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Lee CY, Lin YP, Wang SF, Lu PL. Late cART Initiation Consistently Driven by Late HIV Presentation: A Multicenter Retrospective Cohort Study in Taiwan from 2009 to 2019. Infect Dis Ther 2022; 11:1033-1056. [PMID: 35301666 PMCID: PMC9124249 DOI: 10.1007/s40121-022-00619-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Late initiation (LI) of combination antiretroviral therapy (cART)-defined as having a CD4+ count of < 200 cells/μL or an AIDS-defining disease at cART initiation-has detrimental outcomes but remains prevalent worldwide, with LI trends and etiologies following the implementation of various HIV policies remaining underinvestigated. We assessed key concerns, characterized the determinants of various statuses at cART initiation, and evaluated the effects of those statuses on all-cause mortality after cART initiation. METHODS This multicenter retrospective cohort study enrolled 1198 patients with newly diagnosed HIV infection during 2009-2019 who were grouped by status at cART initiation: those without LI (non-LI group, 56.01%); those with LI but without late presentation (LP) of HIV (LP: a CD4 + count of < 200 cells/μL at HIV presentation or AIDS events ≤ 3 months of HIV diagnosis) [LILP(-) group, 4.51%]; and those with LI and with LP of HIV [LILP(+) group, 39.48%]. Joinpoint regression was used to identify changes in LI proportion. RESULTS The median CD4+ count at cART initiation increased significantly between 2009 (98 cells/μL) and 2015 (325 cells/μL) and stabilized thereafter (P for trend < 0.001). For LI, we identified one joinpoint in 2015: a substantial decrease from 77.14% in 2009 to 34.45% in 2015, followed by a nonsignificant increase to 39.1% in 2019. Overall, LILP(+) explained 89.8% of LI, without significant changes (92.59% in 2009 to 94.23% in 2019). In addition to HIV diagnosis during 2009-2012, multinomial logistic regression identified an age over 30 years and acute HIV infection as risk factors for LILP(+) and LILP(-), respectively. LILP(-) and LILP(+) were associated with a higher all-cause mortality risk. CONCLUSION Given the rise in LI from 2015 in the era of treat-all and rapid cART initiation, strategic interventions to increase earlier cART initiation must be intensified in Taiwan, especially among populations with delayed access to HIV testing services.
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Affiliation(s)
- Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Department of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
- College of Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan ROC
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Lee CY, Wu PH, Lu PL, Liang FW. Different Trends of Distinct Time Points of AIDS Events Following HIV Diagnosis in Various At-risk Populations: A Retrospective Nationwide Cohort Study in Taiwan. Infect Dis Ther 2021; 10:1715-1732. [PMID: 34245451 PMCID: PMC8322356 DOI: 10.1007/s40121-021-00494-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Acquired immune deficiency syndrome (AIDS) events at distinct time points after human immunodeficiency virus (HIV) diagnosis require various AIDS prevention strategies. However, no nationwide epidemiological surveillance studies have been conducted to explore the trends of distinct AIDS event time points in various at-risk populations. The aim of this study was to explore the issues and characterize the determinants of AIDS status after HIV diagnosis. Methods This nationwide cohort study enrolled HIV-positive Taiwanese during 1984–2016. AIDS events were classified into three time points (≤ 3, 4–12, > 12 months) by their occurrence time after HIV diagnosis. The periods of HIV/AIDS diagnosis were divided into six categories according to the calendar year of HIV/AIDS diagnosis: 1984–1991, 1992–1996, 1997–2001, 2002–2006, 2007–2011, and 2012–2016. HIV-positive Taiwanese during 1984–2011 were then selected to determine the factors associated with four AIDS statuses within 5 years after HIV diagnosis (no AIDS, AIDS ≤ 3 months, within 4–12 months, > 12 months) using multinomial logistic regression. Results Of 33,142 cases, we identified 15,254 (46%) AIDS events. The overall AIDS incidence (events/100 person-years) peaked during 1992–1996 (20.61), then declined, and finally stabilized from 2002 (8.96–9.82). The evolution of the proportion of distinct time points of AIDS events following HIV diagnosis changed significantly in heterosexuals and intravenous drug users (IDUs) during 1984–2016 (decline at ≤ 3 months in IDUs, decline at 4–12 months in IDUs, and increase at > 12 months in heterosexuals and IDUs) but not among men who have sex with men (MSM). Time points at ≤ 3 months remained at > 50% among MSM and at > 55% among heterosexuals. In multinomial logistic regression, IDUs (vs. men who have sex with men; MSM) had a lower risk of all AIDS statuses; heterosexuals (vs. MSM) had a higher risk of AIDS events ≤ 3 months after HIV diagnosis. Conclusion The magnitude of AIDS in Taiwan has been stable since 2002. Enhancing early diagnosis among people with sexual contact and optimizing the HIV care continuum among heterosexuals and IDUs should be priorities for further AIDS prevention strategies.
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Affiliation(s)
- Chun-Yuan Lee
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd., Xiaogang Dist., Kaohsiung City, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Hua Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
| | - Po-Liang Lu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
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Srithanaviboonchai K, Sitthi W, Musumari PM, Tangmunkongvorakul A, Rerkasem K, Techasrivichien T. Sexual Behavior and Attitudes Toward Sex of Older Adults Living with HIV. AIDS Behav 2020; 24:1825-1834. [PMID: 31820183 DOI: 10.1007/s10461-019-02756-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The number of older adults living with HIV (OALHIV) is increasing rapidly due to effective antiretroviral therapy. The current research describes sexual behavior, attitudes toward sex, and HIV transmission risk among OALHIV. Participants were HIV-infected persons aged 50 years and older enrolled from community hospitals in Chiang Mai Province, Northern Thailand. Of the 328 participants, 57.6% were women, and the average age was 58.8 years. The majority of participants (93.9%) had undetectable viral load. Most participants (77.1%) thought that it is ok/acceptable for PLHIV to have sex. About one-third of OALHIV participants were sexually active. Being male, younger, married, a previous smoker or a non-smoker, having a positive attitude toward sex, and not having a chronic health condition were independent predictors of having had sex in the last 12 months. Risk of HIV sexual transmission was likely low due to consistent condom use, undetectable viral load, and low instances of extramarital sex.
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Aguiar RB, Leal MCC, Marques APDO. Knowledge and attitudes about sexuality in the elderly with HIV. CIENCIA & SAUDE COLETIVA 2018; 25:2051-2062. [PMID: 32520253 DOI: 10.1590/1413-81232020256.18432018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/11/2018] [Indexed: 05/30/2023] Open
Abstract
This is a cross-sectional quantitative study carried out with 241 elderly diagnosed with HIV, assisted in the services of reference of Recife, Pernambuco State, Brazil. Knowledge and attitudes were evaluated through the Aging Sexual Knowledge and Attitudes Scale (ASKAS). Senior men, participants with higher educational level, those without depressive symptoms and individuals diagnosed with HIV for more than 12 years have a higher level of knowledge about sexuality in old age. Conservative attitudes toward sexuality in aging have been strongly associated with women, illiterate participants, practicing evangelical and Catholic religions, and elderly diagnosed with HIV with less than 12 years. Elderly with less knowledge had more conservative attitudes regarding sexuality in aging (r = 0.42; p < 0.0001). Thus, it is essential to carry out health actions with the aim of improving knowledge and attitudes regarding sexuality in the elderly, paying particular attention to those who are most vulnerable to HIV infection.
