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@ItsOfficialNemo: Valuing oneself more while getting a clearer understanding of life

@ItsOfficialNemo, who was diagnosed to be HIV-positive in March 2012, believes in looking forward. “There’s no point in pointing who’s to blame now because it’s clear to me that it was also my fault,” he said. And to others on the same boat as he is, “life goes on. Let’s continue to love and live responsibly this time. Our status does not define who we are, and we should not feel any less just because (of it). In the end, it’s not our status that will (define) us but how well we live our lives.”

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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.

In March 2012, @ItsOfficialNemo was diagnosed to be HIV-positive. “Prior to discovering my status, I was already (going) in and out of the hospital because of my pertinent fever at the time. I started getting sick frequently sometime around October 2011, but private hospitals won’t allow me to check in because they thought it was just a simple fever,” he recalled. “However, in February 2012 I collapsed in my own apartment and I was rushed to the hospital in Makati to be examined. At that point, I requested the doctor (to allow me to) stay for further examinations because I was really getting scared and I was losing weight abruptly.”

Because of his health condition at that time, the personal and professional aspects of @ItsOfficialNemo’s life were already affected. His boss, in particular, was already very concerned about his health. “So there I was, admitted in one of the private hospitals in Makati, doctors examining my condition because – aside from my fever – I had some rashes in some parts of my body. I went through a couple of tests at that time (and) it was during my ultrasound schedule that the doctor noticed some oversize nodules/lymph nodes situated at the left side of my neck. After further tests, the doctor recommended that I go through a major operation to take out those lymph nodes for them to be examined.”

And so from a couple of days in the hospital, @ItsOfficialNemo’s stay stretched to more than a week. At that time, he already asked his mother to fly into Manila to be with him before his operation.

READ:  HIV is not inability

Before the operation, no explanation was given to him about his health condition. Instead, the doctors just told him to wait after the operation so they can validate his test results.

When @ItsOfficialNemo returned to the hospital, the document with the test result indicated that he had TB of the lympnodes as the diagnosis. He recalled that “I proceed to my doctor on that same day with a sigh of relief that it’s not the diagnosis I was expecting.” But his doctor started to ask him questions related to his sexual practices. The doctor also asked him if he ever had HIV Ab test – which he never had until then – and eventually recommending it.

@ItsOfficialNemo admitted that “I didn’t submit myself for testing right away.” Instead, he only religiously took the medicines prescribed by the doctor for TB. It took him seven months before he considered getting tested.

“While I was browsing my Facebook account, I saw one posting of my friend who is a member of an organization promoting HIV awareness. At that time, he posted an invitation for (people to avail of) free HIV testing.” To make the story short, it was then that @ItsOfficialNemo found out about his HIV-positive status.

At the time of him getting tested, @ItsOfficialNemo recalled that “when I opened the envelope (containing the result), I was not hoping anymore that it would be negative because I had a very strong feeling beforehand that something was very wrong about my health and the possibility of me being infected is something I (could not avoid). And there, under my name, it stated positive. There was this long silence. It’s like the doctor and the counselor were waiting for me to break down or to react before they did or said something, but I could not find any word to say at that moment.”

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In hindsight, “counting back (when) I got terribly sick to the time I was diagnosed, I just got out from a relationship that went bad. After that traumatic break-up, that’s when I lost myself and experimented with different kinds of illegal drugs (and had sexual contacts with) strangers I met mostly online,” @ItsOfficialNemo. While he has a gut feeling he knows who, specifically, infected him, @ItsOfficialNemo said that “there’s no point in pointing who’s to blame now because it’s clear to me that it was also my fault. All I can think of at that time is how am I going to get through this by myself.”

@ItsOfficialNemo decided to inform his two close friends first about his status. “It started as an obligation for me to tell someone because it was required for my counseling session before I could start taking ARV,” he said. But having disclosed, “I realized it gave me a sense of relief and comfort exposing my status to my two friends and how they reacted without judgment but love and understanding to me.”

