Current Issue : October - December Volume : 2013 Issue Number : 4 Articles : 7 Articles
AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are\r\nthe ââ?¬Å?payer of last resortââ?¬Â for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS.\r\nADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased\r\ntheir contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living\r\nlonger; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United\r\nStates is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding,\r\nADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not\r\nsustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation\r\nof the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for\r\nvulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after\r\nthe implementation of the ACA....
Aims of this study were to assess the associations between stimulant use and attitudes toward and engagement in HIV medical\r\ncare and to examine technology use among stimulant-using and nonstimulant-using men who have sex with men (MSM). HIVpositive\r\nMSM (?? = 276; mean age = 42 years; 71% white, non-Hispanic; 43% with college degree) completed an online survey in\r\n2009. Most men (69%) had not missed any scheduled HIV medical appointments in the past year, while 23% had missed at least\r\none, and 9% had not attended any appointments. Stimulant use was significantly associated with not attending any HIV medical\r\nappointments in the unadjusted model (relative risk ratio (RRR) = 2.84, 95% CI [1.07, 7.58]), as well as in models adjusted for\r\ndemographic (RRR = 3.16, 95% CI [1.13, 8.84]) and psychosocial (RRR = 3.44, 95% CI [1.17, 10.15]) factors (???? < 0.05). Fewer\r\nstimulant-using than non-stimulant-using men rated HIV medical care a high priority (57% versus 85%; ?? < 0.01). Few significant\r\ndifferences were found in online social networking or mobile phone use between stimulant-using and non-stimulant-using MSM,\r\neven when stratified by engagement in HIV care. Findings indicate that stimulant use is uniquely associated with nonengagement\r\nin HIV medical care in this sample, and that it may be possible to reach stimulant-using MSM using online social networking and\r\nmobile technologies....
This study explored barriers to and facilitators of using family planning services among HIV-positive men in Nyanza Province,\r\nKenya. FromMay to June 2010, in-depth interviews were conducted with 30 men receiving care at 15 HIV clinics.Thekey barriers to\r\nthe use of family planning included concerns about side effects of contraceptives, lack of knowledge about contraceptive methods,\r\nmyths and misconceptions including fear of infertility, structural barriers such as staffing shortages at HIV clinics, and a lack\r\nof male focus in family planning methods and service delivery. The integration of family planning into HIV clinics including\r\nfamily planning counseling and education was cited as an important strategy to improve family planning receptivity among men.\r\nIntegrating family planning into HIV services is a promising strategy to facilitate male involvement in family planning. Integration\r\nneeds to be rigorously evaluated in order to measure its impact on unmet need for contraception among HIV-positive women and\r\ntheir partners and assure that it is implemented in a manner that engages both men and women....
Mitochondrial damage is implicated in highly active antiretroviral therapy (HAART) toxicity. HIV infection also causes\r\nmitochondrial toxicity (MT). Differentiating between the two is critical for HIV management. Our objective was to test the utility\r\nof the Mitochondrial Disease Criteria (MDC) and the EnquÃ?â? ete PÃ?´erinatale FrancÃ?¸aise (EPF) to screen for possible HAART related\r\nMT in HIV-infected children in Ghana. The EPF and MDC are compilations of clinical symptoms, or criteria, of MT: a (+) score\r\nindicates possible MT. We applied these criteria retrospectively to 403 charts of HIV-infected children. Of those studied, 331/403\r\nreceived HAART. ComparingHAART exposed and HAART naÃ?¨ive children, the difference in EPF score, but notMDC, approached\r\nsignificance (P = 0.1). Young age at HIV diagnosis or at HAART initiation was associated with (+) EPF (P = 0.01). Adherence to\r\nHAART trended toward an association with (+) EPF (P = 0.09). Exposure to nevirapine, abacavir, or didanosine increased risk of\r\n(+) EPF (OR = 3.55 (CI = 1.99ââ?¬â??6.33), 4.76 (2.39ââ?¬â??9.43), 4.93 (1.29ââ?¬â??18.87)). Neither EPF nor MDC identified a significant difference\r\nbetween HAART exposed or naÃ?¨ive children regarding possible MT. However, as indicators of HAART exposure are associated with\r\n(+) EPF, it may be a candidate for prospective study of possible HAART related MT in resource-poor settings....
Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and\r\npractices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province,\r\nKenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare\r\nworkers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed\r\ncontraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration.\r\nData were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few\r\nproviders thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe\r\nand 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive\r\nwomen. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including\r\nmisunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP\r\ntraining, and contraceptive shortages. Conclusions.These findings suggest the importance of considering issues such as patient flow,\r\nprovider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing\r\nintegrated FP/HIV services in high HIV prevalence areas....
This study considers social network interactions as a potential source of support for individuals living with HIV/AIDS in Iran. This\r\ncross-sectional study was conducted on 224 people with HIV/AIDS who refer to behavioral counseling centers. Participants were\r\nrandomly selected among all people with HIV/AIDS from these centers. Relatives were more reported as sources of support than\r\nnonrelatives. They were closer to participants, but there was difference between the closest type among relative and nonrelative\r\nsupporters (P = 0.01). Mean of functional support with considering the attainable range 0ââ?¬â??384 was low (126.74 (SD = 76.97)).\r\nSocial support of participants has been found to be associated with CD4 cell count (P = 0.000), sex (P = 0.049), and network size\r\n(P = 0.000) after adjusted for other variables in the final model. Totally, in this study, many of participants had the static social\r\nsupport network that contained large proportions of family and relatives.The findings contribute to the evidence for promotion of\r\nknowledge about social support network and social support of people living with HIV/AIDS...
With wider access to antiretroviral therapy, people living with HIV are reconsidering their reproductive decisions: remarrying and\r\nhaving children. The purpose of the paper is to explore sources of information for reproductive decision used by couples living with\r\nHIV in patrilineal and matrilineal districts of Malawi. Data were collected from forty couples from July to December 2010. Our\r\nresults illuminate five specific issues: some of the informants (1) remarry after divorce/death of a spouse, (2) establish newmarriage\r\nrelationshipwith spouses livingwith HIV, and (3) have children hence the need for information to base their decisions.There are (4)\r\nshared and interactive couple decisions, and (5) informal networks of people livingwith HIV are the main sources of information. In\r\naddition, in matrilineal community, cultural practices about remarriage set up structures that constrained information availability\r\nunlike in patrilineal community where information on sexual and reproductive health, HIV, and AIDS was disseminated during\r\nremarriage counselling. However, both sources are not able to provide comprehensive information due to complexity and lack\r\nof up to date information. Therefore, health workers should, offer people living with HIV comprehensive information that takes\r\ninto consideration the cultural specificity of groups, and empower already existing and accepted local structures with sexual and\r\nreproductive health, HIV, and AIDS knowledge....
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