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Affiliation(s)
- Rosaline Bezerra Aguiar
- Programa de Pós-Graduação em Saúde Coletiva, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rêgo s/n, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Márcia Carréra Campos Leal
- Programa de Pós-Graduação em Saúde Coletiva, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rêgo s/n, Cidade Universitária. 50670-901, Recife, PE, Brasil.
| | - Ana Paula de Oliveira Marques
- Programa de Pós-Graduação em Saúde Coletiva, Hospital das Clínicas, Universidade Federal de Pernambuco. Av. Prof. Moraes Rêgo s/n, Cidade Universitária. 50670-901, Recife, PE, Brasil.
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Sok P, Gardner S, Bekele T, Globerman J, Seeman MV, Greene S, Sobota M, Koornstra JJ, Monette L, Hambly K, Hwang SW, Watson J, Walker G, Rourke SB. Unmet basic needs negatively affect health-related quality of life in people aging with HIV: results from the Positive Spaces, Healthy Places study. BMC Public Health 2018; 18:644. [PMID: 29783965 PMCID: PMC5963101 DOI: 10.1186/s12889-018-5391-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background Basic needs (e.g., food security and stable housing) are important determinants of health and well-being, yet their impact on health-related quality of life (HRQoL) in the context of HIV and aging has not been systematically investigated. Methods Multiple linear regression models examined the relationship between unmet basic needs, and physical and mental HRQoL by age strata (20-34, 35-49 and 50+) in a cross-sectional sample of 496 people living with HIV in Ontario, Canada. Results An overwhelming majority of participants (87%) reported unmet needs related to food, clothing or housing. The prevalence of unmet basic needs in the two older groups appeared to be lower than among younger participants, but the difference did not reach statistical significance. The presence of unmet basic needs predicted substantially lower mean physical health and mental health summary scores in the two oldest groups. Notably, age moderated the influence of unmet basic needs on HRQoL. Conclusions The availability and accessibility of food security, appropriate clothing and stable housing for people living with HIV who are aging need to become a higher priority for program planners and decision makers.
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Affiliation(s)
- Phan Sok
- Institute of Medical-Science, University of Toronto, Toronto, Canada.
| | | | | | | | - Mary V Seeman
- Institute of Medical-Science, University of Toronto, Toronto, Canada
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, Canada.,Fife House, Toronto, Canada
| | | | | | | | | | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - James Watson
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Glen Walker
- Positive Living Niagara, St. Catherine, Canada
| | - Sean B Rourke
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Lee CY, Jen IA, Lan YC, Yen YF, Chuang PH, Chen M, Lee Y, Chen YMA. AIDS incidence trends at presentation and during follow-up among HIV-at-risk populations: a 15-year nationwide cohort study in Taiwan. BMC Public Health 2018; 18:589. [PMID: 29720151 PMCID: PMC5932870 DOI: 10.1186/s12889-018-5500-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Taiwan has implemented several important interventions for various HIV-at-risk populations to combat the HIV epidemic, little is known regarding AIDS incidence at presentation and during follow-up among the various HIV-at-risk populations in Taiwan. A better understanding of AIDS incidence trends would help improve patient care and optimize public health strategies aimed at further decreasing HIV-related morbidity and mortality. METHODS Data from Taiwan Centers for Disease Control-operated Notifiable Diseases Surveillance System and Taiwan National Health Insurance Research Database (1998-2012) was divided into five cohort periods (consecutive 3-year groups). Logistic regression was employed to identify factors associated with AIDS incidence at presentation. Time-dependent Cox regression was used to identify factors associated with AIDS incidence during the follow-up period. RESULTS Of 22,665 patients [mean age: 32 years; male (93.03%)], 6210 (27.4%) had AIDS incidence over 2 (1.16) [median (interquartile range)] years of follow-up. AIDS developed in ≤3 months of HIV diagnosis in 73.6% AIDS patients. AIDS incidence trends at presentation and during follow-up differed according to HIV transmission routes over the five periods: AIDS at presentation increased in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.648 for bisexuals) but decreased to a nadir in period 3 and then increased slightly in period 5 (P < 0.001) in people who injected drugs (PWIDs). AIDS incidence during the follow-up period increased from period 1 to a peak in period 3 or 4, before declining slightly in period 5, in the sexual contact groups (P < 0.001 for homosexuals/heterosexuals; 0.549 for bisexuals). However, it increased throughout the five periods in PWIDs (P < 0.001). Older age, sexual contact group versus PWIDs, high versus low income level, cohort periods, and HIV diagnosis regions helped predict AIDS at presentation and during follow-up. CONCLUSIONS Disparities in AIDS incidence trends in various HIV-at-risk populations reflect different sociodemographic variables of HIV exposure and the adopted HIV prevention strategies. This study suggests the urgent need for tailored strategies aimed at specific populations at presentation and during follow-up.
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Affiliation(s)
- Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
| | - I-An Jen
- Department and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ching Lan
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Yung-Feng Yen
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
| | - Pei-Hung Chuang
- Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Yun Lee
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
| | - Yi-Ming A. Chen
- Center for Infectious Disease and Cancer Research (CICAR), Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807 Taiwan
- Department of Microbiology and Institute of Medical Research, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Zhao Q, Mao Y, Li X, Shen Z, Zhou Y. Age differences in sexual risk behaviors and related factors among people living with HIV in Guangxi, China. AIDS Care 2018; 30:523-530. [PMID: 29357682 DOI: 10.1080/09540121.2018.1429560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual risk behaviors by people living with HIV (PLHIV) can result in secondary HIV transmission and other health problems. Given the dearth of research on age differences in sexual behaviors among PLHIV, the objective of the study is to compare sexual risk behaviors and related factors among PLHIV by age groups. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 in Guangxi, China. PLHIV were selected randomly from 12 sites with the largest number of HIV/AIDS cases. The 2,987 PLHIV completing the survey were included in the study. Participants were asked about key sociodemographic characteristics, health condition, same-sex behavior, and sexual risk behaviors (number of sex partners, condom use consistency, and change in condom use after HIV diagnosis). Univariate logistic regression analyses were conducted to evaluate associations of sexual risk behaviors with age and other factors. Those variables with a p-value of less than 0.2 were entered into multivariate logistic regression models. All statistical analyses were conducted using SAS 9.4. Differences in sexual risk behaviors across age groups were observed. Compared with their younger counterparts, who were ≥ 50 years of age were more likely to have multiple partners, use condoms inconsistently, and use condoms less than before HIV diagnosis. Moreover, lower education attainment, being in the lowest or highest category of income, having a sero-concordant or sero-unknown steady partner or no steady partner, and having contracted HIV from steady or casual/commercial partners, or through injection drug use appeared to be predictive of at least one of the sexual risk behaviors examined in the study. The findings call for HIV prevention interventions to be tailored to different age groups. The interventions that can help reduce unprotected sex among older PLHIV are urgently needed.
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Affiliation(s)
- Qun Zhao
- a School of Law & Public Affairs , Nanjing University of Information Science & Technology , Nanjing , People's Republic of China
| | - Yuchen Mao
- b Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , USA
| | - Xiaoming Li
- a School of Law & Public Affairs , Nanjing University of Information Science & Technology , Nanjing , People's Republic of China.,b Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , USA
| | - Zhiyong Shen
- c Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
| | - Yuejiao Zhou
- c Guangxi Center for Disease Control and Prevention , Nanning , People's Republic of China
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Surkan PJ, Li Y, Jacobson LP, Cox C, Silvestre A, Gorbach P, Teplin L, Plankey M. Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART). AIDS Behav 2017; 21:2874-2885. [PMID: 27990578 DOI: 10.1007/s10461-016-1614-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to determine the association between psychosocial determinants of unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI). Data from 417 HIV positive men who have sex with men (MSM) in the Multicenter AIDS Cohort Study from April 1999 to March 2012 were analyzed and adjusted odds were calculated. It was found that 66% (n = 277) and 72% (n = 299) reported any UIAI or URAI over follow-up, respectively. Cumulative cART-years (median = 5.30 years) was associated with 33 and 47% increases in UIAI and URAI, respectively. Not having reduced concern about HIV transmission (UIAI: OR 0.37, p-value = 0.0004; URAI: OR 0.57, p-value = 0.04), increased safe sex fatigue (UIAI: OR 2.32, 95% p-value = 0.0002; URAI: OR 1.94, p-value = 0.003), and sexual sensation seeking (UIAI: OR 1.76, p-value = 0.002; URAI: OR 1.56, p-value = 0.02) were associated with UIAI and URAI. Serosorting was associated with UIAI (OR 6.11, p-value < 0.0001) and URAI (OR 6.80, p-value < 0.0001). Findings suggest that negative attitudes about HIV transmission are sustained among older men who have sex with men.
