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Eric: Unwavering positive attitude in facing HIV

For Eric, who tested HIV positive in January 2013, the biggest challenge he believe he had to go through is “getting used to idea that I am now HIV positive from here on out.” But – taking it a day at a time – he says “I no longer feel depressed and sad about it. Time has certainly helped in dealing with it.” He now shares his story to Outrage Magazine, hoping others can learn from it.

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This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”. More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Eric tested HIV positive only on January 26, 2013. “I went to see my primary physician after I complained of tonsillitis. I had tonsillitis the previous year, so I thought it had recurred again,” he recalled.

He also knew that “I had unprotected sex the previous month, so in the back of my mind, I knew the possibility that it may be more than just tonsillitis. When I saw my doctor, I told her about the unprotected sex. She suggested that I get tested for sexually transmitted infections (STIs), including an HIV antibody test.”

Eric then went to the lab and had blood drawn; he then waited for a phone call from his doctor.

“I was surprised that it was taking too long to know the results. I had the blood drawn on Saturday, January 19th, but my doctor had left me a voicemail on Friday, January 25th asking me to come in the following Monday. I couldn’t wait. The following day, Saturday, January 26th, I went to a local HIV testing center and had the rapid HIV test. I found out that same day that I tested positive for HIV antibodies.”

Eric recalled that “exactly one month before I tested positive for HIV, on December 26, 2012, I met up with a guy I dated four years prior. I saw his picture and profile on an Internet hook up site and sent him a message. We exchanged several messages and made arrangements to meet up on that day. He talked about getting high on ecstasy and engaging in bareback sex. We discussed HIV and I had told him that I tested negative three times in the past year. The last HIV test I had was on December 2, 2012, and I was definitely sure that I was HIV negative. He assured me that he is also HIV negative. I needed to ask the question since I was the receptive partner and wanted to have the discussion and make the decision to proceed. I trusted him even though I had not seen him in four years.”

Upon knowing his HIV positive status, “I felt numb at the news when the counselor came back to the room, sat down and said, ‘Your test came back positive.’ I expected the result since I knew that even though the symptoms of HIV seroconversion and tonsillitis were similar, there was something very different about the symptoms I was experiencing. In the back of my mind, I knew that I will test positive for HIV antibodies.”

Eric is, by the way, in an open relationship with an HIV-positive partner, and they have been together for several years. “He is very supportive and gave me a lot of emotional support. He has been HIV positive for over 20 years and I had seen him go through the emotional rollercoaster of having HIV,” he said.

For Eric, the biggest challenge he believe he had to go through is “getting used to idea that I am now HIV positive from here on out. I know the challenges that I have to go through since I witnessed firsthand the stigma and the challenges of being HIV positive from my partner. I don’t want people to treat me differently, so I only revealed my status to three people. I don’t want anyone else to know. I have lost my sex drive, which was very high prior to my diagnosis. I do get emotionally crushed whenever I think about having this disease. It had taken me several months to finally stop crying whenever I think about being HIV positive. I used to get visceral and heart crushing pain whenever I think that I am now HIV positive.”

Eric added: “I am taking it one day at a time. I no longer feel depressed and sad about it. Time has certainly helped in dealing with it.”

Eric chose not to reveal his status to his family. “I revealed my status to three of my closest friends. Two of them are a couple who both have HIV as well. They have been very supportive and offered words of encouragement. I have chosen not to tell my parents since I didn’t want them to worry, and there really isn’t much they can do. I am very much aware of how to care for myself and I have the support I needed to get through the emotional and psychological effects of my diagnosis, so the need to tell them is not necessary at this time.”

Support largely comes from his partner. “I decided not to go to a support group. No one in my family knows. I live with my partner and we have been together for 22 years. I was dating him when he found out he’s HIV positive, so I was there in the initial stages of his diagnosis. He was there when I became HIV positive; so in a way, this incident has brought us closer together.”

When Eric tested HIV positive, he was referred by his primary physician to an infectious disease specialist, and “I have been seeing a specialist for my care since then. I get CD4 and viral load blood analysis every three months. My initial CD4 was 271 and my viral load was 161,000. I had to take ARV immediately. She had told me that it didn’t matter to her if my CD4 was over 500, she would have asked me to be on ARV therapy right away.”

