2012 14:37:02 +0000 http://www.hindawi.com/journals/art/2012/560361/ Background. HIV-infected women are disproportionately burdened by gynaecological complications, psychological disorders, and certain sexually transmitted infections that may not be adequately addressed by HIV-specific care. We estimate the prevalence and covariates of women’s health care (WHC) utilization among harder-to-reach, treatment-experienced HIV-infected women in British Columbia (BC), Canada. Methods. We used survey data from 231 HIV-infected, treatment-experienced women enrolled in the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) study, which recruited harder-to-reach populations, including aboriginal people and individuals using injection drugs. Independent covariates of interest included sociodemographic, psychosocial, behavioural, individual health status, structural factors, and HIV clinical variables. Logistic regression was used to generate adjusted estimates of associations between use of WHC and covariates of interest. Results. Overall, 77% of women reported regularly utilizing WHC. WHC utilization varied significantly by region of residence (P value ). In addition, women with lower annual income (AOR (95% CI) = 0.14 (0.04–0.54)), who used illicit drugs (AOR (95% CI) = 0.42 (0.19–0.92)) and who had lower provider trust (AOR (95% CI) = 0.97 (0.95–0.99)), were significantly less likely to report using WHC. Conclusion. A health service gap exists along geographical and social axes for harder-to-reach HIV-infected women in BC. Women-centered WHC and HIV-specific care should be streamlined and integrated to better address women’s holistic health. Xuetao Wang, Kate A. Salters, Wen Zhang, Lawrence McCandless, Deborah Money, Neora Pick, Julio S. G. Montaner, Robert S. Hogg, and Angela Kaida Copyright © 2012 Xuetao Wang et al. All rights reserved. Thu, 08 Nov 2012 16:07:01 +0000 http://www.hindawi.com/journals/art/2012/595762/ In the early years of the highly active antiretroviral therapy (HAART) era, HIV with resistance to two or more agents in different antiretroviral classes posed a significant clinical challenge. Multidrug-resistant (MDR) HIV was an important cause of treatment failure, morbidity, and mortality. Treatment options at the time were limited; multiple drug regimens with or without enfuvirtide were used with some success but proved to be difficult to sustain for reasons of tolerability, toxicity, and cost. Starting in 2006, data began to emerge supporting the use of new drugs from the original antiretroviral classes (tipranavir, darunavir, and etravirine) and drugs from new classes (raltegravir and maraviroc) for the treatment of MDR HIV. Their availability has enabled patients with MDR HIV to achieve full and durable viral suppression with more compact and cost-effective regimens including at least two and often three fully active agents. The emergence of drug-resistant HIV is expected to continue to become less frequent in the future, driven by improvements in the convenience, tolerability, efficacy, and durability of first-line HAART regimens. To continue this trend, the optimal rollout of HAART in both rich and resource-limited settings will require careful planning and strategic use of antiretroviral drugs and monitoring technologies. Marianne Harris, Bohdan Nosyk, Richard Harrigan, Viviane Dias Lima, Calvin Cohen, and Julio Montaner Copyright © 2012 Marianne Harris et al. All rights reserved. Thu, 01 Nov 2012 10:52:19 +0000 http://www.hindawi.com/journals/art/2012/524936/ A recent multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives. Together with a prior cohort study on African women seeking health services, these data are the strongest yet to appear on the HC-HIV risk. This paper will briefly review the Heffron study strengths and relevant biological and epidemiologic evidence; address the futility of further trials; and propose instead an alternative framework for next steps. The weight of the evidence calls for a discontinuation of progestin-dominant methods. We propose here five types of productive activities: (1) scaling injectable hormones down and out of the contraceptive mix; (2) strengthening and introducing public health strategies with proven potential to reduce HIV spread; (3) providing maximal choice to reduce unplanned pregnancy, starting with quality sexuality education through to safe abortion access; (4) expanding provider training, end-user counseling and access to male and female barriers, with a special renewed focus on female condom; (5) initiating a serious research agenda to determine anti-STI/HIV potential of the contraceptive cervical cap. Trusting women to make informed choices is critical to achieve real progress in dual protection. Erica Gollub and Zena Stein Copyright © 2012 Erica Gollub and Zena Stein. All rights reserved. Thu, 01 Nov 2012 07:20:25 +0000 http://www.hindawi.com/journals/art/2012/978790/ Background. Liver fibrosis is accelerated in HIV and hepatitis C coinfection, mediated by profibrotic effects of angiotensin. The objective of this study was to determine if angiotensin converting enzyme inhibitors (ACE-Is) attenuate liver fibrosis in coinfection. Methods. A retrospective review of 156 coinfected subjects was conducted to analyze the association between exposure to ACE-Is and liver fibrosis. Noninvasive indices of liver fibrosis (APRI, FIB-4, Forns indices) were compared between subjects who had taken ACE-Is and controls who had not taken them. Linear regression was used to evaluate ACE-I use as an independent predictor of fibrosis. Results. Subjects taking ACE-Is for three years were no different than controls on the APRI and the FIB-4 but had significantly higher scores than controls on the Forns index, indicating more advanced fibrosis. The use of ACE-Is for three years remained independently associated with an elevated Forns score when adjusted for age, race, and HIV viral load (). There were significant associations between all of the indices and significant fibrosis, as determined clinically and radiologically. Conclusions. There was not a protective association between angiotensin inhibition and liver fibrosis in coinfection. These noninvasive indices may be useful for ruling out significant fibrosis in coinfection. Lindsey J. Reese, Diane S. Tider, Alicia C. Stivala, and Dawn A. Fishbein Copyright © 2012 Lindsey J. Reese et al. All rights reserved. Wed, 31 Oct 2012 08:31:47 +0000 http://www.hindawi.com/journals/art/2012/869891/ Pharmacists have made many contributions to HIV/AIDs research and are still showing their significance as members of the healthcare team through innovative clinical trials. Pharmacists are showing advances in several healthcare settings including inpatient, outpatient, and community pharmacies. Because of the complex regimens of highly active antiretroviral therapy (HAART), the increased life span of patients living with HIV, and other concomitant medications taken for comorbid disease states, there is a high risk for health-related complications and the development of adverse events. These adverse events may lead to decreased adherence to HAART, which may cause the development of HIV drug resistance. Pharmacists are providing examples through growing research on how they help combat medication-related errors and also continue to contribute as healthcare providers as a part of a holistic healthcare team. Alexis E. Horace Copyright © 2012 Alexis E. Horace. All rights reserved.