@ItsOfficialNemo found people from Twitter he considers as “friends of the same status like mine”. “At first, I didn’t know that a certain community like ours existed. I discovered this channel when I saw a blog one time that led me to create an account in Twitter, and that blogger who is now a good friend of mine introduced me to my fellow ‘pozzies’. We keep in touch and meet once in a while to show support to each other, and it really feels good a having people with you who understand your new journey and are with you in this new life.”

@ItsOfficialNemo has been taking ARVs since June 2012 and “it has been pleasant for me. Though I was warned by my doctor that during the first two weeks of taking ARV, I may experience some side effects, in general, I didn’t experience any major struggle. I am thankful that my body is responding well to the ARVs.” @ItsOfficialNemo thinks his mentality contributed a lot in the whole process of taking the drugs. “I was so determined at that point that things will get better now that I am taking ARV. Setting a positive mindset and putting things in perspective helped me a lot in processing my condition with the support of my friends.”

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At this point, @ItsOfficialNemo has yet to disclose his status to his family. “I am still contemplating how and when,” he said. “To be honest, the fear of losing them after I disclosed my status to them is still strong at this point.”

His friends now serve as his support system. “I still consider myself blessed to have met new friends sharing the same experience (as me, and forging) a new life with, and this opens new doors for me. They made me realize that my status will not stop me from living. Instead, they made me value myself more and gave me a clearer understanding about life.”

As an HIV-positive person, @ItsOfficialNemo has lessons he believes he can teach others.

“Be responsible, for those who are non-positive – it is still best to have yourself tested. We are so fortunate that we have NGOs that offer free HIV testing, and our community is very aggressive nowadays in promoting HIV awareness in all channels (Internet, television, broadsheet, et cetera). Do not be afraid, you owe this yourself,” @ItsOfficialNemo said.

And for “my fellow beautiful people or ‘pozzies’, life goes on. Let’s continue to love and live responsibly this time. Our status does not define who we are, and we should not feel any less just because (of it). In the end, it’s not our status that will (define) us but how well we live our lives.”

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Health should not be a privilege for the rich — UNAIDS

Gaps in public financing for health can be met by eliminating tax dodging and implementing progressive taxation; health and development must be protected from the growing impact of debt.

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UNAIDS is calling on governments to ensure that the right to health is realized by all by prioritizing public investments in health. At least half of the world’s population cannot access essential health services. Every two minutes a woman dies while giving birth. Among the people being left behind are women, adolescents, people living with HIV, gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people, migrants, refugees and poor people.

“The right to health is eluding the poor and people trying to lift themselves out of poverty are being crushed by the unacceptably high costs of health care. The richest 1% benefit from cutting-edge science while the poor struggle to get even basic health care,” said Winnie Byanyima, Executive Director of UNAIDS.

Nearly 100 million people are pushed into extreme poverty (defined as living on US$ 1.90 or less a day) because they have to pay for health care, and more than 930 million people (around 12% of the world’s population) spend at least 10% of their household budgets on health care. In many countries, people are denied health care or receive poor quality health care because of unaffordable user fees. Stigma and discrimination denies poor and vulnerable people, especially women, their right to health.

Every week, 6000 young women around the world become infected with HIV. In sub-Saharan Africa, four out of five new HIV infections among adolescents are among adolescent girls and AIDS-related illnesses are the biggest killer of women of reproductive age in the region. Despite significant progress in reducing AIDS-related deaths and new HIV infections, there were 1.7 million new HIV infections in 2018 and nearly 15 million people are still waiting to receive HIV treatment.

READ:  HIV is not inability

“Publicly financed health care is the greatest equalizer in society,” said Ms Byanyima. “When health spending is cut or inadequate, it is poor people and people on the margins of society, especially women and girls, who lose their right to health first, and they have to bear the burden of caring for their families.”

Delivering health care for all is a political choice that too many governments are not making. Thailand has reduced mortality rates for children under the age of five years to 9.1 per 1000 live births, while in the United States of America the rate is 6.3 per 1000 live births, even though Thailand’s gross domestic product per capita is about one tenth of that of the United States. Thailand’s progress has been achieved through a publicly financed health-care system that entitles every Thai citizen essential health services at all life stages and leaves no one behind.