For Eric, the initial experience was not at all unpleasant. “I take one pill, once a day of a three drug combination pill. It is a very easy regimen. I take it at night before bedtime because the medication causes dizziness. I am doing well with the regimen and so far, so good.”

Eric believes that there is a stigma associated with being HIV positive. “There is still a lot of fear and people do not know how to deal with people who are HIV positive so they treat them differently. I am afraid to disclose my status to just anyone. I don’t want my family to know because they will only worry about me. I am healthy and am doing very well, so I have no reason to worry my family.”

If there is a lesson he can teach others as an HIV positive person, it is for them “not to waiver from protecting yourself against HIV infection. Do not use drugs. Do not engage in risky sexual behaviors. Surround yourself with people who are educated about HIV and who are adamant about using condoms when having sex. Men who have sex with men should get tested on a regular basis, at least every three months. The sooner you know about your status, the faster you can get treatment,” Eric ended.

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Link found between drought and HIV among women in less-developed countries

Women in less-developed countries disproportionately bear the burden in terms of ill health when facing food insecurity or a shock or disaster like drought that impacts the ability to get food or harvest food.

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Current research predicts that by 2025, 1,800 million people are expected to be living in countries or regions with insufficient water resources, and models show increased severity of droughts in years to come. Food insecurity and other consequences of droughts will become intensified, influencing disease vulnerabilities among populations in less-developed countries.

New research from Kelly Austin, associate professor of sociology at Lehigh University, explores how droughts shape gender inequalities in the HIV burden, indirectly through increased food insecurity.

The paper, “Drying Climates and Gender Suffering: Links Between Drought, Food Insecurity, and Women’s HIV in Less-Developed Countries,” is published in Social Indicators Research.

This study builds on previous attempts to explain women’s disproportionate share of global HIV cases through biological, cultural and socioeconomic inequalities by bringing the environment and climate-related disasters into the discussion.

“While many infectious diseases like HIV/AIDS do not have a direct link to the environment in their transmission patterns or vectors, disasters such as drought can still have a significant influence on the social conditions that shape and enhance vulnerabilities,” said the researchers, adding that hunger and food insecurity are key factors motivating women’s engagement in early marriage, commercial sex, transactional sex relationships, and other forms of risky sex engagements.

Using a structural equation modeling approach, Austin and her colleagues were able to test the indirect and direct links between food insecurity and HIV as well as the causal chain of factors involving drought, food insecurity, and women’s HIV.

The results from the study found that drought escalates food insecurity, and food insecurity has indirect, negative impacts on women’s status, including lower participation in education, higher fertility rates and reduced access to medical care. Since women’s status and the use of contraceptives are tightly linked, these impediments directly increase the percentage of HIV cases among women, confirming the researchers’ hypothesis.

“Uncovering these mechanisms would not have been possible with more mainstream approaches,” said Austin.

It’s common to see strict gender norms in place where women are typically the household managers, carrying the responsibility for growing and harvesting food, collecting firewood, fetching water, and other tasks that provide household needs through environmental resources. In less-developed countries, droughts are the most common cause of severe food shortages, affecting agriculture first. As a result, changes to the environment are likely to compromise women’s health in these unique ways.

According to the research, when a crisis hits, women are typically the first to sacrifice their own food to ensure their children and others have enough to eat. Food insecurity directly leads to infection risks through nutrient deficiencies. Additionally, food insecurity indirectly intensifies gendered inequalities that limit women’s access to healthcare, education, and improved autonomy, potentially putting women in a more vulnerable position of contracting HIV.

“Women in less-developed countries disproportionately bear the burden in terms of ill health when facing food insecurity or a shock or disaster like drought that impacts the ability to get food or harvest food,” said Austin. “This information would be useful for policy makers and people working in international development and disaster response.”

Austin investigates this subject in a sister paper, “Drought and Disproportionate Disease: An Investigation of Gendered Vulnerabilities to HIV/AIDS in Less-Developed Nations,” published in Springer Nature’s Population & the Environment.

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To live with HIV, ‘start with self-acceptance’

For PLHIV Louie from Laguna, living with HIV can be challenging. But to deal with the challenges, start with self-acceptance.

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“I don’t know how I was able to accept I have HIV,” said Louie, 34, in Filipino. In actuality, it was – perhaps – harder for him to accept that some things in life do not last forever, “such as losing loved ones” because a former partner eventually died from AIDS-related complications.

Louie can still remember the exact date when he was diagnosed to be HIV-positive (on July 3, 2013; he was 28 then).