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Affiliation(s)
- Pamela J Surkan
- Social and Behavioral Intervention Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St., Room E5523, Baltimore, MD, 21205-2179, USA.
| | - Ying Li
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamina Gorbach
- Division of Infectious Diseases, Department of Epidemiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Linda Teplin
- Health Disparities and Public Policy, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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The intimate lives of older adults living with HIV: a qualitative study of the challenges associated with the intersection of HIV and ageing. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x1700068x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTOlder adults living with human immunodeficiency virus (HIV) are at risk of experiencing difficulties in their intimate lives due to the combined effects of HIV and ageing. To date, little research has focused on the lived experience of sexuality. This article seeks to fill in the gap by documenting the challenges faced by this population with respect to their intimate relationships and sexual lives. Based upon the results of a qualitative study conducted in Montreal (2010–2012) using semi-structured interviews with a diverse sample of 38 people aged 50–73 and living with HIV, this study revealed several difficulties, including those related to their social location, whereby HIV and ageing intersect with other social determinants (including gender, sexual orientation and drug use). Difficulties that were identified include lower sexual desire linked to ageing, erectile changes, difficulty in using condoms, stigma related to HIV and/or ageism, changes in appearance caused by HIV and/or ageing, along with the impact of their lifecourse experiences. Our results shed light on the specific nature of the difficulties experienced by older adults living with HIV with regard to their intimate lives, as well as on the importance of using an analysis that combines the theoretical approaches of intersectionality and lifecourse to enhance our capacity for understanding complex and unique experiences.
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Taylor TN, Munoz-Plaza CE, Goparaju L, Martinez O, Holman S, Minkoff HL, Karpiak SE, Gandhi M, Cohen MH, Golub ET, Levine AM, Adedimeji AA, Gonsalves R, Bryan T, Connors N, Schechter G, Wilson TE. "The Pleasure Is Better as I've Gotten Older": Sexual Health, Sexuality, and Sexual Risk Behaviors Among Older Women Living With HIV. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1137-1150. [PMID: 27220311 PMCID: PMC5122465 DOI: 10.1007/s10508-016-0751-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 02/26/2016] [Accepted: 03/29/2016] [Indexed: 05/16/2023]
Abstract
There is limited research examining the sexual health and well-being of older women living with HIV (OWLH). Most studies focus on sexual dysfunction, leaving aside the richer context of sexuality and sexual health, including the effect of age-related psychosocial and interpersonal changes on sexual health behaviors. Guided by the integrative biopsychosocial model and the sexual health model, this study explored the importance of sex and sexuality among OWLH to identify their sexual health and HIV prevention needs for program planning. A purposive sample (n = 50) of OWLH was selected from a parent study (n = 2052). We conducted 8 focus groups and 41 in-depth interviews with 50 African American and Latina OWLH aged 50-69 years old in three U.S. cities. The triangulation approach was used to synthesize the data. Six salient themes emerged: sexual pleasure changes due to age, sexual freedom as women age, the role of relationships in sexual pleasure, changes in sexual ability and sexual health needs, sexual risk behaviors, and ageist assumptions about older women's sexuality. We found that sexual pleasure and the need for intimacy continue to be important for OWLH, but that changing sexual abilities and sexual health needs, such as the reduction of sexual desire, as well as increased painful intercourse due to menopause-associated vaginal drying, were persistent barriers to sexual fulfillment and satisfaction. Particular interpersonal dynamics, including low perceptions of the risk of HIV transmission as related to gender, viral suppression, and habitual condomless sex with long-term partners without HIV transmission have resulted in abandoning safer sex practices with serodiscordant partners. These findings suggest that HIV prevention for OWLH should focus on how sexual function and satisfaction intersect with sexual risk. HIV prevention for OWLH should promote ways to maintain satisfying and safe sex lives among aging women.
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Affiliation(s)
- Tonya N Taylor
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA.
| | | | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Omar Martinez
- College of Public Health, Temple University, Philadelphia, PA, USA
| | - Susan Holman
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Howard L Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Stephen E Karpiak
- AIDS Community Research Initiative of America, New York, NY, USA
- School of Nursing, New York University, New York, NY, USA
| | - Monica Gandhi
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mardge H Cohen
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Adebola A Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rebecca Gonsalves
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Tiffany Bryan
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Nina Connors
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Gabrielle Schechter
- College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Tracey E Wilson
- School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA
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11
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Beuthin R, Sheilds L, Bruce A. Shadows and Sunshine: What Metaphors Reveal about Aging with HIV. Can J Nurs Res 2017; 46:6-25. [DOI: 10.1177/084456211404600302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Sullivan KM, Dawson Rose C, Phillips JC, Holzemer WL, Webel AR, Nicholas P, Corless IB, Kirksey K, Sanzero Eller L, Voss J, Tyer-Viola L, Portillo C, Johnson MO, Brion J, Sefcik E, Nokes K, Reid P, Rivero-Mendez M, Chen WT. Sexual transmission-risk behaviour among HIV-positive persons: a multisite study using social action theory. J Adv Nurs 2016; 73:162-176. [PMID: 27485796 DOI: 10.1111/jan.13087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/19/2022]
Abstract
AIM Sexual risk behaviour was explored and described using Social Action Theory. BACKGROUND The sexual transmission of HIV is complex and multi-factorial. Social Action Theory provides a framework for viewing self-regulation of modifiable behaviour such as condom use. Condom use is viewed within the context of social interaction and interdependence. DESIGN Cross-sectional survey. METHODS Self-report questionnaire administered to adults living with HIV/AIDS, recruited from clinics, service organizations and by active outreach, between 2010 - 2011. FINDINGS Having multiple sex partners with inconsistent condom use during a 3-month recall period was associated with being male, younger age, having more years of education,substance use frequency and men having sex with men being a mode of acquiring HIV. In addition, lower self-efficacy for condom use scores were associated with having multiple sex partners and inconsistent condom use. CONCLUSION Social Action Theory provided a framework for organizing data from an international sample of seropositive persons. Interventions for sexually active, younger, HIV positive men who have sex with men, that strengthen perceived efficacy for condom use, and reduce the frequency of substance use, may contribute to reducing HIV-transmission risk.