South Africa had just 90 people on antiretroviral therapy in 2000, but in 2019 had more than 5 million on HIV treatment. South Africa now has the largest HIV treatment programme in the world. Countries such as Canada, France, Kazakhstan and Portugal have strong publicly financed health systems, yet some other richer countries do not.

Health investments in many countries remain very low compared to their gross domestic product. The United Nations Conference on Trade and Development estimates that developing countries lose between US$ 150 billion and US$ 500 billion every year owing to corporate tax avoidance and profit shifting by big companies. If this lost money were invested in health, health expenditure could triple in low-income countries and could double in lower-middle-income countries. The race to the bottom on corporate tax cheats denies developing countries of much needed revenue and robs ordinary people of vital health services. The countries of the Economic Community of West African States lose an estimated US$ 9.6 billion each year to numerous tax incentives.

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“It is unacceptable that rich people and big companies are avoiding taxes and ordinary people are paying through their ill health,” said Ms Byanyima. “Big companies must pay their fair share of taxes, protect employee rights, provide equal pay for equal work and provide safe working conditions for all, especially women.”

Debt is posing a serious threat to Africa’s economy, health and development, resulting in big cuts in social spending to ensure debt repayment. According to the International Monetary Fund, as of April 2019 half of low-income countries in Africa were either in debt distress or at a high risk of being so. Beyond low-income countries, in Zambia there was a 27% drop in health-care investments and an increase of debt servicing by 790% between 2015 and 2018. Similar trends were seen in Kenya, where debt servicing increased by 176% and health investments declined by 9% between 2015 and 2018. “There is an urgent need to manage debt in ways that protects people’s health. That means ensuring new financing focuses on social investments, debt repayments being halted for a period if needed to allow economic recovery and debt restructuring under a coordinated mechanism to protect spending on HIV, health and development,” said Ms Byanyima.

A major factor of ill health is the denial of human rights. According to the World Bank, more than one billion women lack legal protection against domestic violence and close to 1.4 billion women lack legal protection against domestic economic violence. In at least 65 countries, a same-sex sexual relationship is a crime. In recent years in some countries, crackdowns and restrictions on lesbian, gay, bisexual, transgender and intersex people have increased. Sex work is a criminal offence in 98 countries. Forty-eight countries and territories still maintain some form of HIV-related restrictions on entry, stay and residence. A recent study of sex work policies in 27 countries concluded that those that decriminalized some aspects of sex work have significantly lower HIV prevalence among sex workers.

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In 91 countries, adolescents require the consent of their parents to take an HIV test and in 77 countries they require the consent of their parents to access sexual and reproductive health services, creating barriers to protect young people from HIV infection. One of the consequences of this is that the HIV incidence rate among young women and girls in eastern and southern Africa is twice that of their male peers.

“In the next decade, we can end AIDS as a public health threat and achieve universal health coverage. Governments must tax fairly, provide publicly funded quality health care, guarantee human rights and achieve gender equality for all—it is possible,” said Ms Byanyima.

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Truvada should remain first choice for HIV prevention, experts say

With the exorbitant cost of these drugs, there are huge public health and economic implications if most PrEP users begin to use the newer TAF/FTC pill rather than TDF/FTC for PrEP.

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In October 2019, the US Food and Drug Administration approved a second medication for use as HIV preexposure prophylaxis, also known as PrEP, sparking controversy about which drug should be prescribed. Gilead Sciences, which manufactures both approved drugs, has argued that the new drug is safer and more effective than the old drug. But these claims are overstated, say a team of clinical and public health experts.

Their commentary, “Tenofovir Alafenamide for HIV Preexposure Prophylaxis – What Can We DISCOVER About Its True Value?”, appears in the January 14 issue of Annals of Internal Medicine.

PrEP, which is 99% effective in preventing HIV, exists in two forms: tenofovir disoproxil fumarate with emtricitabine (TDF/FTC) – best known as Truvada, its brand name in the US – and tenofovir alafenamide with emtricitabine (TAF/FTC), known as Descovy. TDF/FTC has been used for PrEP for more than 7 years, with ample evidence of its safety and effectiveness.

