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HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 11707

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Special Issue Editors

Prof. Dr. Sphiwe Madiba

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Guest Editor

Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
Interests: HIV prevention; HIV testing; disclosure; intersectional stigma; psychosocial well-being; engagement in care

Prof. Dr. Perpetua Modjadji

E-Mail Website
Guest Editor

Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa
Interests: multimorbidity; health promotion; social determinants of health; chronic diseases management; food security

Special Issue Information

Dear Colleagues,

Biomedical advancements in HIV prevention and the expansion of effective HIV treatment as well as other differentiated approaches applied to every stage of the HIV care cascade have led to a significant decrease in new HIV diagnoses and global aspirational commitment to end the HIV epidemic. Although the number of new HIV infections continues to decline globally, the UNAIDS targets were missed globally and at regional levels. There has been unequal progress in reducing new HIV infections and ending AIDS-related deaths. In 2021, 650,000 (510,000–860,000) people died from HIV-related causes and 1.5 million (1.1–2.0 million) people contracted HIV. Regarding increasing access to treatment, many marginalized populations in countries hardest hit by HIV still do not have access to prevention, care, and treatment (UNAIDS) and are at risk of new HIV infections.

This Special Issue invites papers that highlight global and community-based effective HIV prevention interventions and policies that have led to a significant decrease in new HIV diagnoses as well as those that examine structural and societal factors impacting on increased access to HIV care, uptake of prevention options, successful treatment outcomes, and disengagement in care, particularly in underserved communities. HIV treatment access is key to the global effort to end HIV; thus, review articles, intervention studies, and research articles that propose new approaches to enhance prevention interventions, develop social enablers for HIV prevention, and maximize HIV treatment and care services to end the HIV epidemic are welcome in this issue.

Prof. Dr. Sphiwe Madiba
Prof. Dr. Perpetua Modjadji
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

HIV testing
marginalized populations at high HIV risk
HIV care models
HIV interventions
HIV disclosure and interventions
engagement/disengagement in care
lost to follow-up
structural barriers
societal barriers
intersecting societal stigmas
food security
sexual behaviors
universal testing and treatment

Published Papers (6 papers)

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Research

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10 pages, 308 KiB

Open AccessArticle

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students’ Perceptions

by Melitah Molatelo Rasweswe, Nancy Mamoeng Kgatla, Irene Thifhelimbilu Ramavhoya and Fhumulani Mavis Mulaudzi

Int. J. Environ. Res. Public Health 2024, 21(2), 229; https://doi.org/10.3390/ijerph21020229 - 15 Feb 2024

Viewed by 1413

Abstract

Stigma is one of the documented barriers to achieving universal access to human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment, care, and support programs. The lack of African social theories to emphasize these issues may be the cause of the continent’s failure to reduce stigma. We can use Ubuntu, an African philosophy that emphasizes sociability and ethics, to deepen our understanding of how to reduce HIV- and TB-related stigma in South Africa. In many African regions, Ubuntu values and principles were found to assist in reducing problems related to HIV. Ubuntu is a comprehensive phrase used by Africans to signify the characteristics that incorporate the core human virtues of compassion and humanity. We explored the perceptions of nursing students regarding the use of Ubuntu in the fight against HIV and TB stigma. Qualitative participatory research was used to engage all first- and second-level nursing students enrolled for the 2023 academic year at the selected university in South Africa. Purposive sampling was used to recruit the participants. An interactive workshop was used to gather data. The data from the recordings and flip charts were analysed together. Throughout the study, trustworthiness and ethical principles were upheld. Two primary themes emerged as expressions of Ubuntu in relation to a reduction in HIV and TB stigma and recognition of Ubuntu as a tool to combat stigma associated with HIV and TB. This confirms that within Ubuntu, there are elements that might be applied to reduce stigma attached to HIV and TB. Full article

(This article belongs to the Special Issue HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas)

11 pages, 312 KiB

Open AccessArticle

HIV Voluntary Counselling and Testing Utilisation among School of Healthcare Sciences Undergraduate Students at the University of Limpopo

by Melitah Molatelo Rasweswe, Mamare Adelaide Bopape and Tshepo Albert Ntho

Int. J. Environ. Res. Public Health 2024, 21(2), 183; https://doi.org/10.3390/ijerph21020183 - 6 Feb 2024