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Affiliation(s)
- Kathleen M Sullivan
- University of Hawaii at Manoa School of Nursing and Dental Hygiene, Honolulu, Hawaii, USA
| | - Carol Dawson Rose
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - J Craig Phillips
- School of Nursing, University of Ottawa School of Nursing, Ottawa, Ontario, Canada
| | | | - Allison R Webel
- Case Western Reserve University School of Nursing, Cleveland, Ohio, USA
| | - Patrice Nicholas
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Inge B Corless
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Kenn Kirksey
- Nursing Strategic Initiatives Harris Health System, Houston, Texas, USA
| | | | - Joachim Voss
- Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Lynda Tyer-Viola
- Baylor College of Medicine and AVP Texas Children's Hospital, Houston, Texas, USA
| | - Carmen Portillo
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Mallory O Johnson
- University of California San Francisco School of Nursing, San Francisco, California, USA
| | - John Brion
- Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Elizabeth Sefcik
- Texas A&M University-Corpus Christi, Corpus, Christi, Texas, USA
| | - Kathleen Nokes
- Hunter College, CUNY School of Nursing, New York, New York, USA
| | - Paula Reid
- University of North Carolina at Wilmington, Wilmington, North Carolina, USA
| | | | - Wei-Ti Chen
- Yale University School of Nursing, New Haven, Connecticut, USA
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13
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MacDonald J, Lorimer K, Knussen C, Flowers P. Interventions to increase condom use among middle-aged and older adults: A systematic review of theoretical bases, behaviour change techniques, modes of delivery and treatment fidelity. J Health Psychol 2016; 21:2477-2492. [PMID: 25921479 DOI: 10.1177/1359105315580462] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review collates, examines and syntheses condom use interventions for middle-aged and older adults. Associations between effectiveness and theoretical basis, behaviour change techniques, mode of delivery and treatment fidelity were explored. Five interventions were included; one was effective. Compared to interventions with non-significant findings, the effective telephone-administered intervention used theory to a greater extent, had a higher number of behaviour change techniques and employed more treatment fidelity strategies. There is a need to develop theory-based interventions targeting condom use among this population and evaluate these in randomised controlled trials that are rigorously designed and reported. Health psychologists have a key role in this endeavour.
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14
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Innes KE, Selfe TK, Khalsa DS, Kandati S. A randomized controlled trial of two simple mind-body programs, Kirtan Kriya meditation and music listening, for adults with subjective cognitive decline: Feasibility and acceptability. Complement Ther Med 2016; 26:98-107. [DOI: 10.1016/j.ctim.2016.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/14/2022] Open
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15
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Ama NO, Shaibu S, Burnette JD. HIV-related knowledge and practices: a cross-sectional study among adults aged 50 years and above in Botswana. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1167310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Innes KE, Selfe TK, Khalsa DS, Kandati S. Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial. J Alzheimers Dis 2016; 52:1277-98. [PMID: 27079708 PMCID: PMC5649740 DOI: 10.3233/jad-151106] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer's disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention. OBJECTIVE In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD. METHODS Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments. RESULTS Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p's≤0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p's≤0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies. CONCLUSIONS Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group.
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Affiliation(s)
- Kim E. Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, VA, USA
| | - Terry Kit Selfe
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, VA, USA
| | - Dharma Singh Khalsa
- Department of Internal Medicine and Integrative Medicine, University of New Mexico School of Medicine, Albuquerque, NM and the Alzheimer’s Research and Prevention Foundation, Tucson, AZ, USA
| | - Sahiti Kandati
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
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17
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Aggarwal P, Bhattar S, Sahani SK, Bhalla P, Garg VK. Sexually transmitted infections and HIV in self reporting men who have sex with men: A two-year study from India. J Infect Public Health 2016; 9:564-70. [PMID: 26776704 DOI: 10.1016/j.jiph.2015.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/18/2015] [Accepted: 12/11/2015] [Indexed: 11/25/2022] Open
Abstract
Homosexuality is not legally and socially accepted in India. Thus, this area of research has largely been ignored by Indian authors, resulting in dearth of knowledge, particularly with respect to sexually transmitted infections (STIs) in this high-risk group. Over a period of two years (2013-2014), 738 males sought care at skin and venereal diseases clinics, 52 (7.05%, 95% CI=5.4-9.14%) of who identified themselves as MSM and were enrolled in the study. Diagnosis was made on the basis of clinical presentation and laboratory testing, wherever indicated. Thirty six percent of MSM had only homosexual preferences, while 64% were bisexual. The most common sexually transmitted infection was genital warts (23.08%, 95% CI=13.58-36.28%). Fourteen patients (26.92%, 95% CI=16.67-40.35%) were VDRL and TPHA positive (two, five and four with primary syphilis, secondary syphilis and latent syphilis, respectively). These were followed by genital herpes (11.54%, 95% CI=5.03-23.34%), genital molluscum contagiosum (9.62% 95% CI=3.75-21.04%), and gonorrhea (5.77%, 95% CI=1.38-16.25%). Of those tested, 23.08% (95% CI=13.58-36.28%) of patients were reactive for HIV serology. Thus, MSM is a high-risk group with high prevalence of HIV and other STIs in this group, mandating greater focus, education and counseling.
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Affiliation(s)
- Prabhav Aggarwal
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Sonali Bhattar
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Satyendra K Sahani
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi 110002, India.
| | - Preena Bhalla
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Vijay K Garg
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi 110002, India.
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18
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Thomason A, Capps N, Lefler L, Richard-Davis G. Factors Affecting Gynecologic and Sexual Assessment in Older Women: A Lesson for Primary Care Providers. Healthcare (Basel) 2015; 3:683-94. [PMID: 27417790 PMCID: PMC4939570 DOI: 10.3390/healthcare3030683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/19/2015] [Accepted: 08/07/2015] [Indexed: 11/17/2022] Open
Abstract
Guidelines for screening of cervical cancer and pelvic exams for older women have recently changed. These changes may have unexpected sequelae in women over 65 years of age. This manuscript provides a review of gynecologic screening recommendations for older women in the U.S. and potential ramifications of these recent changes. Peer reviewed guidelines from the American College of Obstetrics and Gynecology, U.S. Preventative Task Force Services, the American Cancer Society, The Centers for Disease Control, and multiple original research articles and reviews were reviewed for this manuscript. Women over 65 are at greatest risk to develop late stage diagnoses of cancers, pelvic organ disease, incontinence, and infections. Clinicians will need to acutely consider this fact when communicating and screening this population. We conclude that practitioners should be aware of the new guidelines and should consider including gynecologic health history and symptom analysis as part of annual exams in women of all ages.
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Affiliation(s)
- Ayasha Thomason
- College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
| | - Natalie Capps
- College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
| | - Leanne Lefler
- College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 529, Little Rock, AR 72205, USA.
| | - Gloria Richard-Davis
- College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 518, Little Rock, AR 72205, USA.
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19
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Illa L, Echenique M, Bustamante-Avellaneda V, Sanchez-Martinez M. Review of recent behavioral interventions targeting older adults living with HIV/AIDS. Curr HIV/AIDS Rep 2015; 11:413-22. [PMID: 25288277 DOI: 10.1007/s11904-014-0231-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Increasing attention has been paid to older adults living with HIV over the past few years given the increasing prevalence of HIV in this age group. Yet, despite numerous studies documenting psychosocial and behavioral differences between older and younger HIV-infected adults, few evidence-based behavioral interventions have been developed for this population. This review found only 12 manuscripts describing behavioral intervention studies in older HIV-positive adults published between 2011 and 2014, and they reported on a total of six interventions. Despite promising findings, there is a clear need for large-scale clinical trials to replicate these initial results and further develop additional interventions to address important clinical issues such as depression, sexual risk behaviors, cognition, and other significant issues affecting this cohort. This represents an exciting opportunity for behavioral scientists and HIV specialists to develop interventions that combine the psychological and behavioral with medical aspects of the disease.