“I didn’t know anything about HIV then,” he said, adding that the only thing he knew was “if you have HIV, you’d already die.”

He actually didn’t have any medical condition that merited him to get tested; but his former partner had AIDS diagnosis, so he also had to get tested.

When Louie’s HIV test came out, he said he felt two things.

First, he felt happy because – following his former logic that if one has HIV, then he/she will already die – he and his former partner can then die together and “stay happy wherever we may go after death.”

But there was also sadness because if he died, then he’d leave behind his family.

At that time, Louie also had opportunistic infections – e.g. TB (which he got from his former partner). The bad thing for him at that time was his body’s non-acceptance of widely used TB meds; so he had to be issued a different med that had to be injected every now and then. This meant he had to be at his treatment hub more frequently.

It was this – the need to be at his treatment hub more often that he needed to be if only his situation wasn’t dire – that led to his resignation from work, since “I didn’t know how to inform (my boss) anymore about the frequent absence.”

It was his sister who knew first of his status; but then one morning, before he was to go to his treatment hub again, his mom confronted him. “She asked me how I was. I got nervous. Then she said she already knew; my sister told her,” Louie said.

Though her mom cried then, Louie was able to pacify her by telling her he’d be okay; and that he’s already taking his meds (LTE).

The relationship is okay now; and there are times when she’d tell him she wishes there’s a cure for HIV. But Louie said he’d kid her: “Even if there’s a cure, I doubt we’d be able to afford it; it will be extremely expensive.”

Louie said he keeps telling his mom to just “accept… and love.”

Louie is in a relationship with an HIV-negative person now (Matt). And he said that may PLHIVs think that because of their HIV status, no one will love them anymore. “That someone will only love you because if he/she doesn’t, you’d get depressed and you’d kill yourself.”

But Louie doesn’t believe this.

“This never entered my mind,” he said, suggesting for PLHIVs “just to be honest. If he/she accepts you, then that’s love. If he/she doesn’t that’s not really love; so just look for another. If he/she really loves you, whatever your HIV status may be, he/she will love you.”

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Glutathione precursor GlyNAC reverses premature aging in people with HIV

Overall, these findings in HIV patients provide proof-of-concept that dietary supplementation of GlyNAC improves multiple hallmarks of aging and that glutathione deficiency and oxidative stress could contribute to them.

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Premature aging in people with HIV is now recognized as a new, significant public health challenge. Accumulating evidence shows that people with HIV who are between 45 to 60 years old develop characteristics typically observed in people without HIV that are more than 70 years of age. For instance, declining gait speed, physical function and cognition, mitochondrial aging, elevated inflammation, immune dysfunction, frailty and other health conditions are significantly higher in people with HIV when compared to age- and sex-matched uninfected people.

This is what endocrinologist Dr. Rajagopal Sekhar, associate professor of medicine-endocrinology at Baylor College of Medicine, and his team eyed in a study published in the journal Biomedicines. Specifically, they wanted to “build a bridge between laboratory bench and bedside by showing proof-of-concept that supplementing people with HIV specifically with a combination of glycine and N-acetylcysteine, which we call GlyNAC, as precursors of glutathione, a major antioxidant produced by the body, improves multiple deficits associated with premature aging,” said Sekhar.

Why we age?

For several decades, experimental evidence has supported two theories for aging. The free radical theory and the mitochondrial theory propose that elevated free radicals (oxidative stress) and mitochondrial dysfunction, respectively, are at the core of geriatric aging. Both, elevated oxidative stress and mitochondrial dysfunction, are present in people with HIV.

Free radicals, such as reactive oxygen species, and the mitochondria are physiologically connected. The mitochondria are like the batteries of the cell, they produce the energy needed for conducting cellular functions. The body transforms the food we eat into sugar and fat, which the mitochondria burns as fuel to produce energy.

However, one of the waste products of cellular energy generation is free radicals, which are highly reactive molecules that can damage cells, membranes, lipids, proteins and DNA. Cells depend on antioxidants, such as glutathione, to neutralize these toxic free radicals. When cells fail to neutralize free radicals, there is an imbalance between the radicals and the antioxidant responses, leading to harmful and damaging oxidative stress.

“The free radicals produced during fuel burning in the mitochondria can be compared to some of the waste products produced by a car’s combustion engine, some of which are removed by the oil filter,” Sekhar said. “If we don’t change the oil filter periodically, the car’s engine will diminish its performance and give less mileage.”