Cited by 1 | Viewed by 1198

Abstract

Existing evidence indicates that South African university students have low utilisation of Human Immunodeficiency Virus (HIV) Voluntary Counselling and Testing (VCT). A cross-sectional survey was conducted to determine the utilisation of HIV VCT among undergraduate students in the School of Healthcare Sciences. Structured questionnaires were used to collect data through Google Forms. The results are presented through descriptions and percentages and illustrated in tables. Out of 389 undergraduate students, only 324 completed the questionnaire. The majority (97.2%) were aware of the health centre on campus, while only (74.7%) knew about the HIV VCT services offered on campus. Despite the awareness, many (36.7%) do not utilise the campus HIV VCT services, and some (9.6%) have never tested for HIV. There was an association between awareness of Voluntary Counselling and Testing of HIV services offered at the campus health and wellness centre and utilisation of HIV Voluntary Counselling and Testing at (<0.001). Therefore, it is imperative to urgently escalate the level of HIV/AIDS education in higher institutions of learning and emphasise the mounting danger of HIV infection and the immense importance of regular HIV testing. The findings of this study could serve as a foundation for creating HIV prevention and control programmes for youth, particularly in higher education institutions. Full article

(This article belongs to the Special Issue HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas)

10 pages, 279 KiB

Open AccessArticle

Pilot Testing Two Versions of a Social Network Intervention to Increase HIV Testing and Case-finding among Men in South Africa’s Generalized HIV Epidemic

by Leslie D. Williams, Alastair van Heerden, Xolani Ntinga, Georgios K. Nikolopoulos, Dimitrios Paraskevis and Samuel R. Friedman

Int. J. Environ. Res. Public Health 2024, 21(1), 54; https://doi.org/10.3390/ijerph21010054 - 30 Dec 2023

Cited by 1 | Viewed by 1811

Abstract

Locating undiagnosed HIV infections is important for limiting transmission. However, there is limited evidence about how best to do so. In South Africa, men have been particularly challenging to reach for HIV testing due, in part, to stigma. We pilot-tested two versions of a network-based case-finding and care-linkage intervention. The first, TRIP, asked “seeds” (original participants) to recruit their sexual and/or injection partners. The second, TRIPLE, aimed to circumvent some stigma-related issues by asking seeds to recruit anyone they know who might be at risk of being HIV-positive-unaware. We recruited 11 (18% male) newly diagnosed HIV-positive (NDP) seeds from two clinics in KwaZulu-Natal, South Africa and randomly assigned them to either TRIP or TRIPLE. Network members were recruited two steps from each seed. The TRIP arm recruited 12 network members; the TRIPLE arm recruited 62. Both arms recruited NDPs at higher rates than local clinic testing, with TRIP (50.0%) outperforming (p = 0.012) TRIPLE (14.5%). However, TRIPLE (53.2%) was far superior to clinics (27.8%) and to TRIP (25.0%) at recruiting men. Given challenges around testing and treating men for HIV in this context, these findings suggest that the TRIPLE expanded network-tracing approach should be tested formally among larger samples in multiple settings. Full article

(This article belongs to the Special Issue HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas)

15 pages, 379 KiB

Open AccessArticle

Community Perceptions of HIV Stigma, Discriminatory Attitudes, and Disclosure Concerns: A Health Facility-Based Study in Selected Health Districts of South Africa

by Mathildah Mokgatle and Sphiwe Madiba

Int. J. Environ. Res. Public Health 2023, 20(14), 6389; https://doi.org/10.3390/ijerph20146389 - 18 Jul 2023

Cited by 7 | Viewed by 2250

Abstract

Research data about HIV stigma perceptions and discriminatory attitudes among the general population are limited. Furthermore, the willingness of HIV-negative individuals to engage with HIV prevention and disclosure interventions has not been established in South Africa. The study investigated community perceptions of stigma as well as discriminatory attitudes towards HIV disclosure to understand if and how these perceptions might influence the uptake of disclosure interventions. This facility-based study used a validated questionnaire to measure the four constructs of HIV stigma among 670 adults recruited from health districts of two provinces of South Africa. Of these, 72% were female, 87% had ever been tested for HIV, and 31% knew someone who has HIV. Stigma towards people living with HIV (PLHIV) is widespread in the general population. A high proportion (75%) endorsed disclosure concerns, 75% perceived stigma to be common, and 56% endorsed negative statements indicating perceived stigma in communities. Fear, moral and social judgement, and rejection underlined their perceptions about PLHIV. Almost half (45.7%) were unwilling to care for family members sick with AIDS, suggesting negative distancing reactions and discriminatory attitudes towards PLHIV. The widespread discriminatory attitudes and the perceived stigma that is evident in the general population might heighten the disclosure concerns endorsed, promote non-disclosure, and increase HIV transmission. To design interventions, it is crucial to be cognisant of disclosure concerns, discriminatory attitudes, and perceived stigma evident in communities. Thus, the findings underscore the need to increase efforts to challenge and reduce community drivers of negative discriminatory attitudes and perceived stigma. Full article

(This article belongs to the Special Issue HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas)