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Affiliation(s)
- Lourdes Illa
- Department of Psychiatry and Behavioral Sciences, 1695 NW 9th Ave, Suite 1404, Miami, FL, 33136, USA,
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20
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Longitudinal Trends in Sexual Behaviors with Advancing Age and Menopause Among Women With and Without HIV-1 Infection. AIDS Behav 2015; 19:931-40. [PMID: 25245474 DOI: 10.1007/s10461-014-0901-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We assessed changes in self-reported sexual activity (SA) over 13 years among HIV-infected and uninfected women. The impact of aging and menopause on SA and unprotected anal or vaginal intercourse (UAVI) was examined among women in the Women's Interagency HIV Study (WIHS), stratifying by HIV status and detectable viral load among HIV-infected women. Generalized mixed linear models were fitted for each outcome, adjusted for relevant covariates. HIV-uninfected women evidenced higher levels of SA and UAVI than HIV-infected. The odds of SA declined by 62-64 % per decade of age. The odds of SA in a 6-month interval for women aged 40-57 declined by 18-22 % post-menopause (controlling for age). Among HIV+/detectable women only, the odds of any UAVI decreased by 17 % per decade of age; the odds of UAVI were unchanged pre-menopause, and then decreased by 28 % post-menopause. Elucidating the factors accounting for ongoing unprotected sex among older women should inform interventions.
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21
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Pilowsky DJ, Wu LT. Sexual risk behaviors and HIV risk among Americans aged 50 years or older: a review. Subst Abuse Rehabil 2015; 6:51-60. [PMID: 25960684 PMCID: PMC4410899 DOI: 10.2147/sar.s78808] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although HIV-related sexual risk behaviors have been studied extensively in adolescents and young adults, there is limited information about these behaviors among older Americans, which make up a growing segment of the US population and an understudied population. This review of the literature dealing with sexual behaviors that increase the risk of becoming HIV-infected found a low prevalence of condom use among older adults, even when not in a long-term relationship with a single partner. A seminal study by Schick et al published in 2010 reported that the prevalence of condom use at last intercourse was highest among those aged 50–59 years (24.3%; 95% confidence interval, 15.6–35.8) and declined with age, with a 17.1% prevalence among those aged 60–69 years (17.1%; 95% confidence interval, 7.3–34.2). Studies have shown that older Americans may underestimate their risk of becoming HIV-infected. Substance use also increases the risk for sexual risk behaviors, and studies have indicated that the prevalence of substance use among older adults has increased in the past decade. As is the case with younger adults, the prevalence of HIV infections is elevated among ethnic minorities, drug users (eg, injection drug users), and men who have sex with men. When infected, older adults are likely to be diagnosed with HIV-related medical disorders later in the course of illness compared with their younger counterparts. Physicians are less likely to discuss sexual risk behaviors with older adults and to test them for HIV compared with younger adults. Thus, it is important to educate clinicians about sexual risk behaviors in the older age group and to design preventive interventions specifically designed for older adults.
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Affiliation(s)
- Daniel J Pilowsky
- Columbia University Medical Center, Department of Epidemiology, Mailman School of Public Health New York City, NY, USA ; Division of Epidemiology, New York State Psychiatric Institute, New York City, NY, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA ; Center for Child and Family Policy, Duke University, Durham, NC, USA
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22
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Dispenza F, Dew BJ, Tatum AK, Wolf ECM. Sexual Health Risk Behaviors Among Older Men Who Have Sex With Men: Implications for Interventions. ADULTSPAN JOURNAL 2015. [DOI: 10.1002/j.2161-0029.2015.00035.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Franco Dispenza
- Department of Counseling and Psychological Services; Georgia State University
| | - Brian J. Dew
- Department of Counseling and Psychological Services; Georgia State University
| | - Alexander K. Tatum
- Department of Counseling and Psychological Services; Georgia State University
| | - Edison C. M. Wolf
- Department of Counseling and Psychological Services; Georgia State University
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Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A. Changes in sexual behavior of HIV-infected older adults enrolled in a clinical trial of standalone group psychotherapies targeting depression. AIDS Behav 2015; 19:1-8. [PMID: 24668254 DOI: 10.1007/s10461-014-0746-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
By 2015, one-half of all HIV-positive persons in the U.S. will be 50-plus years of age, and as many as 30 % of older adults living with HIV/AIDS continue to engage in unprotected sexual intercourse. Contemporary positive prevention models often include mental health treatment as a key component of HIV prevention interventions. This secondary data analysis characterized longitudinal patterns of sexual behavior in HIV-positive older adults enrolled in a randomized controlled trial of group mental health interventions and assessed the efficacy of psychosocial treatments that targeted depression to reduce sexual risk behavior. Participants were 295 HIV-positive adults ≥50 years of age experiencing mild to severe depressive symptoms, randomized to one of three study conditions: a 12-session coping improvement group intervention, a 12-session interpersonal support group intervention, or individual therapy upon request. Approximately one-fifth of participants reported one or more occasions of unprotected anal or vaginal intercourse with HIV-negative sexual partners or persons of unknown HIV serostatus over the study period. Changes in sexual behavior did not vary by intervention condition, indicating that standalone treatments that target and reduce depression may be insufficient to reduce sexual risk behavior in depressed HIV-positive older adults.
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Affiliation(s)
- Travis I Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA,
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24
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Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care 2014; 27:520-8. [PMID: 25397643 DOI: 10.1080/09540121.2014.978734] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to examine the independent influence of age on levels of HIV-related stigma experienced by adults living with HIV/AIDS. To accomplish this, cross-sectional data from the Ontario HIV Treatment Network Cohort Study were used to determine whether older age is associated with overall stigma among HIV-positive adults living in Ontario, Canada (n = 960). The relationship was also tested for enacted, anticipated, and internalized stigma. Covariates included sociodemographic (e.g., gender, sexual orientation, race) and psychosocial variables (e.g., depression). Modifying effects of covariates were also investigated. Those 55 and older have significantly lower overall and internalized stigma than adults under age 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping, and social support. Age does not predict enacted or Anticipated Stigma when accounting for the demographic and psychosocial variables. A significant interaction between depression and age suggests that stigma declines with age among those who are depressed but increases to age 50 and then decreases in older age groups among those who are not depressed. Age matters when it comes to understanding stigma among adults living with HIV/AIDS; however, the relationship between age and stigma is complex, varying according to stigma type and depression level.
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Affiliation(s)
- Charles A Emlet
- a Social Work Program , University of Washington Tacoma , Tacoma , WA , USA
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25
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Zhou Y, Ding Y, Gu K, Lu X, Gao M, He N. Motivations for sexual risk behaviors among older men in Shanghai, China: a qualitative study. BMC Public Health 2014; 14:802. [PMID: 25099016 PMCID: PMC4137080 DOI: 10.1186/1471-2458-14-802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China's population is quickly aging and this trend is expected to continue. Thus it is important to develop HIV interventions to help protect older Chinese from infection. Limited information exists regarding sexual risk behaviors and associated personal motivations among persons aged 50 and over in China. METHODS In-depth interviews were conducted with 12 HIV-infected and 14 uninfected men aged 50 and over in Shanghai, China. RESULTS More than 71% of heterosexual participants had engaged in commercial sex, 37.5% either had engaged in casual sex or had a steady extramarital partner. All gay/bisexual participants had engaged in casual sex with men, and 16.7% had engaged in commercial sex. Personal motivations associated with sexual risk behaviors included sexual desire and interest in sex remaining high at an older age, unfulfilled sexual desires within marriage, homosexual or bisexual orientation, need to socialize with others, peer influence, personal choice of "hobby", and financial freedom. CONCLUSIONS This study sheds light on the sexual needs of older people. Our findings underscore the need for both greater education in order to reshape societal perceptions of sexuality among older adults and prevention strategies to help the older male population maintain a healthy sexual life.
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Affiliation(s)
| | | | | | | | | | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai 200032, China.