“These drugs are equally effective when used for PrEP in gay and bisexual men and transgender women, and the potential safety benefits of TAF/FTC over TDF/FTC have not yet been shown to be clinically significant,” said lead author Douglas Krakower, MD, Assistant Professor at the Harvard Pilgrim Health Care Institute, Beth Israel Deaconess Medical Center, and Harvard Medical School.

The high cost of PrEP medications, around $24,000 per year in the US, has been a major barrier to PrEP use. Activists have argued that taxpayer money funded the development of PrEP medications, and the US Department of Health and Human Services recently sued Gilead Sciences over patent infringement.

READ:  31% of new HIV cases from 15-24 age bracket; 99% were infected through sex

The older PrEP medication, TDF/FTC, will be available as a generic as early as 2020, which could reduce costs and increase access. But Gilead Sciences holds the exclusive rights to manufacture TAF/FTC until 2022 and has requested a patent extension to 2025. If the generic version of TDF/FTC is perceived to be less safe, uptake of TAF/FTC would presumably rise – with cost ramifications.

“With the exorbitant cost of these drugs, there are huge public health and economic implications if most PrEP users begin to use the newer TAF/FTC pill rather than TDF/FTC for PrEP,” said senior author Julia Marcus, PhD, Assistant Professor in the Department of Population Medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School. “Gilead is asking us to ‘update’ our PrEP to TAF/FTC, but that’s not a clinically necessary or cost-effective choice for the vast majority of PrEP users.”

The authors examined the available data on the safety, efficacy, and public health context for the two PrEP medications. Robust data show the effectiveness of TDF/FTC in all priority populations at risk for HIV, including gay and bisexual men, transgender women, people who inject drugs, and heterosexuals whose partners are living with HIV. In contrast, the only efficacy data for TAF/FTC come from the DISCOVER trial, which enrolled solely gay and bisexual men and a small number of transgender women.

“In the DISCOVER study, TDF/FTC was associated with small changes in renal and bone biomarkers, while TAF/FTC was linked to weight gain and changes in cholesterol,” noted Dr. Krakower. But there were no differences between the groups in clinical events or the number of people who stopped the drug for safety reasons, suggesting that these small changes may not be clinically important. “Given the available clinical evidence and public health context, TDF/FTC should remain the first choice for the vast majority of PrEP users,” he said.

READ:  HIV is not inability

In addition to Drs. Krakower and Marcus, authors of the commentary included Demetre Daskalakis, MD, Deputy Commissioner at the New York City Department of Health and Mental Hygiene, and Judith Feinberg, MD, Professor of Medicine at West Virginia University and Chair of the Board of Directors of the HIV Medicine Association.

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Phl reported 36 new HIV cases per day as of end-August 2019

In August 2019, there were 1,228 newly confirmed HIV-positive individuals reported to the HIV/AIDS & ART Registry of the Philippines. This was 17% higher compared with the diagnosed cases (1,047) in the same period in 2018.

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In August 2019, there were 1,228 newly confirmed HIV-positive individuals reported to the HIV/AIDS & ART Registry of the Philippines (HARP). This was 17% higher compared with the diagnosed cases (1,047) in the same period in 2018.

This is worth noting: The figure is ALSO higher than the month before, July 2019, when the HARP recorded 35 new HIV cases per day.

As of end-August, the Philippines now has 36 new HIV cases per day; up one case in July 2019.

As contained in the still-delayed report of the DOH, 15% of the new cases in August (or 185) had clinical manifestations of advanced HIV infection (WHO clinical stage 3 or 4) at the time of diagnosis.

Ninety-five percent (1,170) of the newly diagnosed were male. The median age was 27 years old (age range: 1-72 years old). Almost half of the cases (47%, 578) were 25-34 years old and 35% (424) were 15-24 years old at the time of testing.

More than a third (34%, 417) were from the National Capital Region (NCR). Region 4A (18%, 218), Region 3 (9%, 117), Region 7 (8%, 93), and Region 6 (7%, 82) comprised the top five regions with the most number of newly diagnosed cases for the month, together accounting for 76% of the total figure.

