2021 Climate and Health Review - Uncharted Territory: Extreme Weather Events and Morbidity

A Scoping Review of Factors Associated with HIV Acquisition in the Context of Humanitarian Crises

Humanitarian crises-natural or human-made events that can threaten communities' health, safety, security, and well-being-may affect the HIV epidemic dynamics. Common aspects of humanitarian crises such as poverty, powerlessness, disruptions to the health systems, and social instability can contribute to a person's vulnerability to HIV infection through increased risk behaviors and limited access to health services. Guided by the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we conducted a scoping review of literature published in English between January 1990 and March 2022 to characterize the global evidence of modifiable and non-modifiable factors for HIV acquisition in the context of humanitarian crises. We systematically searched, screened, and synthesized literature from MEDLINE, Embase, Global Health (all accessed via Ovid), and Scopus, and also grey literature through websites of humanitarian agencies and relevant non-government organizations, the International AIDS Society's abstract databases, and Google Scholar. We considered studies presenting empirical data on HIV prevalence, incidence, or risk factors in humanitarian crises-affected populations, including refugees, asylum seekers, and internally displaced persons. Forty-nine studies met the inclusion criteria. The majority of studies were quantitative (n = 43, 87.8%) and cross-sectional (n = 37, 75.5%) in design. Most were single-country studies (n = 43, 87.8%) and conducted in Sub-Saharan Africa (n = 31, 63.3%). We identified 5 non-modifiable factors for HIV acquisition (i.e., age, gender, location, place of birth or origin, and ethnicity) and 60 modifiable factors that we further classified into five categories, namely 18 policy and structural, 9 sociocultural, 11 health and mental health, 16 sexual practice, and 6 humanitarian crisis-related traumatic event factors. Within the modifiable categories, factors that were most often investigated were education level, marital status, sexually transmitted infection diagnosis, condom use, and experience of rape or sexual trauma, respectively. Informed by the findings, we applied the social-ecological model to map the identified multidimensional factors associated with HIV acquisition at the levels of individual, social and sexual networks, community, public policy, and the context of humanitarian crises. The current review provides a comprehensive, global analysis of the available evidence on HIV prevalence, incidence, and risk factors in humanitarian crises and implications for potential programs and research. Future research is warranted to further understand the directionality of the non-modifiable and modifiable factors affecting HIV acquisition, and the multilevel barriers and facilitators to the uptake of HIV prevention strategies in the context of humanitarian crises. Such research can generate actionable evidence to inform the development of ethical, trauma-informed, and culturally appropriate HIV prevention interventions in humanitarian settings.

Indoor Air Quality Considerations for Laboratory Animals in Wildfire-Impacted Regions-A Pilot Study

Wildfire events are increasing across the globe. The smoke generated as a result of this changing fire landscape is potentially more toxic than air pollution from other ambient sources, according to recent studies. This is especially concerning for populations of humans or animals that live downwind of areas that burn frequently, given that ambient exposure to wildfire smoke cannot be easily eliminated. We hypothesized that a significant indoor air pollution risk existed for laboratory animal facilities located proximal to fire-prone areas. Here, we measured real time continuous outdoor and indoor air quality for 28 days at a laboratory animal facility located in the Rocky Mountain region. We demonstrated that during a wildfire event, the indoor air quality of this animal facility is influenced by ambient smoke events. The daily average indoor fine particulate matter value in an animal room exceeded the Environmental Protection Agency's ambient annual standard 14% of the time and exceeded the World Health Organization's ambient annual guideline 71% of the time. We further show that specialized cage filtration systems are capable of mitigating air pollution penetrance and could improve an animal's microenvironment. The potential effects for laboratory animal physiology that occur in response to the exposure levels and durations measured in this study remain to be determined; yet, even acute wildfire exposure events have been previously correlated with significant differences in gene regulatory and metabolic processes in vivo. We believe these findings warrant consideration for indoor laboratory animal facility air quality monitoring and development of smoke exposure prevention and response protocols, especially among facilities located downwind of fire-prone landscapes.