Similarly, if the balance between free radical production and antioxidant response in cells consistently favors the former, in time cellular function could be disrupted. Glutathione helps cells keep oxidative stress in balance, it keeps the oil filter clean. GlyNAC helps the cell make glutathione.

Sekhar and his colleagues have been studying mitochondrial function and glutathione for more than 20 years. Their findings, and those of other researchers, have shown that glutathione is the ultimate natural antioxidant.

Interestingly, compared to those in younger people, glutathione levels in older people are much lower, and the levels of oxidative stress are much higher. Glutathione levels also are lower and oxidative stress is higher in conditions associated with mitochondrial dysfunction, including ageing, HIV infection, diabetes, neurodegenerative disorders, cardiovascular disorders, neurometabolic diseases, cancer, obesity and other conditions.

“When the mitochondrial batteries are running low on power, as a medical and scientific community, we do not know how to recharge these batteries,” Sekhar said. “Which raised the question, if the levels of glutathione were restored in cells, would the mitochondria be recharged and able to provide power to the cell? Would restoring mitochondrial functioning improve conditions associated with mitochondrial dysfunction?”

Restoring glutathione

Restoring glutathione in cells was not straightforward because glutathione cannot work if taken orally for the same reasons that diabetic patients cannot eat insulin. It would be digested before it reached the cells. Also, providing glutathione in the blood cannot correct glutathione deficiency because every cell makes its own.

“Glutathione is a small protein made of three building blocks: amino acids cysteine, glycine and glutamic acid. We found that people with glutathione deficiency also were deficient in cysteine and glycine, but not glutamic acid,” Sekhar said. “We then tested whether restoring deficient glutathione precursors would help cells replenish their glutathione. But there’s another catch, because cysteine cannot be given as such, we had to supplement it in another form called N-acetylcysteine.”

In past studies, Sekhar and his colleagues determined that supplementing GlyNAC, a combination of glycine and N-acetylcysteine, corrected glutathione deficiency inside the cells of naturally aged mice to the levels found in younger mice. Interestingly, the levels of glutathione and mitochondrial function, which were lower in older mice before taking GlyNAC, and oxidative stress, which was higher before GlyNAC, also were comparable to those found in younger mice after taking GlyNAC for six weeks.

The same results were observed in a small study in older humans who had high oxidative stress and glutathione deficiency inside cells. In this case, taking GlyNAC by mouth for 2-weeks corrected the glutathione deficiency and lowered both oxidative stress and insulin resistance (a pre-diabetic risk factor).

In past clinical trials, Sekhar provided GlyNAC to small groups of people to correct a nutritional deficiency, and produced encouraging evidence supporting further studies of the value of this approach to restoring mitochondrial function in clinical trials.

Improving premature aging in people with HIV

In the current study, Sekhar and his colleagues conducted an open-label clinical trial that included six men and two women with HIV, and eight age-, gender- and body mass index-matched uninfected controls, all between 45 and 60 years old. The people with HIV were on stable antiretroviral therapy and had not been hospitalized for six months prior to the study.

Before taking GlyNAC, the group with HIV, compared with the controls, was deficient in glutathione and had multiple conditions associated with premature aging, including higher oxidative stress; mitochondrial dysfunction; higher inflammation, endothelial dysfunction and insulin resistance; more damage to genes; lower muscle strength; increased belly fat and impaired cognition and memory.

The results are encouraging. GlyNAC supplementation for 12 weeks improved all the deficiencies indicated above. Some of the improvements declined eight weeks after stopping GlyNAC.

“It was encouraging to see that GlyNAC can reverse many of these hallmark defects in people with HIV as there is no current treatment known to reverse these abnormalities. Our findings could have implications beyond HIV and need further investigation,” Sekhar said.

Overall, these findings in HIV patients provide proof-of-concept that dietary supplementation of GlyNAC improves multiple hallmarks of aging and that glutathione deficiency and oxidative stress could contribute to them.

Encouraged by these results, Sekhar has continued his investigations by testing the value of GlyNAC supplementation for improving the health of the growing older population, and has completed an open label trial, and another NIH-funded, double-blind, placebo-controlled trial in older adults.