Sexual contact remained as the predominant mode of transmission (98%, 1,202). Among the newly diagnosed, 61% (748) reported transmission through male to male sex, 25% (310) through sex with both males and females, and 12% (144) were through male to female sex. Other modes of transmission were sharing of infected needles (1%, 13) and vertical (formerly mother-to-child) transmission (<1%, 2). Eleven cases had no data on mode of transmission.

READ:  Same-day HIV testing & treatment improves outcomes for PLHIVs

Among the newly diagnosed females this month, nine were pregnant at the time of diagnosis. Five cases were from NCR, two from Region 7 and one case each from Regions 3 and 11.

SPECIAL POPULATIONS

HIV continues to greatly adversely affect the young.

In August 2019, 424 (35%) cases were among youth 15-24 years old; and 97% were male. Almost all were infected through sexual contact (29 male-female sex, 288 male-male sex, 105 sex with both males and females). One case was infected through sharing of needles and one had no data on mode of transmission.

Still for the same period, there were 69 newly diagnosed adolescents (10-19 years old) at the time of diagnosis. Of these, two cases were 10-14 years old, 18 were 15-17 years old, and 49 were 18-19 years old. Almost all were infected through sexual contact (four male-female sex, 48 male-male sex, and 16 had sex with both males and females) and one had no data on mode of transmission. In addition, there were two diagnosed cases less than 10 years old and both were infected through vertical/mother-to-child transmission.

Sixty-three Filipinos who worked overseas within the past five years, whether on land or at sea, were diagnosed in August 2019. They comprised 5% of the total newly diagnosed cases for the month. Of these, 86% (54) were male. All were infected through sexual contact (seven male-female sex, 30 male-male sex, and 17 sex with both males and females). The ages of male OFWs ranged from 21 to 68 years (median: 32 years). Four were 15-24 years old, 27 were 25-34 years old, 22 were 35-49 years old, and one case was 50 years & older. Among the nine female OFWs diagnosed in August 2019, four each were in 25-34 & 35-49 years old age group and one was 50 years and older at the time of testing. The age range among diagnosed female OFWs were 31 to 56 years (median: 35 years old).

The number of those getting infected with HIV from transactional sex is still noteworthy.

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In August 2019, 13% (163) of the newly diagnosed engaged in transactional sex. Ninety-eight percent (159) were male and aged from 13 to 72 years old (median: 28 years). Fifty-eight percent (92) of the males reported paying for sex only, 35% (56) reported accepting payment for sex only and 7% (11) engaged in both. Also, among the four female cases who engaged in transactional sex, two were reported to have accepted payment for sex only, one case was paying for sex only and one case had engaged in both paying and accepting payment in exchange for sex.

Meanwhile, and as already stated, nine pregnant women were newly diagnosed with HIV. Five cases were from NCR, two from Region 7 and one case each from Regions 3 and 11. The age of diagnosis ranged from 19 to 36 (median age: 31).

ACCESS TO MEDS

The number of those in ART has FINALLY breached half the total number of PLHIVs.

The first case of HIV infection in the Philippines was reported in 1984. Since then, there have been 70,740 confirmed HIV cases reported to the HARP.

In August 2019, there were 922 patients who were initiated on ART. The median CD4 of these patients upon enrollment was 207 cells/mm. With the 922, a total of 40,952 people living with HIV (PLHIV) were presently on ART as of end-August. Most of whom were males (97%). The age of reported cases ranged from 1 to 81 years (median: 31 years old). Ninety-five percent were on first line regimen, 4% were on second line, and 1% were on other line of regimen.

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Still also worth noting is the continuing problem with access to treatment in the Philippines. The DOH itself has been lambasted for its problematic procurement issues that affect ART intake; and this is even if DOH continues to deny that there are issues hounding its HIV-related efforts.

COUNTING DEATHS

But that HIV is no longer a death sentence remains an invalid claim in the Philippines.

In August 2019, there were 70 reported AIDS-related deaths. Ninety-six percent (67) were males. One (1%) were less than 15 years old at the time of death, 16 (23%) cases were 15-24 years old, 30 (43%) were 25-34 years old, 19 (27%) were 35-49 years old and four (6%) were 50 years and older. Eighty-nine percent of the cases were reported to have acquired the infection through sexual contact.