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Shacham E, Rosenburg N, Önen NF, Donovan MF, Overton ET. Persistent HIV-related stigma among an outpatient US clinic population. Int J STD AIDS 2014; 26:243-50. [PMID: 24828557 DOI: 10.1177/0956462414533318] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite advancements in the public's understanding of HIV infection, felt stigma towards individuals living with HIV persists. Stigma has been associated with adverse health outcomes, including poor adherence to care, and increased participation in HIV transmission risk behaviours. We evaluated the level of felt stigma and its relationship to other psychosocial and medical factors among a sample of 201 individuals with HIV engaged in care. The overall mean stigma score, as measured by the Reece Stigma Scale, was 21.7 (SD 8.7). In univariate analysis, felt stigma scores were higher among women, African Americans, younger participants, and individuals with less education. Higher felt stigma scores were also found among individuals who reported having fair to poor overall health, moderate to severe symptoms of depression and anxiety, and those with a current diagnosis of alcohol dependence, generalised anxiety disorder, agoraphobia, pain disorder, and current smokers. Higher felt stigma scores were independently associated with individuals with anxiety symptoms. These analyses highlight that stigma persists among individuals with HIV and may play an important role in HIV care. The relationship between psychiatric disorders and psychosocial factors highlights an opportunity to develop interventions that will address these common comorbidities and reduce stigma.
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Affiliation(s)
- Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Neal Rosenburg
- School of Nursing, Nevada State College, Henderson, NV, USA
| | - Nur F Önen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA
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Lee KA, Gay C, Pullinger CR, Hennessy MD, Zak RS, Aouizerat BE. Cytokine polymorphisms are associated with poor sleep maintenance in adults living with human immunodeficiency virus/acquired immunodeficiency syndrome. Sleep 2014; 37:453-63. [PMID: 24587567 DOI: 10.5665/sleep.3474] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES Cytokine activity and polymorphisms have been associated with sleep outcomes in prior animal and human research. The purpose of this study was to determine whether circulating plasma cytokines and cytokine polymorphisms are associated with the poor sleep maintenance commonly experienced by adults living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). DESIGN Cross-sectional descriptive study. SETTING HIV clinics and community sites in the San Francisco Bay area. PARTICIPANTS A convenience sample of 289 adults (193 men, 73 women, and 23 transgender) living with HIV/AIDS. INTERVENTIONS None. MEASUREMENTS AND RESULTS A wrist actigraph was worn for 72 h to estimate the percentage of wake after sleep onset (WASO%) and total sleep time (TST), plasma cytokines were analyzed, and genotyping was conducted for 15 candidate genes involved in cytokine signaling: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1B, IL1R2, IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factor of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor-alpha (TNFA). Controlling for demographic variables such as race and sex, and clinical variables such as CD4+ count and medications, higher WASO% was associated with single nucleotide polymorphisms (SNPs) of IL1R2 rs11674595 and TNFA rs1041981 and less WASO% was associated with IL2 rs2069776. IL1R2 rs11674595 and TNFA rs1041981 were also associated with short sleep duration. CONCLUSIONS This study strengthens the evidence for an association between inflammation and sleep maintenance problems. In this chronic illness population, cytokine polymorphisms associated with wake after sleep onset provide direction for intervention research aimed at comparing anti-inflammatory mechanisms with hypnotic agents for improving sleep maintenance and total sleep time.
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Affiliation(s)
- Kathryn A Lee
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA
| | - Caryl Gay
- Department of Family Health Care Nursing, University of California at San Francisco, San Francisco, CA ; Lovisenberg Diakonale Hospital, Oslo, Norway ; Lovisenberg Diakonale University College, Oslo, Norway
| | - Clive R Pullinger
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, CA ; Cardiovascular Research Institute, University of California at San Francisco, San Francisco, CA
| | - Mary Dawn Hennessy
- Department of Women, Children, and Family Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Rochelle S Zak
- Sleep Disorders Center, University of California at San Francisco, San Francisco, CA
| | - Bradley E Aouizerat
- Department of Physiological Nursing, University of California at San Francisco, San Francisco, CA ; Institute for Human Genetics, University of California at San Francisco, San Francisco, CA
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Molina Y, Ramirez-Valles J. HIV/AIDS stigma: measurement and relationships to psycho-behavioral factors in Latino gay/bisexual men and transgender women. AIDS Care 2013; 25:1559-68. [PMID: 23668809 PMCID: PMC3800251 DOI: 10.1080/09540121.2013.793268] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the increased interest in HIV/AIDS stigma and its negative effects on the health and social support of people living with HIV/AIDS (PLWHA), little attention has been given to its assessment among Latino gay/ bisexual men and transgender women (GBT) living with HIV/AIDS. The purpose of this paper is twofold: to develop a multidimensional assessment of HIV/AIDS stigma for Latino GBT living with HIV/AIDS, and to test whether such stigma is related to self-esteem, safe sex self-efficacy, social support, and alcohol, and drug use. The sample included 170 HIV+ Latino GBT persons. The results revealed three dimensions of stigma: internalized, perceived, and enacted HIV/AIDS stigma. Enacted HIV/AIDS stigma comprised two domains: generalized and romantic and sexual. Generalized enacted HIV/AIDS stigma was related to most outcomes. Internalized HIV/AIDS stigma mediated the associations between generalized enacted HIV/AIDS stigma and self-esteem and safe sex self-efficacy. In addition, romantic and sexual enacted HIV/AIDS stigma significantly predicted drug use. Perceived HIV/AIDS stigma was not associated with any outcome. These findings expand the understanding of the multidimensionality of stigma and the manner in which various features impact marginalized PLWHA.
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Affiliation(s)
- Y. Molina
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J. Ramirez-Valles
- Community Health Sciences University of Illinois-Chicago, Chicago, IL, USA
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Aouizerat BE, Gay CL, Lerdal A, Portillo CJ, Lee KA. Lack of energy: an important and distinct component of HIV-related fatigue and daytime function. J Pain Symptom Manage 2013; 45:191-201. [PMID: 22917712 PMCID: PMC3547130 DOI: 10.1016/j.jpainsymman.2012.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 01/23/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
CONTEXT Fatigue is a prevalent symptom among adults living with HIV. There is increasing evidence that fatigue and energy are related, yet distinct constructs. Although HIV-related fatigue has been well studied, little is known about perceived energy and how it relates to fatigue, individual characteristics, and other symptoms. OBJECTIVES To describe the experience of perceived energy in adults with HIV and evaluate its relationship to demographic and clinical characteristics as well as symptoms of fatigue, sleep disturbance, anxiety, depression, and daytime function. METHODS The design was descriptive, comparative, and correlational. The sample of 318 adults with HIV completed a demographic questionnaire; the Memorial Symptom Assessment Scale; and measures of fatigue, sleep disturbance, anxiety, depressive symptoms, and daytime function. Medical records were reviewed for disease and treatment data. Participants who reported a lack of energy were compared with those who did not on demographic, clinical, and symptom variables. Regression models of perceived energy and its interference with daytime function also were evaluated. RESULTS Perceived lack of energy was highly prevalent (65%) and more strongly related to interference with daytime function than more general measures of fatigue severity, even when controlling for other characteristics and symptoms. Like other aspects of fatigue, lack of energy was associated with sleep disturbance, anxiety, and depressive symptoms. Lack of energy was more strongly related to morning fatigue than to evening fatigue. CONCLUSION Lack of energy interferes with daytime function and is not just the inverse of fatigue but a distinct perception that differs from fatigue.
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Affiliation(s)
- Bradley E Aouizerat
- Department of Physiological Nursing and Institute for Human Genetics, University of California at San Francisco, San Francisco, California 94143, USA.
