Stigma due to an HIV diagnosis is a well-known phenomenon and is a major barrier to accessing care.1 Over the last forty years, HIV has been transformed from a fatal disease to a manageable one, thanks to the remarkable success of antiretroviral (ARV) medication.2 When people living with HIV (PLHIV) start ARV treatment early, their life expectancy is almost completely restored. Moreover, a suppressed viral load means that PLHIV are no longer able to infect other people.3 They can have children naturally without risk to their seronegative partner or their child. PLHIV nowadays are more likely to die with HIV, not of HIV. While a cure remains elusive, the successful global rollout of ARVs means that there is no good reason for a PLHIV to die of AIDS and its complications due to lack of access to proper treatment. The Philippine AIDS Law Republic Act 8504 and its successor, Republic Act 11116 explicitly states that the State should “ensure access to HIV and AIDS-related services by eliminating the climate of stigma and discrimination that surrounds the country’s HIV and AIDS situation, and the people directly and indirectly affected by it.” Unfortunately, despite this admonition, stigma remains a significant cause of delayed HIV testing and of not seeking treatment in our country. In this issue of the journal, Dr. De Los Santos and her colleagues examine the effect of healthcare facility stigma on PLHIV accessing care in the Philippines.4 They report that 81% of their Filipino PLHIV respondents experienced stigma, which is an unacceptably high number. They identify which facilities are more likely to be correlated with stigma and make suggestions on how to address this problem. This study is very timely and comes at a time when the Department of Health is shifting first line antiretrovirals to dolutegravir-based regimens.5 Dolutegravir-based treatment is associated with fewer side effects than efavirenz-based regimens and is much more durable against resistance.6 With an HIV transmitted-drug resistance rate of 11.7%, it is imperative that PLHIV are started on more durable regimens which they are less likely to discontinue.7 Properly addressing stigma means that more people will access care. Better regimens will ensure that people stay in care. This will go a long way towards minimizing the impact of HIV and AIDS on Filipino PLHIV. Stigma among PLHIV is a complicated subject matter. Aside from the stigma associated with diagnosis, there is also stigma associated with the mode of acquisition of the disease. The most-at-risk populations are highly stigmatized. Men who have sex with men, people who inject drugs, and female sex workers experience additional stigma on top of the stigma from an HIV diagnosis.8 Aside from societal stigma, PLHIV are also prone to self-stigma.9 This phenomenon occurs when PLHIV believe they no longer deserve to live since they contracted the disease from deviant or sinful behavior. High rates of depression are found among these self-stigma sufferers. This significantly impacts the entire HIV healthcare cascade, starting from early diagnosis, to accessing treatment, and staying in care. The finding that Public Rural Health Units are the most stigmatizing healthcare facilities is very concerning since these are usually the only facilities available to PLHIV in far-flung areas. This needs to be addressed with better sensitivity training as well as concrete guidelines on avoiding stigma. It is very troubling that facilities that are supposed to cater to vulnerable populations inadvertently make it difficult for them to access care.10 Unfortunately, even facilities in urban areas are not immune to discrimination and stigmatizing behavior. I recall the experience of one of my early PLHIV patients who developed and eventually succumbed to a disseminated fungal infection.11 He told me that he had tried getting tested several years earlier but he had a traumatic experience in the government health facility that he accessed. He made a wrong turn and entered a different clinic in that hospital and when he asked for an HIV test, people recoiled from him in horror. Because of that terrible experience, he put off getting his HIV test for years until he started developing the fungal infection that eventually killed him. Had he been started on proper treatment earlier, he could have been saved. For me, it wasn’t just the fungus that killed him but it was the delay in diagnosis and care as a direct result of stigma. Addressing HIV-related stigma in our country entails a whole-of-society and a whole-of-nation approach. Mental health services to address self-stigma and depression should be standard of care not just among confirmed PLHIV but among the most-at-risk populations. Proactive education of all members of society, especially healthcare workers in facilities that diagnose and care for PLHIV is essential for ensuring sustained linkage to care. Ensuring that the majority of the PLHIV population are properly diagnosed, enrolled in treatment hubs, and have suppressed viral loads will ultimately lead to fewer transmissions and less AIDS-related deaths.
HIV ; AIDS