13 pages, 348 KiB

Open AccessArticle

Barriers and Facilitators to Pre-Exposure Prophylaxis by Men Who Have Sex with Men and Community Stakeholders in Malaysia

by Aviana O. Rosen, Jeffrey A. Wickersham, Frederick L. Altice, Antoine Khati, Iskandar Azwa, Vincent Tee, Alma Jeri-Wahrhaftig, Jeffrey Ralph Luces, Zhao Ni, Adeeba Kamarulzaman, Rumana Saifi and Roman Shrestha

Int. J. Environ. Res. Public Health 2023, 20(9), 5669; https://doi.org/10.3390/ijerph20095669 - 27 Apr 2023

Cited by 1 | Viewed by 2096

Abstract

Background: Men who have sex with men (MSM) in Malaysia are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy; yet, uptake remains low among Malaysian MSM, who have a limited understanding of barriers to PrEP. Methods: We employed the nominal group technique (NGT), a structured mixed-methods strategy to understand the barriers and facilitators to PrEP use among Malaysian MSM, combined with a qualitative focus group. Six virtual focus group sessions, three among MSM (n = 20) and three among stakeholders (n = 16), were conducted using a video-conferencing platform. Rank-ordering of barriers from NGT was recorded, and thematic analysis was conducted for content. Results: Similar barriers were reported by MSM and community stakeholders, with aggregated costs associated with PrEP care (e.g., consultation with a clinician, medication, laboratory testing) being the greatest barrier, followed by limited knowledge and awareness of PrEP. Additionally, the lack of access to PrEP providers, the complex clinical protocol for PrEP initiation and follow-up, and social stigma undermined PrEP delivery. Qualitative discussions identified potential new strategies to overcome these barriers, including expanded outreach efforts to reach hard-to-reach MSM, a ‘one-stop’ delivery model for PrEP services, a patient-centered decision aid to guide PrEP uptake, and easy access to LGBT-friendly PrEP providers. Conclusion: Current barriers may be overcome through governmental subsidy for PrEP and evidence-informed shared decision aids to support both MSM and PrEP providers. Full article

(This article belongs to the Special Issue HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas)

Other

Jump to: Research

16 pages, 2380 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis on the Impact of Statin Treatment in HIV Patients on Antiretroviral Therapy

by Kabelo Mokgalaboni, Wendy Nokhwezi Phoswa, Samantha Yates, Sogolo Lucky Lebelo, Sphiwe Madiba and Perpetua Modjadji

Int. J. Environ. Res. Public Health 2023, 20(9), 5668; https://doi.org/10.3390/ijerph20095668 - 27 Apr 2023

Cited by 3 | Viewed by 2300

Abstract

The rate of new human immunodeficiency virus (HIV) infections globally is alarming. Although antiretroviral therapy (ART) improves the quality of life among this group of patients, ARTs are associated with risk of cardiovascular diseases (CVD). Moreover, virally suppressed patients still experience immune activation associated with HIV migration from reservoir sites. Statins are widely recommended as therapeutic agents to control ART-related CVD; however, their impacts on the cluster of differentiation (CD)4 count and viral load are inconsistent. To assess the effect of statins on markers of HIV infections, immune activation and cholesterol, we thoroughly reviewed evidence from randomised controlled trials. We found 20 relevant trials from three databases with 1802 people living with HIV (PLHIV) on statin–placebo treatment. Our evidence showed no significant effect on CD4 T-cell count standardised mean difference (SMD): (−0.59, 95% confidence intervals (CI): (−1.38, 0.19), p = 0.14) following statin intervention in PLHIV on ART. We also found no significant difference in baseline CD4 T-cell count (SD: (−0.01, 95%CI: (−0.25, 0.23), p = 0.95). Our findings revealed no significant association between statins and risk of viral rebound in PLHIV with undetectable viral load risk ratio (RR): (1.01, 95% CI: (0.98, 1.04), p = 0.65). Additionally, we found a significant increase in CD8⁺CD38⁺HLA-DR⁺ T-cells (SMD (1.10, 95% CI: (0.93, 1.28), p < 0.00001) and CD4⁺CD38⁺HLA-DR⁺ T-cells (SMD (0.92, 95% CI: (0.32, 1.52), p = 0.003). Finally, compared to placebo, statins significantly reduced total cholesterol (SMD: (−2.87, 95% CI: (−4.08, −1.65), p < 0.0001)). Our results suggest that the statin lipid-lowering effect in PLHIV on ART may elevate immune activation without influencing the viral load and CD4 count. However, due to the limited evidence synthesised in this meta-analysis, we recommend that future powered trials with sufficient sample sizes evaluate statins’ effect on CD4 count and viral load, especially in virally suppressed patients. Full article

(This article belongs to the Special Issue HIV Prevention: Maximizing Access and Uptake of Prevention Services amidst Societal and Structural Barriers and Intersecting Societal Stigmas)

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