“The results from these recently completed trials support the findings of the HIV study,” said Sekhar, who is currently the Principal Investigator of two NIH-funded randomized clinical trials studying the effect of GlyNAC in older humans with mild cognitive impairment, and with Alzheimer’s disease.

Other contributors to this work include Premranjan Kumar, Chun Liu, James W. Suliburk, Charles G. Minard, Raja Muthupillai, Shaji Chacko, Jean W. Hsu and Farook Jahoor. The authors are affiliated with one or more of the following institutions: Baylor College of Medicine, Baylor-St. Luke’s Medical Center- Houston and the Thomas Street HIV-Health Center.

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New cause of inflammation in people with HIV identified

While current antiretroviral treatments for HIV are highly effective, data has shown that people living with HIV appear to experience accelerated aging and have shorter lifespans – by up to five to 10 years – compared to people without HIV. These outcomes have been associated with chronic inflammation, which could lead to the earlier onset of age-associated diseases.

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While current antiretroviral treatments for HIV are highly effective, data has shown that people living with HIV appear to experience accelerated aging and have shorter lifespans – by up to five to 10 years – compared to people without HIV. These outcomes have been associated with chronic inflammation, which could lead to the earlier onset of age-associated diseases, such as atherosclerosis, cancers, or neurocognitive decline.

A new study led by researchers at Boston Medical Center examined what factors could be contributing to this inflammation, and they identified the inability to control HIV RNA production from existing HIV DNA as a potential key driver of inflammation. Published in The Journal of Infectious Diseases, the results underscore the need to develop new treatments targeting the persistent inflammation in people living with HIV in order to improve outcomes.

After infection, HIV becomes a part of an infected person’s DNA forever, and in most cases, infected cells are silent and do not replicate the virus. Occasionally, however, RNA is produced from this HIV DNA, which is a first step towards virus replication. Antiretroviral treatments help prevent HIV and AIDS-related complications, but they do not prevent the chronic inflammation that is common among people with HIV and is associated with mortality.

“Our study set out to identify a possible association between HIV latently infected cells with chronic inflammation in people with HIV who have suppressed viral loads,” said Nina Lin, MD, a physician scientist at Boston Medical Center (BMC) and Boston University School of Medicine (BUSM).

For this study, researchers had a cohort of 57 individuals with HIV who were treated with antiretroviral therapy. They compared inflammation in the blood and various virus measurements among younger (age less than 35 years) and older (age greater than 50 years) people living with HIV.

They also compared the ability of the inflammation present in the blood to activate HIV production from the silent cells with the HIV genome. Their results suggest that an inability to control HIV RNA production even with antiretroviral drugs correlates with inflammation.

Antiretroviral treatments help prevent HIV and AIDS-related complications, but they do not prevent the chronic inflammation that is common among people with HIV and is associated with mortality.

“Our findings suggest that novel treatments are needed to target the inflammation persistent in people living with HIV,” said Manish Sagar, MD, an infectious diseases physician and researcher at BMC and the study’s corresponding author. “Current antiretroviral drugs prevent new infection, but they do not prevent HIV RNA production, which our results point as a potential key factor driving inflammation in people living with HIV.”

According to the Centers for Disease Control and Prevention, it is estimated that 1.2 million Americans are living with HIV; however, approximately 14 percent of these individuals are not aware that they are infected.

Another CDC reporter found that of those diagnosed and undiagnosed with HIV in 2018, 76 percent had received some form of HIV care; 58 percent were retained in care; and 65 percent had undetectable or suppressed HIV viral loads. Antiretroviral therapy prevents HIV progression and puts the risk of transmission almost to zero.

The authors note that these results need to be replicated in larger cohorts. “We hope that our study results will serve as a springboard for examining drugs that stop HIV RNA production as a way to reduce inflammation,” added Sagar, also an associate professor of medicine and microbiology at BUSM.

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Global HIV response is neglecting gay and bi men, and trans women – study

To date, gay and bisexual men account for about one in five new HIV infections. However, they were only allocated approximately 2% of the $57 billion in global donor funding to treat the virus and combat its spread between 2016 and 2018.

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Funding to fight HIV among gay and bisexual men, as well as transgender women is just a fraction of what it should be. This is according to researchers from Dutch HIV charity Aidsfonds.

To date, gay and bisexual men account for about one in five new HIV infections. However, they were only allocated approximately 2% of the $57 billion in global donor funding to treat the virus and combat its spread between 2016 and 2018.