Sexual contact (96%) was the most common mode of HIV transmission among reported deaths (752 through male-female sex, 1,698 through male-male sex, 987 through males who have sex with both males and females). Other modes of transmission of reported deaths were sharing of infected needles (79), vertical/mother-to-child transmission (26),

To stress, the actual number of AIDS-related deaths in the country is questionable because of non- and/or under-reporting.

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Pregnant women with HIV often not given recommended treatment

A study involving more than 1,500 women found that 30% were prescribed drugs that had insufficient evidence of safety in pregnancy.

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Women living with HIV who are also pregnant don’t always receive recommended antiretroviral medications, according to a recent study of prescribing patterns carried out by a MassGeneral Hospital for Children (MGHfC) researcher in collaboration with other members of the Surveillance Monitoring for ART Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS) network.

Few studies, if any, have compared actual prescribing patterns of HIV medications for pregnant women to national treatment guidelines. This study suggests that physicians may be prescribing ahead of the published recommendations, and using drugs or drug combinations they have seen work in the adult population in general.

“We studied, more than 1,500 women and found that 30% were prescribed drugs that had insufficient evidence of safety in pregnancy,” says Kathleen M. Powis, MD, MPH, investigator in MGHfC’s division of Pediatric Global Health and first author of the study, which was published in JAMA Network Open.

For the last 25 years, the US Department of Health and Human services Panel on Treatment of HIV-infected Pregnant Women and Prevention of Perinatal Transmission has published Perinatal HIV Treatment Guidelines on prescribing antiretroviral medications (ARVs) during pregnancy. In 1994, the guidelines just addressed the use of zidovudine, then the only drug approved to treat HIV infection. But by 2008 the prescribing guidelines for pregnant women were updated to recommend the use of triple ARVs, regardless of the woman’s HIV disease status. Pregnant women are typically excluded from studies testing newer drugs until safety has been established in nonpregnant adults. As a result, this data is usually some of the last to be collected.

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“The guidelines change nearly annually,” says Powis, who is also an assistant professor of Pediatrics at Harvard Medical School (HMS). “And a lot of the treatments that doctors are already using simply had ‘insufficient data’ to recommend their use in pregnant women. But doctors were prescribing them anyway.”

Since many of these regimens (70%) were eventually recommended for pregnant women, Powis suggests that doctors may be prescribing “ahead of time.” That is, they are seeing promising therapeutic results in the general population, and prescribing HIV drug treatment combinations to pregnant women based on that experience, rather than on guidelines.

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Even with early treatment, HIV still attacks young brains, says MSU study

While early antiretroviral therapy, or ART, has ensured less deadly outcomes for children living with and exposed to HIV, studies show the virus still may affect the brain. HIV may disrupt neurodevelopment, affecting how children learn, reason and function.

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While early antiretroviral therapy, or ART, has ensured less deadly outcomes for children living with and exposed to HIV, studies show the virus still may affect the brain. HIV may disrupt neurodevelopment, affecting how children learn, reason and function.

That’s why Michael Boivin, professor and director of the Psychiatry Research Program in the Michigan State University College of Osteopathic Medicine, set out to understand exactly how HIV impacts children’s neuropsychological development in a two-year longitudinal study, published in Clinical Infectious Diseases.

The research was supported in part by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Boivin and his colleagues evaluated the neuropsychological development of three groups of children aged 5 to 11: those who acquired HIV perinatally and were treated with ART, those exposed but HIV-negative, and those who were never exposed. The research took place at six study sites across four countries in sub-Saharan Africa for a robust view of how HIV is affecting children in the region.

To date, it’s the first well-validated, multi-site neuropsychological evaluation of African school-aged children affected by HIV.

What the researchers discovered through various assessments was that even in the face of early treatment and good clinical care, there are still significant neuropsychological problems for children living with HIV.

“These children came into the study with a deficit compared to their counterparts,” Boivin said. “It stayed about the same throughout the two years, except in one important area: reasoning and planning. On that specific test domain, the children living with HIV failed to progress over time.”

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In other words, the gap between infected and HIV-negative children grew in the planning and reasoning area over the study period. Typically, these abilities tend to blossom in the school-aged years in healthy children.