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30
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Psaros C, Barinas J, Robbins GK, Bedoya CA, Safren SA, Park ER. Intimacy and sexual decision making: exploring the perspective of HIV positive women over 50. AIDS Patient Care STDS 2012. [PMID: 23199193 DOI: 10.1089/apc.2012.0256] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Due to advances made in HIV treatment, the population of individuals with HIV over the age of 50 is growing. Aging women face many developmental challenges and some of these challenges, including having or maintaining intimate partner relationships, may be particularly pronounced for aging women living with HIV. However, research exploring the psychosocial needs of aging women with HIV is limited. Thus, the aim of this study was to explore factors that impact intimate partner relationships for older women with HIV. Nineteen women (mean age=56.79, SD=4.63 years) referred from Boston-area community organizations and hospitals completed in-depth individual interviews. Forty-seven percent of participants identified themselves as Black/African American, and 37% as White/Caucasian. Average time since diagnosis was 16.32 years (SD=5.70). Interviews continued until saturation of content was reached. Inclusion criteria included: biologically born female; aged 50 years or older; diagnosis of HIV/AIDS; and English speaking. Qualitative interviews were coded by two raters and content analyses were conducted using NVivo 9 software. The findings are described across the following three main themes: (1) stigma; (2) body image concerns; and (3) the disclosure dilemma. The themes and issues identified by this study may help guide sexual health-related interventions for older HIV-infected women.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jennifer Barinas
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Gregory K. Robbins
- Department of Infectious Disease, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - C. Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Steven A. Safren
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Elyse R. Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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31
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Mayer KH. Sexually transmitted diseases in men who have sex with men. Clin Infect Dis 2012; 53 Suppl 3:S79-83. [PMID: 22080272 DOI: 10.1093/cid/cir696] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men who have sex with men (MSM) have increased rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) compared with demographically matched controls. The reasons for the disproportionate infection burden are complex, including biological, behavioral, and sociocultural factors. HIV and syphilis may often be coprevalent among MSM. The use of nucleic acid amplification testing has enhanced the ability to detect frequently asymptomatic gonococcal and chlamydial infections of the rectum and other sites. Lymphogranuloma proctitis outbreaks among MSM were noted in the developed world several years ago but have not been common recently. MSM are at increased risk for viral hepatitis and anal human papillomavirus disease. Preventive interventions include vaccination for the former and anal cytologic screening for the latter. Because of the diverse ways in which MSM may be exposed to STDs, it is essential for clinicians to obtain a thorough sexual history in a culturally competent manner.
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Affiliation(s)
- Kenneth H Mayer
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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33
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Lerdal A, Gay CL, Aouizerat BE, Portillo CJ, Lee KA. Patterns of morning and evening fatigue among adults with HIV/AIDS. J Clin Nurs 2011; 20:2204-16. [PMID: 21752119 DOI: 10.1111/j.1365-2702.2011.03751.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES Describe patterns of morning and evening fatigue in adults with HIV and examine their relationship to demographic and clinical factors and other symptoms. BACKGROUND Most studies of HIV-related fatigue assess average levels of fatigue and do not address its diurnal fluctuations. Patterns of fatigue over the course of the day may have important implications for assessment and treatment. DESIGN A cross-sectional, correlational design was used with six repeated measures over 72 hours. METHOD A convenience sample of 318 HIV-infected adults was recruited in San Francisco. Socio-demographic, clinical and symptom data were collected with questionnaires. CD4+ T-cell count and viral load were obtained from medical records. Participants completed a four-item version of the Lee Fatigue Scale each morning and evening for three consecutive days. Participants were grouped based on their diurnal pattern of fatigue (high evening only, high morning only, high morning and evening and low morning and evening). Group comparisons and logistic regression were used to determine the unique predictors of each fatigue pattern. RESULTS The high evening fatigue pattern was associated with anxiety and the high morning pattern was associated with anxiety and depression. The morning fatigue pattern showed very little fluctuation between morning and evening, the evening pattern showed the largest fluctuation. The high morning and evening pattern was associated with anxiety, depression and sleep disturbance and this group reported the most fatigue-related distress and interference in functioning. CONCLUSIONS These results provide initial evidence for the importance of assessing the patient's daily pattern of fatigue fluctuation, as different patterns were associated with different symptom experiences and perhaps different aetiologies. RELEVANCE TO CLINICAL PRACTICE Different fatigue patterns may benefit from tailored intervention strategies. Management of depressive symptoms could be tested in patients who experience high levels of morning fatigue.
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Affiliation(s)
- Anners Lerdal
- Lovisenberg Deaconal University College and Oslo University Hospital, Medical Department, Section of Gastroenterology, Oslo, Norway.
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34
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Dimensions of Psychological Well-being Predict Consistent Condom Use among Older Adults Living with HIV. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-011-9126-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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35
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HIV, Sexual Health, and Psychosocial Issues Among Older Adults Living with HIV in North America. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-011-9111-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Dimensions of Psychological Well-being Predict Consistent Condom Use among Older Adults Living with HIV. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-011-9113-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Poynten IM, Templeton DJ, Grulich AE. Sexually transmissible infections in aging HIV populations. Sex Health 2011; 8:508-11. [DOI: 10.1071/sh11027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/16/2011] [Indexed: 12/26/2022]
Abstract
There is limited published research on sexually transmissible infections (STI) among aging HIV populations. The available literature on sexual behaviour and STI among older people with HIV is reviewed here and contrasted with data from older individuals in the general population and from older populations at high risk of HIV. A sizeable minority of older people with HIV continue to engage in higher risk sexual behaviour and thus remain at high risk of STI. There is no clear evidence of a consistent effect of older age on STI rates, clinical presentation or clinical course among HIV-infected populations, although gay men with HIV aged in their 40s or older seem to be at higher risk than younger men of acquiring several STI, including syphilis and lymphogranuloma venereum. STI risks in older people living with HIV need to be regularly assessed. Higher risk sexual behaviour and disproportionately higher rates of STI indicate that regardless of age, a thorough STI assessment should be regularly undertaken for all HIV-positive gay men as part of their routine HIV care.
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Comparisons of sexual behaviors and STD prevalence among older and younger individuals with HIV infection. AIDS Care 2010; 22:711-7. [PMID: 20467941 DOI: 10.1080/09540120903373573] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Knowledge of an HIV-infected individual's sexual behaviors and routine sexually transmitted diseases (STDs) testing greatly facilitates HIV prevention efforts, but current data in older individuals are lacking. This study was developed to compare sexual behaviors and STD prevalence between older HIV-infected individuals and their younger counterparts. We conducted a cross-sectional cohort study of HIV-infected individuals > or =18 years who completed an annual behavioral assessment. A total of 541 individuals completed the assessment. Analyses were performed to examine differences in sexual behaviors and STD prevalence between age groups: younger (18-35 years) (30%), middle-aged (36-49 years) (46%), and older (> or =50 years) (24%). Older individuals were most likely to be male and Caucasian with longest time since HIV diagnosis, greatest receipt of highly active antiretroviral therapy (HAART), and highest rates of HIV RNA <50 copies/mL (all p<0.001). Reports of recent sexual activity decreased with age, younger (56%) vs. middle-aged (43%) vs. older (27%) (p<0.001). The median number of recent sex partners was one (range 1-25) and 68% overall reported using condoms consistently; these parameters did not differ by age group. STD prevalence was 8% (gonorrhea [9], chlamydia [7], and syphilis [20]) and was highest among younger individuals (younger [11%] vs. middle-aged [7%] vs. older [3%]). Our results demonstrated that with older age, sexual activity declines but inconsistent condom use remains commonly reported. Furthermore, STDs were identified among all age groups. This latter finding reinforces the need for secondary prevention efforts among all individuals living with HIV/AIDS.