Meanwhile, while trans people represented about 1% of new global HIV infections in 2018, programs targeting them received only 0.06% of the total funding.

The Aidsfonds report stated that globally, the total number of new HIV infections hasn’t declined for several years, stagnating at 1.7 million in 2018. This is above the global target of 500,000 per year by 2020, and can even be a reflection of a worsening picture for key populations.

Between 2016 and 2018, the total combined resources for the HIV response was approximately $57.3 billion. In the same period, the total funding of HIV programs for key populations is estimated at around US$1.3 billion.

This means that “programs targeting key populations received only 2% of all HIV funding, even though key populations accounted for over half of all new infections in 2018.”

In 2016, UNAIDS estimated that $6.3 billion was needed for the delivery of comprehensive service packages for key populations between 2016 and 2018. Another $551 million was required for the distribution of pre-exposure prophylaxis (PrEP) to these communities, making a total of $6.8 billion needed.

And so “there was a staggering gap of 80% between the budget required for HIV programs targeting key populations ($6.8 billion) and the amount made available ($1.3 billion),” Aidsfonds stated.

To end the AIDS epidemic by 2030, Aidsfonds’ recommendations included:

  1. Increase of funders’ investments towards the $36.49 billion
    needed for HIV programming for key populations, over the next decade.
  2. Scale up the proportion of funding focused on community-led and community-based interventions.
  3. Increase the proportion of funding for advocacy and support to key populations to create enabling environments.
  4. Undertake concerted and coordinated efforts to systematically disaggregate, track and make public, funding allocation and spending for key population HIV programming.
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Stereotypes and discrimination contribute to HIV-related stigma among nursing staff

Faculty attitudes about caring for PLHIV can impact student attitudes and the care they provide.

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In December 2012, Xander (not his real name) was tested HIV-positive. And he recalled that during one of his visits to his treatment hub in Metro Manila, “there was this one nurse who told me: ‘Now you’re HIV-positive; stop having sex and stop increasing your numbers’,” he said, adding that it was never clear to him “how to react when healthcare providers themselves stigmatize and discriminate.”

But HIV-related stigma and discrimination among healthcare providers – e.g. nurses – has been studied before, even if, according to Dr. Juan Leyva (Universitat Autonoma de Barcelona), Dr. Patrick Palmieri (Universidad Norbert Wiener and A.T. Still University), and Dr. Joan Edwards (Texas Woman’s University), this issue has not been frequently re-visited.

This is why they looked at this issue again; though this time, focusing on nursing faculty and students, believing that teaching about HIV-related stigma and discrimination may actually start in nursing schools. Particularly, they did a cross-sectional study of nursing faculty in six countries that appeared in The Open AIDS Journal.

According to them, “since the earliest study about nursing faculty and students attitudes and beliefs about caring for people living with HIV/AIDS (PLHIV) in the early 1990’s, there have only been 17 additional studies.” And so “knowledge in this area of study is still lacking to fill some gaps in understanding attitudes towards people living with the disease.”

The researchers sought to understand HIV-related attitudes of nursing faculty in three continents from six countries (Canada, Colombia, England, Peru, Spain, and the US) and how it correlates to three dimensions of prejudice, stereotypes and discrimination.

The researchers found that HIV-related stigma about caring for PLHIV are slightly positive with notable differences between countries. Apart from Peru, and to a lesser extent neighboring Colombia, the results are consistent with other findings from a few smaller studies. The results can be explained, among other reasons, by the high HIV-related stigma in South America and the pervasive discrimination experienced by the LGBTQ community. Although myths and knowledge deficits about HIV/AIDS remain problematic, the results appear to be influenced by nationality in terms of prejudices, stereotypes, and discrimination.

Faculty attitudes about caring for PLHIV can impact student attitudes and the care they provide. According to Dr. Palmieri, “nursing faculty attitudes can become part of an informal curriculum where implicit learning is impregnated with personal values.”

The researchers note that in terms of HIV/AIDS education, faculty might not be comfortable teaching what they do not understand. The researchers conclude that theory-derived, evidence-informed interventions need to be developed to advance the knowledge and attitudes of nursing faculty about caring for people living with HIV. The researchers plan to attempt to address negative attitudes with a stigma-reduction intervention based on the information from similar studies.

For the likes of Xander, “healthcare providers need to be more sensitive to the plight of PLHIV. Otherwise, they become part of the problem, not the solution.”

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