Background: In sub-Saharan Africa, women's disclosure of HIVpositive status to others may affect their use of services for prevention of mother-to-child transmission of HIV (PMTCT) of HIV and maternal and child health-including antenatal care, antiretroviral drugs (ARVs) for PMTCT, and skilled birth attendance.Methods: Using data from the Migori and AIDS Stigma Study conducted in rural Nyanza Province, Kenya, we compared the use of PMTCT and maternal health services for all women by HIV status and disclosure category (n = 390). Among HIV-infected women (n = 145), associations between disclosure of HIV-positive status and the use of services were further examined with bivariate and multivariate logistic regression analyses.Results: Women living with HIV who had not disclosed to anyone had the lowest levels of maternity and PMTCT service utilization. For example, only 21% of these women gave birth in a health facility, compared with 35% of HIV-negative women and 49% of HIV-positive women who had disclosed (P < 0.001). Among HIVpositive women, the effect of disclosure to anyone on ARV drug use [odds ratio (OR) = 5.8; 95% confidence interval (CI): 1.9 to 17.8] and facility birth (OR = 2.9; 95% CI: 1.4 to 5.7) remained large and significant after adjusting for confounders. Disclosure to a male partner had a particularly strong effect on the use of ARVs for PMTCT (OR = 7.9; 95% CI: 3.7 to 17.1).Conclusions: HIV-positive status disclosure seems to be a complex yet critical factor for the use of PMTCT and maternal health services in this setting. The design of interventions to promote such disclosure must recognize the impact of HIV-related stigma on disclosure decisions and protect women's rights, autonomy, and safety.
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Julie A. Womack;
Terrence E. Murphy;
Harini Bathulapalli;
Kathleen M. Akgun;
Cynthia Gibert;
Ken M. Kunisaki;
David Rimland;
Maria Rodriguez-Barradas;
H. Klar Yaggi;
Amy C. Justice;
Nancy S. Redeker
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Tiffany L Breger;
Daniel Westreich;
Andrew Edmonds;
Jessie K Edwards;
Lauren C Zalla;
Stephen R Cole;
Catalina Ramirez;
Ighovwerha Ofotokun;
Seble G Kassaye;
Todd T Brown;
Deborah Konkle-Parker;
Deborah L Jones;
Gypsyamber D'Souza;
Mardge H Cohen;
Phyllis C Tien;
Tonya N Taylor;
Kathryn Anastos;
Adaora A Adimora
Objectives:The aim of this study was to define a smoking cessation 'cascade' among USA women with and without HIV and examine differences by sociodemographic characteristics.Design:An observational cohort study using data from smokers participating in the Women's Interagency HIV Study between 2014 and 2019.Methods:We followed 1165 women smokers with and without HIV from their first study visit in 2014 or 2015 until an attempt to quit smoking within approximately 3 years of follow-up, initial cessation (i.e. no restarting smoking within approximately 6 months of a quit attempt), and sustained cessation (i.e. no restarting smoking within approximately 12 months of a quit attempt). Using the Aalen-Johansen estimator, we estimated the cumulative probability of achieving each step, accounting for the competing risk of death.Results:Forty-five percent of smokers attempted to quit, 27% achieved initial cessation, and 14% achieved sustained cessation with no differences by HIV status. Women with some post-high school education were more likely to achieve each step than those with less education. Outcomes did not differ by race. Thirty-six percent [95% confidence interval (95% CI): 31-42] of uninsured women attempted to quit compared with 47% (95% CI: 44-50) with Medicaid and 49% (95% CI: 41-59) with private insurance.Conclusion:To decrease smoking among USA women with and without HIV, targeted, multistage interventions, and increased insurance coverage are needed to address shortfalls along this cascade.
Antiretroviral therapy (ART) has altered the clinical environment of HIV, shifting the traditional focus on AIDS-induced opportunistic infections and cancers to one in which the most common morbidities and causes of death differ little from those seen in noninfected adults. The primary distinction is that these conditions, which include cardiovascular diseases, declining physical function, neurocognitive and neuropsychiatric disorders, and alterations in body composition, first manifest in people living with HIV (PLWH) approximately 5–10 years earlier than HIV-uninfected individuals.1–3 The accelerated aging in HIV has now been further complicated by the emergence of SARS-CoV-2 infection and postacute COVID syndrome (PACS). Exploring the linkages—and points of difference—between these 2 viral conditions, while promoting multidisciplinary collaboration among researchers to identify new perspectives on HIV and aging, was the aim of “HIV and Aging in the Era of ART and COVID-19 inter-CFAR symposium.”
BACKGROUND: Men who have sex with men are disproportionately burdened by HIV/AIDS, and the advent of pre-exposure prophylaxis (PrEP) has provided an effective strategy to reduce the risk of HIV transmission. Research has shown that improving one partner's health-promoting behaviors increases the likelihood that their partner adopts healthier behaviors. We examined the longitudinal relationship between favorable HIV treatment outcomes with current PrEP use among HIV serodiscordant male partners. SETTING: Data are from Project Stronger Together, a randomized controlled trial that recruited serodiscordant male couples from Atlanta, GA; Boston, MA; and Chicago, IL. METHODS: Serodiscordant couples completed assessments at baseline, 6, 12, 18, and 24 months. We analyzed longitudinal data from 120 HIV serodiscordant male partners to assess the relationship between the HIV-negative partner's current PrEP use and their HIV-positive partner's current ART use, ART adherence, and viral load using generalized estimating equation models. RESULTS: Fewer than half of the HIV-negative partners were on PrEP at baseline and nearly two-thirds of their HIV-positive partners were virally suppressed. HIV-negative male partners who had partners with an undetectable viral load had greater odds of being a current PrEP user than HIV-negative partners with partners with a detectable viral load. CONCLUSION: Our study highlights the need to develop dyad-level interventions to improve HIV medication use/adherence by HIV serodiscordant male couples. Our findings also suggest that dyad-level interventions may be able to leverage our understanding of how partners can influence each other's health-promoting behaviors to develop programs that improve health outcomes for both partners.