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Chaiyamahapurk S, Pannarunothai S, Nopkesorn T. Sexual practice among Thai HIV-infected patients: prevalence and risk factors for unprotected sex. ACTA ACUST UNITED AC 2010; 9:278-83. [PMID: 20739591 DOI: 10.1177/1545109710373831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positive prevention which focuses on prevention of HIV transmission from those already infected to those uninfected is an important issue for HIV prevention. A self-administered questionnaire on sexual practice survey of HIV-infected patients attending HIV clinics was undertaken. Of the 1160 patients, 53% knew their HIV status after being ill and 59% believed that they got infection from their regular sexual partner. In 3 months prior to the survey, 18% reported unprotected sex. Unprotected sex significantly decreased in people having adequate condoms but increased in those who believed that their sexual partners were already infected. Effect of disclosure of HIV status on unprotected sex depended on whether patients were men or women. Non-disclosure HIV-positive men claimed to have less unprotected sex than their counterpart, HIV-positive women. Factors related to unprotected sex should be addressed and sexual health must be integrated and promoted in HIV health care.
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Illa L, Echenique M, Jean GS, Bustamante-Avellaneda V, Metsch L, Mendez-Mulet L, Eisdorfer C, Sanchez-Martinez M. Project ROADMAP: Reeducating Older Adults in Maintaining AIDS Prevention: a secondary intervention for older HIV-positive adults. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:138-147. [PMID: 20387984 DOI: 10.1521/aeap.2010.22.2.138] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The number of older adults living with HIV/AIDS is larger than ever. Little is known about their sexual behaviors, although contrary to stereotypes, older adults desire and engage in sexual activity. Despite increased recognition of the need for prevention interventions targeting HIV-positive individuals, no secondary HIV prevention interventions have specifically targeted the older HIV-positive adult. Efforts to target high-risk sexual behaviors may be even more critical in the older population because of sociocultural, biological, and behavioral vulnerabilities. In response, Project ROADMAP (Reeducating Older Adult in Maintaining AIDS Prevention) intervention was developed to reduce high-risk sexual behaviors among older HIV-positive patients in primary care clinics. The purpose of this article is to report the 6-month outcomes of a behavioral intervention designed to reduce sexual risk behaviors in older HIV-positive adults.
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Affiliation(s)
- Lourdes Illa
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, 1695 NW 9th Ave, Suite 1404 H, Miami, FL 33136, USA.
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Aouizerat BE, Miaskowski CA, Gay C, Portillo CJ, Coggins T, Davis H, Pullinger CR, Lee KA. Risk factors and symptoms associated with pain in HIV-infected adults. J Assoc Nurses AIDS Care 2010; 21:125-33. [PMID: 20116299 DOI: 10.1016/j.jana.2009.10.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 10/29/2009] [Indexed: 11/30/2022]
Abstract
Studies suggest that people living with HIV (PLWH) experience many unrelieved symptoms. The purpose of this study was to estimate the occurrence of pain in adult PLWH and to determine whether participants with pain differed from those without pain on selected demographic factors, clinical characteristics, symptoms of fatigue, sleep disturbance, anxiety, or depression. The authors conducted a descriptive, comparative, and correlational study of 317 PLWH seen at academic and community clinics in San Francisco. Participants completed a demographic questionnaire, the Memorial Symptom Assessment Scale, the Fatigue Severity Scale, the General Sleep Disturbance Scale, the Profile of Moods State Tension-Anxiety subscale, and the Center for Epidemiological Studies-Depression Scale. Clinical characteristics (i.e., disease and treatment information) were obtained by self-report. A single item on pain from the Memorial Symptom Assessment Scale was used to classify participants into those with and without pain. Pain was highly prevalent (55%) and was associated with immune status (CD4+ T-cell count), race, and sleep disturbance, but not with age, gender, or symptoms of fatigue, depression, or anxiety.
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Affiliation(s)
- Bradley E Aouizerat
- Department of Physiological Nursing and Institute for Human Genetics, University of California, San Francisco, USA
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Abstract
HIV-related stigma has been identified as a barrier to HIV testing and prevention efforts internationally and nationally. Although the prevalence of HIV/AIDS is rapidly increasing in women aged 50 and older, little is known about the HIV-stigmatizing behaviors in this underserved population. In this exploratory analysis we investigated the influence of self esteem, sensation seeking, self silencing, and sexual assertiveness on the HIV-stigmatizing behaviors in 572 women aged 50 to 93. The variables considered in this analysis included subscales for the variables self silencing (Externalized Self Perception, Care as Self Sacrifice, Silencing the Self, Divided Self) and sexual assertiveness (Information Communication, Initiation, Refusal). Contributing predictive variables in the final model included: Self esteem (beta = -.190, t = -4.487, p = .000), Care as Self-Sacrifice (beta = .125, t = 2.714, p = .007), and Silencing the Self (beta = .164, t = 3.290, p = .001). Initiation (beta = .108, t = -2.619, p = .009) and Refusal (beta = -.091, t = -2.154, p = .032). Implications for social work and health perception regarding HIV prevention in midlife and older women are considered. Development of age- and gender-appropriate strategies assisting women in addressing HIV-stigma and related influences are addressed.
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Affiliation(s)
- Robin J Jacobs
- Department of Preventive Medicine and Department of Psychiatry and Behavioral Medicine, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida 33314, USA.
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Onen NF, Shacham E, Stamm KE, Turner Overton E. Sexual behaviors and results of bacterial sexually transmitted infections testing among frail HIV-infected individuals. JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE (CHICAGO, ILL. : 2002) 2010; 9:30-3. [PMID: 20071595 PMCID: PMC3608415 DOI: 10.1177/1545109709356946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of premature frailty in HIV-infected individuals on the prevalence of sexual behaviors and sexually transmitted infections (STIs) is unknown. METHODS We compared these factors among individuals aged ≥ 18 years, who had prior determination of a frailty phenotype at the Washington University HIV Clinic between June and December 2008. All P values were 2-tailed and considered significant at <.05. RESULTS Of 445 individuals (71% male, 30% Caucasian, median age 43 years) assessed, the prevalence of frailty was 9%. Reports of recent sexual activity (44%) did not differ by frailty status. Consistent condom use (69% overall) was similar between sexually active frail and nonfrail individuals, and there was no significant difference in STI prevalence between groups (0 vs 32 [9%], P = .08). CONCLUSION In this relatively young population, frailty did not affect reports of recent sexual activity or consistent condom use and no significant difference in STI prevalence was observed.
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Affiliation(s)
- Nur F Onen
- Washington University School of Medicine, St Louis, MO 63110, USA.
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Abstract
PURPOSE OF REVIEW To provide a state-of-the-science review of the literature on secondary prevention of HIV infection or 'prevention for positives' (PfP) interventions. RECENT FINDINGS Early work on PfP focused on understanding the dynamics of risky behavior among People Living with HIV/AIDS (PLWH) and on designing, implementing, and evaluating a limited number of interventions to promote safer sexual and drug use behavior in this population (i.e., PfP interventions). Previous meta-analyses demonstrated that PfP interventions can effectively promote safer behavior. However, the understanding of risk dynamics among PLWH and the extant number and breadth of effective PfP interventions were scant. Recent work has addressed some of these problems, yielding greater understanding of risk dynamics and providing additional, effective interventions. Still, only a modest number of recent, rigorously evaluated, effective interventions have been identified. New ideas for creating stronger, more integrated, and effective PfP interventions have emerged that will guide future intervention research and practice. SUMMARY There remains much to be done to understand why, when, and under what conditions PLWH practice risk. Substantial work also needs to be performed to design, implement, rigorously evaluate, and when effective, to disseminate widely, additional, evidence-based PfP interventions targeting diverse populations. Directing such interventions to populations of PLWH at greatest risk for transmission of HIV has the potential to yield significant impact on the pandemic.
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