Background: HIV/AIDS cases are increasing in Viet Nam. It is very difficult to treat for these cases because the cost of pharmaceutical medicines is high. HTA capsule\u2019s components include Radix Astragali, Flos Lonicerae, Herba Andrographis, Radix Achyranthis, Rhizoma Lateralis Curcumae, Flos Chrysanthemi, Semen Vignae Cylindricae, Radix Pallopiae. Objectives: (1) To evaluate on clinical effects of the HTA capsules in the supportive treatment of HIV/AIDS patients. (2) To evaluate any intensive special effects via TCD4; (3) To investigate unexpectable side effects of HTA capsules. Subjects and method: 38 HIV patients treated in the Department of Clinical Medicine of Tropical Diseases of Dong Da hospital in Ha Noi. This was a prospective, opened, clinical controlled trial. Results: HTA capsules raised patient\u2019s weight on average by 2.38 kg (p<0.001); Karnofsky index increased on average 4.8 points (p<0.05). In the HTA-treated group, 5 patients (23.81%) recovered well, none inferior in comparison with the control group: nobody feft better and worse cases still increased (23.43%). HTA increased TCD4 cells an average 43.9 cells/mm3 blood (p<0.05). Conclusions: HTA capsules improved clinical status such as raised average weight, raised Karnofsky index based on clinical classification (CDC \u2013 1993). 23.81% of patients recovered well and no one was worsened by the HTA capsules. HTA increased TCD4 cells. HTA capsules did not have any unexpected clinical effects.
Traditional medicine ; HIV/AIDS

Background: Antiretroviral treatment (ART) can decreased the incidence of HIV dementia, but milder cognitive impairment may not resolve when patients receive ART. In Indonesia, cognitive screening of HIV patients is not routinely performed before starting ART. Here we assess cognitive impairment in ART- naïve HIV patients beginning treatment in Jakarta. Methods: This is a cross sectional study with inclusion criteria: HIV positive, ART naïve, CD4 T-cells below 200 cells/uL, Karnofsky Performance Score (KPS) above 70. HIV-associated neurocognitive disorder (HAND) was defined by performance at least 1 Standard Deviation (SD) below the mean of demographically adjusted normative scores in at least two cognitive areas. Results: We studied 82 subjects with median (range) age 31 (19-48) years. Fifty six subjects (68%) were males. HAND was found in 42 subjects (51%). Eight subjects (19%) had impairment in 4 domains, 15 subjects (36%) in 3 and 19 (45%) in 2. The most common domain affected was memory (63%). Conclusion: Our results show the prevalence of HAND is high among HIV naïve patients in Jakarta. This establishes the need for screening of cognitive function before initiating ART.
AIDS Dementia Complex ; HIV

Background: From the first case of HIV/AIDS in Vietnam on December 1990, up to June 30th 2007, there were 126,543 cases of HIV infections, 24,788 AIDS patients and 13,874 AIDS-related deaths. Strong political commitments were given by the government to develop HIV/AIDS prevention and control programs. Objectives: To discover the current state of the HIV/AIDS epidemic and HIV/AIDS prevention as well as control in a number of northern provinces and to discover various related factors. Subjects and method: An analytic cross-sectional study was carried out from 2006 to 2007 on the leaders of local authorities, health facilities and HIV-infected people in 7 northern provinces. The documents and reports related to HIV/AIDS prevention and control were reviewed. Results: HIV/AIDS epidemic is not the problem of only the health system; it was increasing as a complex problem. HIV infection rate was higher in Quang Ninh, Ha Noi, and Son La. Among HIV-infected people, drug-injected users accounted for 93%. The prevention of HIV/AIDS has been planed, carried out in all communities, but is not very efficient and it requires high-quality solutions that should be widened to control and reduce this disease. Conclusion: The efficacy of current HIV/AIDS prevention and control program was not proficient.
HIV/AIDS epidemic ; prevention ; control

Background: The rate of Khmer ethnic minority living in An Giang, Kien Giang and Hau Giang were 3%, 12.9% and 3%, respectively.These provinces had some specific factors such as low education, income and knowledge about HIV/AIDS, high risk behavior and it is difficult to practice intervention methods therefore the awareness of HIV infection risk on this group is required. Objectives: To determine the HIV prevalence, describe knowledge, attitude and risky behaviors that led to syphilis and HIV infection of the Khmer ethnic group, which are used to propose suitable intervention and prevention models. Subject and methods: A cross sectional survey was conducted from September 2006 to June 2007 in the Khmer ethnic group, including both genders at the age ranging from 15 to 49, living in some districts of An Giang, Hau Giang and Kien Giang. Results: A total of 877 households and 2.400 people were interviewed. 98.62% of the people agreed to take a blood test for HIV. The average age of first intercourse was 20. The condom usage proportion was very low. The number of men using condoms in the latest intercourse with their wives or lovers accounted for only 7.2%. Moreover, only 3% of the women used condoms in the last 12 months. The drug usage was 0.6% in Hau Giang and 0.1 % in Kien Giang. The knowledge about HIV/AIDS of both men and women were 9.2% and 4.5%. The prevalence of people, who made HIV test in the three provinces accounted for only 3 to 4.6%. HIV infection rate was 0.2% in An Giang, 0.5% in Kien Giang and 0.5% in Hau Giang. Syphilis infection rates were 1.6%, 1.4% and 1.5%, respectively. Conclusions: Appropriate communicative model is an effective way for the prevention HIV/AIDS among Khmer ethnic group.
HIV/AIDS ; Khmer ethnic minority