“This is the most important cognitive function for the future of children living with HIV in terms of their likelihood of taking their medications, making good decisions, abstaining from risky behaviors like early sexual activity, psychosocial issues and school-related achievement,” Boivin said.

The bottom line? Early medical treatment, started as early as 6 months of age, is probably not enough to address the neurocognitive deficits associated with HIV, even though it helps keep children alive and healthier than they would be without treatment. In these children, treatment should be started even earlier to improve long-term neurocognitive outcomes.

“We’re going to have to complement the long-term care and support with actual behavioral interventions,” Boivin said.

That’s something Boivin and his colleagues are already working on. Earlier this year, Boivin received a 5-year, $3.2 million NIH grant to continue his work with children affected by HIV in Uganda and Malawi.

Through this grant, researchers will investigate how MSU-developed computer cognitive games can serve as tools for neurocognitive evaluation, enrichment and potentially rehabilitation.

Boivin hopes that the results of both of these studies will help make this model of neuropsychological evaluation a considered part of the cost benefit of care for kids affected by HIV.

“Often it’s overlooked or seen as an afterthought, but unlike other areas of medical follow up, neuropsychological evaluation really gets at how well the kids are going to adapt and function in school, at home, in the community and in society in general,” Boivin said. “It’s really what links us most directly to the human burden of disease.”

READ:  Gay/straight alliance Warwick Rowers marks 10th year; still devoted to LGBTQI-related issues

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Addressing perceived stigma about HIV preventive meds key to helping women at risk

While women make up nearly one in five of all new HIV infections, PrEP is largely underutilized by women who are at risk for infection and little is known about the role of stigma among women.

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Stigma is an important contributor to the continued HIV epidemic in the United States. While pre-exposure prophylaxis (PrEP) is a medication that can be taken to prevent HIV infection, previous research has shown that a barrier preventing gay, bisexual and other men who have sex with men from using PrEP is fear that partners, family members or community members would believe that those who use PrEP are HIV infected. Less is known, however, about these factors among women.

While women make up nearly one in five of all new HIV infections, PrEP is largely underutilized by women who are at risk for infection and little is known about the role of stigma among women. A new study that includes a team from the University of Pennsylvania School of Nursing (Penn Nursing), the New York Blood Center, and The CUNY School of Medicine at the City College of New York advances scientific knowledge about how stigma about PrEP use may affect whether or not a woman at elevated risk for HIV infection is interested in starting PrEP.

“Advancing our understanding of factors that influence uptake of PrEP among women is a critical goal, given how significantly underutilized PrEP is among women at risk for HIV infection in the United States,” says Penn Nursing’s Anne M. Teitelman, PhD, FNP, FAAN, Associate Professor of Nursing, and one of the study’s investigators. Results of the study “PrEP Stigma, HIV Stigma, and Intention to Use PrEP Among Women in New York City and Philadelphia,” will be published in an upcoming issue of the journal Stigma and Health.

Funded by the National Institutes of Health, the study Just4Us Study surveyed 160 women aged 18-55 years in Philadelphia and New York City, cities which have high HIV infection rates. The researchers used a scale developed specifically for women that includes an item of particular sociohistorical importance to people of color, low-income women and other marginalized groups of women. Higher stigma about PrEP use, but not stigma about HIV, was significantly associated with lower intention to start PrEP among the women who participated in the study.

READ:  HIV is not inability

The study recommends different ways to design behavioral interventions that specifically address PrEP stigma among women. They include:

-Expand public messaging to increase PrEP awareness and knowledge among women; -Include messaging that addresses the role of PrEP stigma and challenges stereotyped beliefs about women PrEP users; and -Design interventions that integrate stigma reduction at the individual and community levels.

“The next steps to address this gap are to use these findings to guide intervention development and to rigorously evaluate these interventions,” said Teitelman.

Co-authors of the study include: Beryl A. Koblin, Bridgette M. Brawner, and Annet Davis, all of the University of Pennsylvania; Deepti Chittamuru, of the University of California Merced; Victoria Frye, of the City University of New York; and Hong Van Tieu, of the New York Blood Center.

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