Studies of HIV/AIDS in 1992-2004 show that HIV/AIDS endemic has been recorded since 1992. During 1999 - 2004, it has developed very fast. There were 1,618 accumulated HIV cases, 253 AIDS, and 186 deaths of AIDS. 100% of districts and towns with 81.3% of communes have people infected with HIV. The HIV cases in Nam Dinh town reached up to 59% of total number of the whole province. The HIV prevalence of the province is 81.6/ 100.000 people. Infection rate in Nam Dinh town is 409/100.000 people, 5.5 - 17 times higher than that in other districts. The trend of HIV infection rate among risk groups increased by 27,7% in drug abuser group and 5% in prostitute group. There is the need to inhance the prevention activities, media promotion, addressing social issues to curb the spread.
HIV/AIDS ; Epidemiologic Studies ; Epidemiology

Humans ; AIDS Dementia Complex/pathology* ; HIV Infections

AIDS Vaccines ; HIV Infections ; prevention & control ; Humans ; Nigeria

Determine HIV-1/2, Chembio HIV-1/2 STAT-PAK and PenTest are simple/rapid tests for the detection of antibodies to HIV-1 and HIV-2 in human whole blood, serum and plasma samples. The assay is one step and the result is read visually within 15 minutes. Using 92 known HIV-1 reactive sera and 108 known HIV-1 negative sera, the 3 HIV tests correctly identified all the known HIV-1 reactive and negative samples. The results indicated that Determine HIV-1/2, Chembio HIV-1/2 STAT-PAK and PenTest HIV are as sensitive and specific (100% concordance) as Microparticle Enzyme Immunoassay. The data indicated that these 3 HIV tests are effective testing systems for diagnosis of HIV infection in a situation when the conventional Enzyme Immunoassay is not suitable.
*AIDS Serodiagnosis ; HIV Antibodies/*blood ; Sensitivity and Specificity ; Time Factors

HIV (human immunodeficiency virus) infection is prevalent in many areas of sub-Saharan Africa. Seropositivity rates reach 10-15% in urban adults, 21% in critically ill adults and 30% in surgical inpatients aged 21-40 years. AIDS (acquired immune deficiency syndrome) is a multisystem disease which presents to the surgeon with a wide range of pathologies including Kaposi's sarcoma, lymphadenopathy and sepsis. The more common sites for sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (necrotizing fasciitis) and bone and joints. To prevent iatrogenic HIV infection more use should be made of autologous blood. Occupational exposure to HIV infection can be minimized by double-gloving, protecting the eyes when operating and ensuring that theatre gowns are waterproof. The risk of HIV infection from a needlestick injury is 0.4%. Although contact with blood during a surgical procedure is common, the risk is lower than for a hollow needlestick injury. PIP: In Zambia, 10-15% of urban adults are reported HIV positive, as are over 80% of prostitutes. The HIV seroprevalence rate in a Lusaka hospital's intensive care unit was 21% (27% for surgical and 18% for trauma admissions). HIV-infected patients could be clinically recognized by risk factors or symptoms and signs: weight loss, chronic cough, chronic diarrhea, sepsis, septic arthritis, subacute hematogenous osteomyelitis, a history of sexually transmitted diseases (STDs), death of a spouse or of a child under age 2, recent pregnancy unable to go to term, poor quality or thin hair, appearance of aging beyond years, mental slowness, persistent or unexplained fever, lymphadenopathy, aggressive atypical Kaposi's sarcoma, oral thrush, hairy leukoplakia of the tongue, shingles scars, and scars of maculopapular dermatitis. Common sites for HIV-related sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (e.g., necrotizing fascitis), and bone and joints. Autologous blood transfusion and use of donor blood screened for HIV antibodies, preferably limited to emergencies, would reduce the likelihood of iatrogenic HIV transmission. Surgeons should wear two pairs of gloves, a waterproof gown, and goggles to protect themselves from HIV transmission. If they have skin rashes, cuts, or abrasions on the hands or arms, they should not perform operations. Proper cleaning and disinfection of endoscopes are required. The risk of infection from a needle stick is small ( 0.4%).
AIDS-Related Opportunistic Infections - epidemiology, Adult, HIV Infections - epidemiology